Browsing by Author "Tadokera, Rabecca"

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    Immunological characterization of the HIV-tuberculosis associated immune reconstitution inflammatory syndrome
    (2011) Tadokera, Rabecca; Wilkinson, Robert J; Wilkinson, Katalin
    While the integration of anti-TB and cART therapies is associated with substantial clinical improvement in the majority of patients, HIV-Tuberculosis associated Immune Reconstitution Inflammatory Syndrome (TB-IRIS) has been shown to occur in a significant subset of these patients. TB-IRIS is an inflammatory complication of the combined treatments for HIV-1 and tuberculosis, which is being reported increasingly, particularly in areas endemic to both diseases. This work aimed to characterise the immunopathogenesis of paradoxical HIV-Tuberculosis associated immune reconstitution inflammatory syndrome.
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    Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa
    (2018) Tadokera, Rabecca; Middelkoop, Keren; Bekker, Linda-Gail
    Background: While several studies have studied the associations between biological factors such as HIV-status with TB transmission or clustering, our understanding of the associations between TB transmission and socio-economic risk factors for TB remains incomplete. More studies are required to enhance our understanding, and hence inform targeted interventions to curb TB transmission, particularly in high burden communities. This study aimed to explore the associations between TB transmission and socio-economic risk factors in one such high TB and HIV burdened community. Methods: A cross-sectional molecular epidemiology study was conducted among adult TB patients resident in a geographically well-defined peri-urban township of Cape Town between 2001 and 2010. Following informed consent, clinical and demographic data were extracted from TB registers and clinical folders. Additional socio-economic data were collected using interviewer-administered questionnaires that were designed to capture data on TB history, TB contacts, socio-economic conditions such as occupation, income level, educational level, sexual behaviour, sexual history in addition to other social and demographic data. M.tb isolates from TB patients were previously analysed using IS6110-based RFLP. Strains with <6 copies of IS6110 (low bandwidth strains) are known to be poorly differentiated and so were excluded from analysis. Composite variables were generated for the social and economic factors using a scoring algorithm to create a "social score" and an "economic score". Data was analysed using StataCorp version 12 software. Bivariate associations and adjusted binary logistic regression analyses were performed to determine associations between TB transmission and the social/economic score in addition to other risk factors that were studied. Results: Of the 509 participants who had complete data available, 352 (69%) were classified as clustered while the remaining 157 participants (31%) were classified as non-clustered. Our analysis showed that clustered cases were more likely to have stayed for a longer period in the study community, (OR=1.06, C.I: 1.02 to 1.10, p=0.006). Clustered cases were also more likely to have stayed in the same house for longer, (median=3 years vs. 2 years, p=0.06) and to live in more crowded conditions as shown by the size of the house and number of rooms used for sleeping (p=0.038). While the evidence was weak, there was a tendency towards a positive association between a high social score and clustering (OR=1.39, C.I: 0.94; 2.03, p=0.08). Conversely, there was a moderate negative association between a high economic score and clustering (OR=0.69, C.I: 0.45; 1.06, p=0.09). Conclusions: While the association between poverty (poor socio-economic status) and TB transmission is not new, the association between TB transmission and prolonged stay within a high burdened community that we report in this study is novel. Our findings further suggest that even in poorer communities there is a "sliding-scale of poverty", with individuals at the lower end of the economic scale being at greater risk for acquiring TB infection and that targeted interventions to address TB transmission in such high burdened communities may be required.
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    Knowledge and perceptions about HIV among adolescent girls and young women aged 15 – 24 years: associations with HIV testing and sexual behaviour – a sub-study of the 2012 South African National HIV Household survey
    (2020) Frieslaar, Farzanah; Colvin, Christopher; Tadokera, Rabecca
    Background. While much progress has been made, HIV remains a major global public health problem. South Africa remains home to the highest number of people living with HIV (7.1 million) in the world. Despite remarkable progress in the past decade, adolescent girls and young women aged 15-24 (AGYW) remain at higher risk of HIV exposure and infection than other groups. We do not know enough about AGYW HIV knowledge and perceptions, although it is likely an important factor to consider in AGYW's HIV risk. This paper investigates knowledge and perceptions about HIV risk behaviours and explores associations with demographic and behavioral characteristics among AGYW in South Africa. Methods. This sub-study is based on the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, a cross-sectional population-based household survey. A multistage stratified cluster sampling approach was employed to select the study population. Multivariate logistic regression was used to determine associations or factors which were associated with HIV knowledge. Results. Among the sample of 3700 AGYW aged 15-24 years, White [OR=2.44 (95% CI: 1.48-4.03), p=0.001] and Indian [OR=3.85 (95% CI: 2.39-6.18), p=0.000] AGYW were associated with high HIV knowledge compared to Black Africans. AGYW in urban informal [OR=0.64 (95% CI: 0.45-0.90), p=0.011] and rural informal [OR=0.57 (95% CI: 0.33-0.98), p=0.043] were associated with low HIV knowledge compared to urban formal settings. AGYW in Eastern Cape [OR=0.69 (95% CI: 0.48-1.00), p=0.048], KwaZulu-Natal [OR=0.69 (95% CI: 0.48-0.99), p=0.044], North West [OR=0.50 (95% CI: 0.32-0.77), p=0.002] and Limpopo [OR=0.44 (95% CI: 0.27-0.71), p=0.001] provinces were associated with low HIV knowledge compared to AGYW in Western Cape. Unemployed AGYW were associated with low HIV knowledge [OR=0.57, p=0.001]. While AGYW with higher levels of education: grade 12 [OR=1.66 (95% CI: 1.04-2.64), p=0.034] and tertiary [OR=2.68 (95% CI: 1.47-4.89), p=0.001] were associated with high HIV knowledge. AGYW having had sex in the last 12 months were associated with high HIV knowledge [OR=1.70 (95% CI: 1.08-2.72), p=0.023]. On the contrary, having multiple sexual partners in the last 12 months was associated with low HIV knowledge [OR= 0.60 (95%CI: 0.39-0.99), p=0.045] compared to AGYW that had 1 sexual partner in the last 12 months. AGYW with a low risk of alcohol use were associated with high HIV knowledge [OR=1.4 (95% CI: 1.02-1.87), p=0.039] compared to AGYW that abstained from alcohol. The final multivariate logistic regression model showed that AGYW in urban informal settings have low HIV knowledge [aOR=0.59 (95% CI: 0.35-0.99), p=0.046] among all geotypes. Conclusion. Overall, the main findings show a lack of knowledge among AGYW across race, geotype, province and sexual activity. More specifically that low HIV knowledge was associated with AGYW who were Black South Africans, living in informal settings, from Eastern Cape, KwaZulu Natal, North West and Limpopo, unemployed, had lower levels of education, and have multiple sexual partners. However, in the final multivariate analysis, only geotype stood out, indicating that there is an HIV knowledge deficit in urban informal settings. This can be addressed through the promotion of knowledge through education, equitable and accessible availability of education and sexual and reproductive health services, and HCT and support among AGYW living in urban informal settings.