Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa

line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level.

To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.

Globally, an estimated 38 4 million people were living with HIV (PLHIV) in 2021. Of these number, 25.8 million were from Africa, accounting for 68% of the global HIV prevalence. South Africa had an estimated 7.5 million PLHIV in 2021, yielding an adult (15–49 years) HIV prevalence of 18 3% South Africa also has the largest antiretroviral (ART) programme globally with just over 5 million people on ART.

Efforts in South Africa to strengthen the diagnosis, treatment and management of HIV and AIDS have emphasized building human resource capacity at primary care facility level for delivering ART. These efforts included the development of ART guidelines which are aligned with those of the World Health Organization, involving non-governmental organizations to support treatment delivery and training of PHC nurses on nurse-initiated management of antiretroviral treatment (NIMART)

Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-

A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data

Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients

Reasons for delayed switching of patients to secondline ART are multifactorial and require integrated interventions at health provider, patient and health system levels

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Wits researchers involved: Mafuno Mpinganjira, Tobias Chirwa, Chodziwadziwa Kabudula, Francesc Xavier Gómez-Olivé, Stephen Tollman, Joel Francis

Excessive alcohol use has direct impact on healthrelated Sustainable Development Goal 3 (SDG 3) through infectious diseases (for example HIV, TB, and viral hepatitis), Non Communicable Diseases (NCDs), and mental health. In 2016, approximately 49% of alcohol attributable Disability-adjusted life years (DALYs) were due to NCDs and mental health conditions. Moreover excessive alcohol use resulted in 1.7 million deaths from NCDs, while 12.9% deaths attributable to alcohol consumption were due to infectious diseases.

This study assessed the prevalence of reported alcohol use and its association with multimorbidity among adults aged 40 years and above in a rural, transitioning South African setting Its findings could potentially inform alcohol interventions integration in the prevention and treatment of chronic conditions.

The study analysed data from the first wave of The Health and Ageing in Africa a longitudinal Study in an INDEPTH community (HAALSI) nested within the Agincourt Health and Demographic Surveillance Systems, conducted between November 2014 and November 2015 The researcher computed descriptive statistics and performed univariate analysis to determine factors independently associated with multimorbidity Age, Body Mass Index, education, sex, and household wealth status and variables with a pvalue < 0 20 in univariate analysis were included in multivariable Modified Poisson regression models. Any factors with a p-value of <0.05 in the final models were considered statistically significant The first wave of HAALSI was completed by 5059 participants aged 40 years and above and included 53 6% females

This study sought to determine the association between reported alcohol use and multimorbidity in a population of individuals aged ≥ 40 years in rural South Africa This analysis found that reported alcohol use was common with almost half of the population reporting ever used alcohol. Also, the reported alcohol use was modestly associated with HIV multimorbidity and multimorbidity without HIV

The prevalence of reported ever alcohol use was 44 6% and of these 51.9% reported alcohol use in the last 30 days The prevalence of HIV multimorbidity was 59 6% (3014/5059) and for multimorbidity without HIV 52 5% (2657/5059)

Alcohol use was associated with HIV multimorbidity among all participants (RR: 1 05, 95% CI: 1 02–1 08), and separately for males (RR: 1 05, 95% CI: 1 00–1 10) and females (RR: 1 06, 95%CI: 1 02–1 11) Similarly, alcohol use was associated with multimorbidity without HIV among all participants (RR: 1 05, 95% CI: 1 02–1 09), and separately for males (RR: 1 06, 95% CI: 1 00–1 12) and females (RR:1 06, 95% CI: 1 01–1 11)

Reported alcohol use was common and associated with HIV multimorbidity and multimorbidity without HIV among older adults in rural northeast South Africa

There is a need to integrate Screening, Brief Interventions, and Referral for alcohol Treatment in the existing prevention and treatment of multimorbidity in South Africa

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