Wits Health Sciences Research Review │JULY 2023

WITS HEALTH SCIENCES RESEARCH REVIEW

Offer better HIV care to migrant women in South Africa

Wits leads SSACAB-II to advance health biostatistics research in Africa

Age & cancer incidence in 5 2 Million people with HIV

Breast cancer–related lymphedema

Lipid Nanoparticles for Cervical Cancer

Newly established Infectious Diseases & Oncology Research Institute (Wits-IDORI) to tackle burden of disease in Africa

WHAT'S HAPPENING

Wits Faculty of Health Sciences Prestigious Research Lecture

Wits Paediatrics Conference UpToSPAED

Murder Anatomy in Nazi

Editorial – Research Newsletter

The newsletter is an opportunity for us to present retrospective research article collections to showcase research excellence from the different disciplines in the faculty We celebrate the achievements of the faculty community and are particularly proud to announce the faculty’s newly established Infectious Diseases and Oncology Research Institute (IDORI) that will waylay the burden of diseases in Africa

I am pleased to take this opportunity to congratulate faculty alumni

Drs Stavros Nicolaou and Anastasia Ugwuanyi (who is also a faculty staff member) for making the Health and Wellness Edition of the Class of 2023 honourees in the global 100 lists announced by the Most Influential People of African Descent Your recognition not only signifies the wonderful contributions that you make in the global arena but most importantly at home, in Africa

This issue features several research articles published by some of our faculty researchers in this issue, Well done to all for your exceptional contributions and hard work

Lastly, we invite you to several inaugural lectures and exciting scientific events that we’ll be hosting next month including the Faculty’s 19th Prestigious Research Lecture titled "Unlocking the Potential of Genomics for Precision Medicine in Africa," This talk will be presented by Professor Michèle Ramsay (Director of the Sydney Brenner Institute for Molecular Bioscience) and Dr June Fabian (Research Director at the Wits Donald Gordon Medical Centre) We hope to see you all there!

Happy reading!

Professor Maria Papathanasopoulos Assistant Dean: Research, Innovation and postgraduate Support Wits Faculty of Health Sciences

Research in high-impact factor journals:

A WHO pandemic instrument: substantive provisions required to address global shortcomings

Lancet (IF - 202.731)

Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact

Lancet (IF - 202,731)

COVID-19 resulted in at least 14·8 million excess deaths globally between 2021 and 2022 and derailed progress towards achievement of the Sustainable Development Goals. During the COVID-19 pandemic there have been capacity gaps in national pandemic prevention, preparedness, and response (PPR) strategies, failures of international collaboration and solidarity, and underlying inequities and inequalities.

Inequitable access to medical countermeasures across nations, particularly in Africa, led to poor access to vaccines, diagnostics, and treatments, exacerbated by vaccine nationalism. The negotiation in 2023 by the Intergovernmental Negotiating Body (INB) for a convention, agreement, or other international instrument on PPR and the process of amending the International Health Regulations (2005) (IHR) has been undertaken to address these shortcomings The World Health Assembly in May, 2024 is expected to adopt the new instrument and the amendments to the IHR The Zero Draft of the instrument released on Feb 1, 2023, involved inputs from member states, UN agencies, the public, and other stakeholders through deliberations in the first three INB meetings, as well as written submissions There has been further discussion on the Zero Draft at the fourth INB meeting and at the fifth meeting on April 3–6, 2023. A progress report on INB work will be reported to the World Health Assembly in May, 2023 The content of the final instrument will be negotiated and decided by countries *Read full study

Wits

Erzse, Karen Hofman

(PRICELESS SA): Agnes

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health.

The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented *Read full study

Wits Researchers involved: Precious Matsoso

researchers involved

Lancet (IF - 202,731)

Research in high-impact factor journals:

Small vulnerable newborns—big potential for impact

Lancet (IF - 202,731)

Wits researcher involved: Justus Hofmeyr

Each year, 35 million newborns worldwide are born preterm (<37 weeks of gestation) or small for-gestational age, and may be low birthweight (<2500 g).These small vulnerable newborns (SVNs) have markedly reduced survival chances, with more than half (55·3%) of the 2·4 million neonatal deaths in 2020 attributed to being a SVN. The survivors are vulnerable to health problems throughout their life course, including poor neurodevelopmental outcomes, low educational achievement, and increased risks of adulthood non-communicable diseases, such as hypertension, ischaemic heart disease, and stroke.

For society, there are important human capital, economic, and productivity losses as well as costs such as health-care related costs In addition to one in every four newborns being a SVN, there are 1 9 million stillbirths each year, most of which also are preterm, or have similar SVN profiles A problem of this magnitude, negatively affecting pregnant women, their babies, families, and the whole society, creates an ethical, economic, and developmental imperative to generate a commensurate response Primary prevention has been slow so far, but it is possible to reverse flat global and regional trends. *Read full study

Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital.

Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN) Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society *Read the full article

Wits researcher involved: Justus Hofmeyr

The ethical, economic, and developmental imperative to prevent small vulnerable newborns and stillbirths: essential actions to improve the country and global response

Research in high-impact factor journals:

The Pandemic Fund—towards equitable financing for pandemics

Lancet (IF - 202,731)

Orthopaedic surgical needs during disasters

Lancet (IF - 202,731)

On Feb 3, 2023, the Secretariat of the newly established Pandemic Fund made a call for Expressions of Interest for the first round of funding for potential projects. The Pandemic Fund was created last year to provide additional streams of income to help low-income countries better prepare for and respond to future disease outbreaks. Therefore, the Pandemic Fund will be prioritising areas that build on surveillance for diseases, laboratory systems, and public health workforce capacities in eligible countries. Although such ad-hoc and donor driven schemes have largely shaped global health delivery, the Pandemic Fund in its current form could risk undermining one of its very aims—to support and reinforce capacity building in low-income and middle-income countries.

For instance, in the build-up to the launch of the Pandemic Fund, concerns about its design and operations, which consolidate decision-making power in the hands of a small group of predominantly wealthy nations, organisations, and philanthropies were raised. Low-income countries were only allowed a seat on the Pandemic Fund board after strong global criticism But as a call for Expressions of Interest begins, the 13 implementing entities approved, through which financing will be channelled to support project implementation in the chosen areas of interest, comprise mainly multilateral development banks highincome countries

*Read full study

The earthquakes in Türkiye and Syria on Feb 6, 2023, have left behind a massive burden of injuries, of which a large proportion are likely to be orthopaedic injuries. Generally, orthopaedic surgery is a field that is highly dependent on expensive equipment and supplies and, in most low-income and middle-income countries (LMICs), relies heavily on donations.

Türkiye, as an upper-middle-income country, faces different challenges than the war-torn, lower-income country of Syria However, both are set to face barriers in obtaining sufficient materials specific to their context In humanitarian crises, the provision of surgical supplies is often non-uniform, with central cities that have easy access getting the first claim of them Furthermore, the pre-existing donated equipment in LMICs is often broken, taking up valuable space in health-care facilities due to expensive decommissioning processes in settings before disaster (ie, the baseline)

Despite the increased need for these donations to be effective, equitable, and ethical for acute and longterm responses to mass casualties and provision of surgical care at the baseline, the barriers to equipment availability in LMICs persist These barriers include poor industrial investment and expertise in most LMICs to produce necessary orthopaedic materials locally, inadequate investment by governments to develop and maintain functional supply and disposal chains, and the absence of collaborations between hospital networks in LMICs and orthopaedic companies to facilitate supply chains for proper equipment to reach the correct place. *Read full study

Wits Researchers involved: Nelson Aghogho Evaborhene

Wits researcher involved: Emmanuel Makasa

Research in high-impact factor journals:

Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey

Lancet Infectious Diseases (IF - 71,421)

Opportunities and challenges of leveraging COVID-19 vaccine innovation and technologies for developing sustainable vaccine manufacturing capabilities in Africa

Lancet Infectious Diseases (IF - 71,421)

Wits Researchers involved: Nelesh Govender

Fungal infections are common causes of death and morbidity in those with advanced HIV infection. Data on access to diagnostic tests in Africa are scarce. We aimed to evaluate the diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa.

Methods

This study is a continent-wide survey by collecting data from 48 of 49 target countries across Africa with a population of more than 1 million; for Lesotho, only information on the provision of cryptococcal antigen testing was obtained

Findings

Data were collected between Oct 1, 2020, and Oct 31, 2022 in the 48 target countries We found that cryptococcal antigen testing is frequently accessible to 358·39 million (25·5%) people in 14 African countries here was a moderate correlation between antiretroviral therapy usage and external expenditure on HIV care (R2=0 42) but almost none between external expenditure and AIDS death rate (R2=0 18), when analysed for 40 African countries

Interpretation

This survey highlights the enormous challenges in the diagnosis of HIV-associated Pneumocystis pneumonia, cryptococcal disease, histoplasmosis, and other fungal infections in Africa Urgent political and global health leadership could improve the diagnosis of fungal infections in Africa, reducing avoidable deaths. *Read full study

Wits Researchers involved: Bavesh Kana, Patrick Arbuthnot, Yahya Choonara, Precious Matsoso, Penny Moore, Kubendran Naidoo, Margareth Ndomondo-Sigonda, Shabir Madhi

The COVID-19 pandemic heralded unprecedented resource mobilisation and global scientific collaboration to rapidly develop effective vaccines. Regrettably, vaccine distribution has been inequitable, particularly in Africa where manufacturing capacity remains nominal.

To address this, several initiatives are underway to develop and manufacture COVID-19 vaccines in Africa Nevertheless, diminishing demand for COVID19 vaccines, the cost competitiveness of producing goods locally, intellectual property rights issues, and complex regulatory environments among other challenges can undermine these ventures. We outline how extending COVID-19 vaccine manufacturing in Africa to include diverse products, multiple vaccine platforms, and advanced delivery systems will ensure sustainability

Possible models, including leveraging public–academic–private partnerships to enhance success of vaccine manufacturing capacity in Africa are also discussed Intensifying research in vaccine discovery on the continent could yield vaccines that further bolster sustainability of local production, ensuring greater pandemic preparedness in resourceconstrained environments, and long-term health systems security *Read full study

Research in high-impact factor journals:

Genomic investigations of unexplained acute hepatitis in children

Nature (IF - 64,8)

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK. Here an investigation of 38 cases is reported, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods.

This paper detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases.

Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers Instead, a AAV2 DNA complexes reflecting both HAdV-mediated and HHV6B-mediated replication was identified

It is hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.

Methods

Metagenomic analysis and HAdV sequencing were carried out by the routine diagnostic service at Great Ormond Street Hospital (GOSH) Additional PCRs, immunohistochemistry and proteomics on samples received for metagenomics are part of the GOSH protocol for confirmation of new and unexpected pathogens

Initial diagnostic testing by metagenomics and PCR was performed at GOSH Microbiology and Virology clinical laboratories Further WGS and characterization were performed at UCL

Conclusion

In conclusion the livers of these children have a distinctive pattern of damage which does not indicate a specific aetiology, it does not exclude but does not offer positive support for either autoimmune hepatitis or a direct cytopathic effect of virus on hepatocytes. Each image shows a representative result from histology carried out on a minimum of five cases

*Read full study

Wits Researchers involved: Simon Waddington

Together, Michèle and June will illustrate the potential for precision medicine approaches to managing diseases in African populations Ideally, precision medicine helps to inform an individual’s susceptibility to disease and its progression and response to treatment. As it relies on patient-specific genetic data, precision medicine has the potential to significantly improve prognosis and outcomes As Michèle explains, “It is about individualising diagnosis and treatment for the best possible health outcome and not using a ‘one size fits all’ approach”

Of the 8 billion people on earth, African populations harbour the greatest level of genetic diversity, creating a complex genetic environment that also impacts disease susceptibility However, African populations remain largely underrepresented in genomic studies and delays in conducting research means there won’t be development of appropriate diagnostic tests, treatments, and interventions that can save lives. Their lecture will address how local data and research are essential when seeking solutions for the continent and how the academic community at Wits needs to be at the forefront of this research

Susceptibility to developing common diseases like hypertension, diabetes and cancer is only partly genetic Additional factors such as behaviour, lifestyle, and the environment call for more comprehensive data, novel analysis approaches, and nuanced interpretations in our populations

The rich historical links between genetic variants and environmental selection can also strengthen a population’s ability to resist some diseases

Drug use is relatively recent and all drug development occurs in non-African populations. So despite widespread use, there is much for us to learn about the

Cont impact of genetic variants on response to medication

science and collaboration stating that

“There are many unwanted consequences, some include adverse drug reactions and increased sideeffects in those who don’t metabolise drugs quickly, or the opposite, where the drug may be ineffective and patients do not respond to treatment,” emphasises June current global data do not perform well in African populations. More research and larger well-characterised cohorts are critical to ensure that Africa is not left behind in the era of precision medicine,”

“precision medicine approaches are the future, but we need to ensure that African populations are adequately represented – not an easy task given the genetic diversity within Africa The solution is for us to work closely with other African countries to establish new (and expand current) research collaborations that prioritise our needs and impact the care we offer We also need to develop strong partnerships with industry to ensure equitable and affordable access to treatments - as seen with lessons learned from COVID.”

June further presents important views on translational says Michèle.

Dr June Fabian

Nephrologist and Research Director of the Wits

Gordon Medical Centre

Wits Faculty of Health Sciences much of the research effort is directed towards serious health issues that are affecting our communities. There are currently 28 research entities based in the Faculty and two Research Thrusts (Diseases of Lifestyle and Molecular Biosciences). The quality of the Faculty’s research output ranks amongst the best in South Africa and is respected internationally

Professor Michèle Ramsay Professor in Human Genetics

Donald

Wits leads the DELTAS Africa Sub-Saharan Africa Consortium for Advanced Biostatistics

The Developing Excellence in Leadership, Training, and Science in Africa (DELTAS Africa) was launched as a bold endeavour that continues to redefine and shift the centre of science gravity to the African region. The launch included 14 programmes, and among them was the Sub-Saharan Africa Consortium for Advanced Biostatistics (SSACAB-II) led by Professor Tobias Chirwa, Wits School of Public Health.

Signed through Wits Health Consortium, SSACAB-II is a biostatistics collaborative initiative consisting of seven partner institutions based in Africa and the north, and several collaborating institutions. The initiative is funded by the Wellcome and the UK Foreign Commonwealth & Development Office (FCDO) to the tune of US$4 4 million over 4 years and is being implemented through the Science for Africa (SFA) Foundation.

SSACAB-II aims to develop by providing answers by addressing seven biostatistical research questions that have direct policy implications for the population health and health needs of Sub-Saharan Africa. This programme will contribute towards building highstandard biostatistical capacity in Africa Specialists with such competencies are limited and often inundated with the demand for their expertise

To bridge the gap, this programme assembles likeminded academic and research institutions to increase and strengthen researchers' biostatistical expertise thereby contributing to the growth of the biostatistical network – particularly in Africa.

The first round of SSACAB, which ran from 2015 to 2021, was notably successful in supporting numerous African universities to develop Masters’s programmes in biostatistics To date, 150 fellows have been awarded scholarships, of which 123 were Masters fellowships This programme produced graduates who are employed in both African academia and research institutions, enhancing the programme’s objective to feed highstandard biostatisticians into the continent

In 2019, the University of the Witwatersrand became the first African institution to gain Royal Statistical Society accreditation for a Biostatistics Masters programme. It is thus encouraging that Wits is leading the strides to guide other African institutions to the same capacity SSACAB is invested to upskill the biostatisticians who were already in the field through facilitated conferences as well as face-to-face and online short courses. This has been an effective strategy for developing and teaching advanced biostatistics methods, supervision and mentoring of PhD candidates

In looking to a successful, period ahead for this programme, Professor Chirwa says that

Funding initiatives have hugely

increased the volume of highquality data generated, but there are clear discrepancies between the amount of data and the capacity to analyse it,

says the SSACAB Programme Director, Professor Tobias Chirwa

SSACAB II aims to develop regional nodes of biostatistics excellence in Africa which will be able to work with research and training institutions by applying advanced biostatistical and data science methodology to address cutting edge public health challenges.

Offer better HIV care to migrant women in South Africa

The vulnerability of migrants was highlighted during the COVID-19 pandemic when restrictions affected people’s ability to travel to access treatment.

Around 8 45 million people in South Africa live with HIV – an estimated 13 9% of the population Of South African women aged 15-49, approximately 24% are HIV positive.

The roll-out of services to prevent mother-to-child transmission of HIV has been notably successful in reducing the rate of transmission But there are still gaps in the delivery of HIV treatment and prevention. A case in point is migrant women. People who move across national borders or between regions and provinces are particularly easy for healthcare systems to miss And there’s no integrated system of tracking them. Nor is there any robust national data on how many migrant women, specifically pregnant migrant women, are on treatment and virally suppressed

In 2020, it was estimated that there were 4 million migrants in South Africa, some of whom were women living with HIV The public health system has struggled to respond yet alone integrate this mobile population

he vulnerability of migrants was highlighted during the COVID-19 pandemic when restrictions affected people’s ability to travel to access treatment as well as the delivery of healthcare

In a recent paper we explored the challenges of the COVID-19 pandemic for HIV prevention services in Johannesburg, South Africa’s economic hub We

interviewed healthcare providers and stakeholders in policy and programming The aim was to understand the gaps in ensuring adherence to lifelong antiretroviral therapy for mobile populations.

The information we gathered shone a light on the country’s overburdened healthcare facilities and the shortcomings in the network of referral clinics in Johannesburg and across Gauteng province. We went on to draw from these insights to understand the systemic gaps in the delivery of antiretroviral treatment (ART) to migrant women We identified five in particular And we then identified possible solutions, including how technology could improve access to healthcare.

The pandemic created new problems in healthcare delivery and exposed existing shortcomings Five main themes emerged from our qualitative study.

First, women living with HIV and who were highly mobile feared going to healthcare facilities because

Writer by Melanie Bisnauth

Cont

they were scared of getting COVID This interrupted their treatment and increased their risk of falling ill.

Second, some healthcare workers told us they felt overwhelmed by the added burden of the pandemic on providing HIV prevention services to pregnant women For example, many reported that there was a lack of infrastructural resources to follow social distancing protocols This disrupted their provision of care

Third, migrant women faced a number of logistical barriers:

some who left Gauteng province and then tried to return to collect their medication couldn’t do so due to border and lockdown restrictions some lost their jobs and income and were unable to afford travel to collect their ART some were denied care because they didn’t have documentation (though this should not have been a barrier)

These factors resulted in patients interrupting treatment Fourth, some individuals who sought treatment reported mistreatment and xenophobic attitudes from healthcare providers Even some healthcare providers reported that their colleagues behaved negatively towards migrant women.

Time pressures were the fifth theme Health workers said they needed more time to counsel patients This helps build rapport and strengthens the ability of patients to manage their health. From these insights we drew up a list of interventions we think would improve antiretroviral services to migrant women in South Africa

What can be done?

The first step is to dispense antiretrovirals for a longer duration of time to alleviate stress for individuals on the move and encourage retention in the ART programme.

Secondly, decentralise services and bring care to the community with pop-up delivery that can help remove

logistical barriers like transport to clinics that are far away

Thirdly, introduce virtual care platforms – like online HIV prevention of mother to child transmission services It could help highly mobile individuals to interact with healthcare providers This could help to improve the referral system between clinics and counsellors could follow up patients who had moved The system could keep better patient records and send reminders for medicine collections In addition, it should include translation services to help remove communication barriers between service providers and users And it could better integrate communication of healthcare facilities – even those in other countries –so as to track patients

Fourthly, healthcare providers need better opportunities to build closer relations with each other This could create a better understanding of the changes in their work and the underlying issues that affect them. Greater understanding could help get to the root of where negative attitudes towards migrants stem from to improve behaviours towards patients

In addition, healthcare facilities often improvise to come up with strategies and solutions that meet the requirements and changes to programmes. If these were better documented they could then provide knowledge translation and learning opportunities on a larger scale for other healthcare providers, facilities and programmes.

Fifth, government should evaluate healthcare environments before changing policies and programmes Platforms such as working groups should be provided for collaboration with researchers, service providers and mobile patients to help direct policy and practices

South Africa needs to take a more pragmatic approach to the delivery of antiretroviral treatment. It needs a healthcare system that is migration-aware and offers a service that recognises mobility – one that speaks to the realities of migrant women living with HIV in South Africa

Melanie Bisnauth, Doctoral Researcher, School of Public Health and Public Health Technical Advisor, Anova Health Institute at Wits This article

is republished from The Conversation under a Creative Commons license Read the original article

Exposé on the products and practices collectively called the commercial

Just four industries account for at least one-third of global preventable deaths. These industries are: unhealthy processed food and drinks, fossil fuels, alcohol, and tobacco. Collectively they cause 19 million deaths annually.

Around 8 45 million people in South Africa live with HIV – an estimated 13 9% of the population Of South African women aged 15-49, approximately 24% are HIV positive

These are amongst the findings of a series of reports published by The Lancet and to be launched in South Africa in a hybrid format at Wits University.

The launch features an eminent panel of local and international public health, civil society, government, scientific, and academic representatives whose discussion was moderated by Mr Mark Heywood, Founding co-editor of Maverick Citizen

The Lancet Series on commercial determinants of health is a ground-breaking exposé of the products and practices that are collectively called the commercial determinants of health

The commercial determinants of health are “the systems, practices, and pathways through which commercial actors drive health and equity.”

The Lancet Series comprises three papers of which academics at the SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA, in the School of Public Health at Wits, are co-authors

RICELESS SA Director Professor Karen Hofman and

This paper explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so

Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests.

This power imbalance leads to policy inertia and although many policy solutions are available, they are not being implemented Health harms are escalating, leaving healthcare systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the well-being of future generations, development, and economic growth

“Policy inertia”

Extent of commercial influence on health outcomes

models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing.

But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing.

Paper 2 in the Series, titled Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations

In this paper, the authors develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency

The framework that the authors develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes

Prioritise public interest, challenge contemporary capitalism

Can humanity survive?

Paper 3, titled Commercial Determinants of Health: Future Directions is about the future role of the commercial sector in global health and health equity

The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health – the business

Health and the commercial sector don’t have to be in opposition – in fact, the former are essential to economic development

But what is needed, stress the Series’ authors, is a global re-balancing of power that prioritises public interests and challenges contemporary capitalism The energy and innovation of the commercial sector are powerful and could be better harnessed into profitable enterprises that advance health, well-being, equity, and society

The authors leave readers with this statement,

The question is not whether the world has the resources or will to take such actions, but whether humanity can survive if we fail to make this effort

Wits Establishes Infectious Diseases and Oncology Research Institute to Tackle Burden of Disease in Africa

The University of the Witwatersrand (Wits) is delighted to announce the establishment of the Wits Infectious Diseases and Oncology Research Institute (Wits-IDORI). This ground-breaking initiative brings together a team of internationally recognized scientists who will conduct cuttingedge research in cancer and infectious diseases, ranging from basic sciences to Phase III human clinical trials within well-established collaborative networks.

Under the leadership of Wits Distinguished Professor Robert Breiman, an esteemed expert in global health, Wits-IDORI is poised to make significant strides in understanding and addressing the burden of disease in Africa. Professor Breiman, who has previously held prominent positions in health institutes worldwide, including the Emory University Global Health Institute, brings a wealth of experience and a track record of success to his role as the Institute's Interim Director. Most recently, he was the Director of the Emory University Global Health Institute and the overall Principal Investigator for the Child Health and Mortality Prevention Surveillance (CHAMPS) network, overseeing a grant of US$ 270 million over 10 years. CHAMPS is providing an array of new insights on targetable causes of mortality and was the largest research grant ever given by the Bill and Melinda Gates Foundation at the time

"I am honoured to lead the Wits Infectious Diseases and Oncology Research Institute," said Professor Breiman

Through our collaborative efforts with universities across Africa, academic partners, and industry worldwide, we aim to reduce the growing burden of disease on the continent through mission-driven research and translation of findings into products and strategies that will reduce disease burden, while strengthening scientific capacity By conducting research in Africa and nurturing the next generation of African scientists, we will drive impactful change and improve public health outcomes.

Wits-IDORI will serve as a hub for collaboration, bringing together scientists from universities across Africa who already operate according to international standards. The Institute will also engage with national public health institutes, the Africa Centres for Disease Control, the African Regional Office of the World Health Organization (AFRO), and various professional organizations dedicated to effective cancer management and infectious disease prevention/control

In addition to the nexus of cancer and infectious diseases, IDORI will integrate infectious disease research at Wits, providing a home and broad “umbrella” for Wits work on such topics as antimicrobial resistance and stewardship, emerging infections and pandemic and epidemic, preparedness, response and knowledge acquisition, One Health, and

climate change and health It will also integrate cancer research across Wits, emphasising topics like molecular biology of cancer and immunology, effective empiric therapy for febrile neutropenia (especially in cancer patients), epidemiologic studies and cuttingedge clinical trials

"Wits-IDORI is committed to conducting high-quality, state-of-the-art investigations," said Professor Shabir Madhi, Dean of the Wits Faculty of Health Sciences and the champion of Wits-IDORI

We will prioritize collaboration and foster a culture of nurturing and retaining excellent young talent and junior scientists in Africa By investing strategically and building multi-faceted scientific partnerships, we will accelerate progress in developing products and strategies to reduce disease burden not only in Africa but globally.

of pathogens in cancer development, with the aim of identifying prevention, diagnostic, and therapeutic tools that will lead to measurable beneficial outcomes at the population level Furthermore, Wits-IDORI will conduct research to provide evidence for mitigating the devastating impacts of infectious diseases on cancer, including optimizing timely empiric therapy for managing febrile neutropenic paediatric and adult patients

“This initiative addresses a critical gap in research by combining the fields of infectious diseases and oncology," emphasized Professor Madhi "Currently, there is a significant need for comprehensive investigations that explore the intricate relationship between these two areas of study. Wits-IDORI will bridge this gap and contribute immensely to the scientific landscape by unravelling the complex interplay between infectious diseases and cancer development."

Initially, Wits-IDORI will focus on priority cancers, leveraging burden data specific to Africa. The Institute will undertake comprehensive epidemiologic, clinical, and basic science investigations to understand the role

By defining novel pathways to oncogenesis and cancer burden, Wits-IDORI aims to pave the way for costefficient diagnostics, therapies, and vaccines The vision of the Institute has immense public health ramifications, offering hope for reducing the burden of disease and improving the lives of millions across the African continent and beyond

Did you know the Wits Innovation Centre (WIC) lies at the heart of the University’s innovation ecosystem that seeks to develop an ‘innovation mindset’ across all disciplines and boundaries? Click the banner for info

Age and Cancer Incidence in 5.2 Million People With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study

male PWH Thereafter, the rates of infection-unrelated cancers increased steeply, particularly among male PWH, where prostate cancer became the most frequent cancer type at older age Whereas Kaposi sarcoma rates peaked at 34 years (101/100 000 person-years) in male PWH, cervical cancer remained the most frequent cancer among older female PWH.

Discussion

Old age is an important risk factor for developing cancer, but few data exist on this association in people with human immunodeficiency virus (HIV, PWH) in sub-Saharan Africa The strong association between increasing age and cancer risk may be explained by the accumulation of somatic mutations, a weakening immune system, changes in the tissue environment, and longer exposure to carcinogens However, not all cancer types follow this age pattern. Cancers that occur earlier in life are rare, associated with lifestyle factors or infections.

Methods

The South African HIV Cancer Match study is a nationwide cohort of PWH based on a linkage between HIV-related laboratory records from the National Health Laboratory Service and cancer diagnoses from the National Cancer Registry for 2004–2014 This study included PWH who had HIV-related tests on separate days Using natural splines, these were modeled cancer incidence rates as a function of age. Descriptive statistics were used to assess age, calendar year, and CD4 count of PWH at their first HIV-related laboratory test (baseline)

Results

5 222 827 PWH with 29 580 incident cancer diagnoses were included most commonly cervical, Kaposi sarcoma, and breast cancer In young PWH, the incidence rates for infection-related cancers were substantially higher than for infection-unrelated cancers At age 40 years, the most frequent cancer was cervical cancer in female and Kaposi sarcoma in

The rates of infection-unrelated cancers surpassed those of infection-related cancers by the age of 55 years in the overall study population and by age 51 years in male PWH. In female PWH, infection-related cancers remained the dominant incident cancer type throughout the life span The rates of most cancer types increased continuously with older age In contrast, incidence rates of Kaposi sarcoma and conjunctival cancer 2 cancer types strongly associated with immunodeficiency peaked in middle-aged PWH

Over time, the prevention and early detection of infection-unrelated cancers will become increasingly important to reduce cancer-related morbidity and mortality among PWH in South Africa Prevention strategies for infection-unrelated cancers include smoking cessation interventions, promotion of a healthy lifestyle, avoidance of excessive sun exposure, and adherence to recommended routine screenings Furthermore, early ART initiation may reduce the risk of developing infection-related and potentially also infection-unrelated cancers

Conclusion

In conclusion, incidence rates of most cancers increased with older age among PWH in South Africa, but rates of Kaposi sarcoma and conjunctival cancer peaked among middle-aged PWH. In young PWH infection-related cancers were the dominant cancer types, whereas most cancer diagnoses in PWH above the age of 54 years were infection-unrelated As PWH in South Africa become older, prevention and early detection of infection-unrelated cancers will become increasingly important

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Wits researchers involved: Mazvita Muchengeti

Wits researchers involved: Mary Galantino

Individuals with breast cancer–related lymphedema (BCRL) require self-management strategies to reduce the risk of infection, exacerbation, and/or progression of lymphedema. The coronavirus pandemic thrust the medical field into the world of telehealth; both patients and providers were forced to reduce in-person treatments and engage in this new platform of rehabilitation delivery The role of telehealth in the promotion of self-management for BCRL is unknown. This study examines self-efficacy during cancer rehabilitation for in-clinic versus telehealth visits among individuals with BCRL during the pandemic quarantine from April to November 2020.

The coronavirus 2019 (COVID-19) pandemic has accelerated the growth of telehealth services across the United States This effect has fostered creativity in health care delivery Given the complexity of cancer services during a pandemic, many people who underwent cancer treatment were unable to access rehabilitation and exercise services. Quality care of individuals living with a cancer diagnosis requires a team-based approach A recent review underscored that telehealth is an essential tool in the delivery of cancer care to enable timely ongoing support for exercise interventions for those affected by cancer. It is essential for survivors of cancer to continue to engage in and maintain regular exercise under the guidance of qualified health professionals incorporating evidence-based clinical guidelines.

Methods

Forty women who recently completed oncology rehabilitation for BCRL were asked to complete demographics and 2 Likert surveys, including the Exercise Self-Efficacy Scale (ESES) and the Self-Care Self-Efficacy Scale (SCSE), to compare the efficacy of telehealth versus in-person treatment modalities

Effect of Telerehabilitation Versus In-Clinic Rehabilitation Delivery on Self-Efficacy in Breast Cancer–Related Lymphedema

Discussion

Statistical analysis demonstrates the potential for telehealth as an effective alternative to in-person treatment for individuals with BCRL undergoing oncology-related rehabilitation Participants responded that overall they felt more confident in progressing with their treatment plan, and monitoring their conditions at home, even when difficult The ability to monitor and recognize changes in a condition, as well as selfmanage symptoms, is particularly important for individuals with lymphedema

Rehabilitation practitioners must be prepared to embrace technologies and service delivery models valued in the new post-COVID-19 healthcare environment Telehealth will be valued for its effectiveness and cost-efficiency in addition to the cultivation of self-efficacy Stakeholders and policymakers must realize that oncology rehabilitation services delivered via telehealth technologies can empower people to be active participants in improving quality of life and are an integral component in achieving optimal survivorship

Conclusion

There is value in telehealth to rehabilitate women with a diagnosis of BCRL. Further research needs to distinctly explore self-efficacy across various modes and dosages of delivery Rehabilitation practitioners must advocate for inclusion in future studies and articulate the distinct value of telehealth in rehabilitation for cancer survivorship, chronic disease management, and health promotion Further research is necessary to validate the efficacy and cost-effectiveness of rehabilitation assessments and interventions delivered through telehealth technologies.

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Discordance between PAM50 intrinsic subtyping and immunohistochemistry in South African women with breast cancer

A recent study from South Africa found that 64.9% of patients were diagnosed by IHC4 as B-like, 15 3% as TNC, 13 8% as A-like, and 6 0% as HER2-enriched An earlier country-wide study, found that black South African women had higher levels of ER-negative and PR-negative tumors than women of European, South Asian or admixture heritage, but did not have significantly different HER2 levels More recently, a study showed that white South African women had similar IHC profiles to European women and white American women, with more aggressive subtypes predominant in young women and less aggressive subtypes in older women, whereas black South African women did not have substantial profile changes according to age.

Wits researchers involved: Thérèse Dix-Peek, Boitumelo Phakathi, Eunice van den Berg, Caroline Dickens, Tanya Augustine , Herbert Cubasch, Maureen Joffe, Paul Ruff, Raquel Duarte

Breast cancer is the most commonly diagnosed cancer among South African women accounting for 27.1% of all cancers diagnosed in these women. Breast cancer diagnoses on the African continent have been steadily increasing over the past decades, attributed to longer lifespans and changes in lifestyle associated with westernization In Africa, mortality rates are higher than in Europe and the United States, largely due to late stage at diagnosis and fewer treatment options. Breast cancer is a heterogeneous disease, differing in gene expression patterns, growth rates, responses to treatment and clinical outcomes.

The last decade has seen the development of many commercialized multigene tests to guide treatment and provide prognostic information for patients with breast cancer The PAM50/ Prosigna assay has a 50gene signature that groups tumors into intrinsic molecular subtypes luminal-A, luminal-B, HER2enriched and basal-like. The PAM50 assay is less subjective than the Immunohistochemistry-based (IHC) techniques, but is much more expensive and labor intensive than IHC. In South African public hospitals, IHC continues to be used for clinical subtyping because of its lower cost.

Study participants

The South African Breast Cancer and HIV Outcomes (SABCHO) cohort studied patients recruited at the breast clinic of Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa. Participants were consenting women with biopsy-confirmed breast cancer who self-identified as Black African Exclusion criteria were age < 18 years or current pregnancy Clinical staging was according to the American Joint Committee on Cancer (AJCC) system. The mean age of study participants was 49 7 years Most patients had stage II or III cancers, and were more likely to have grade-2 or -3 tumors between 20 and 50 mm (AJCC T2), with some nodal involvement. The researchers focused on IHC classification of tumors, PAM50 intrinsic subtyping and Statistical analysis

Results

Most of the study participants had hormone receptor positive breast cancer, and even tumors with the HER2-enriched subtype were more likely to be HR positive than HR negative PAM50 is widely used for breast cancer subtyping, with IHC often used in resource constrained settings. The cost and labor of the PAM50 method make it prohibitive for the South African public health care sector and its inability to distinguish between HER2-positive B-subtypes and HR negative/HER2 positive subtypes must also give pause.

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In Vitro Prototyping of a NanoOrganogel for Thermo-Sonic Intra-Cervical Delivery of 5Fluorouracil-Loaded Solid Lipid

Nanoparticles for Cervical Cancer

Wits researchers involved: Samson Adeyemi, Zardad Az-Zamakhshariy, Yahya Choonara

Solid lipid nanoparticles (SLNs) are used extensively to achieve site-specific drug delivery with improved bioavailability and reduced toxicity. This work focused on a new approach to provide site-specific stimuli-responsive delivery of SLNs loaded within thermo-sonic nanoorganogel (TNO) variants to deliver the model chemotherapeutic agent 5-FU in treating cervical cancer. Pharmaceutically stable nanospherical SLNs comprising poly-L-lactic acid (PLA), palmitic acid (PA), and polyvinyl alcohol (PVA) were prepared and incorporated into TNO variants augmented by external thermal and ultrasound stimuli for release of 5-FU in the cervix.

The establishment of nanomedicine has revolutionized advances in chemotherapy for oncology Nanoenabled drug delivery systems continue to progress as an efficient therapeutic approach using various nanostructures such as nanoparticles, nanomicelles, or nanoliposomes. For example, the chemotherapeutic agent 5-flourouracil (5FU) has been successfully used as adjunct drug therapy to treat cervical cancer, and recent research has shown that when applied locally within nanolipids, it provides enhanced drug loading and controlled-release chemotherapy for women diagnosed with cervical intraepithelial neoplasia 2 (CIN II)

Similarly, solid lipid nanoparticles (SLNs) are widely used to achieve site-specific drug delivery with superior bioavailability SLNs provide an augmented drug encapsulating capacity during formulation and surface functionalization can occur for the targeted

delivery of bioactives However, a disadvantage of SLNs used in chemotherapeutic applications is their rapid clearance from the body.

Conventional gels used to carry SLNs have a fibrous network comprising gelators that support the solvent molecules and therefore display sponge-like viscoelastic properties. Alternatively, organogels are a class of gels constituting a liquid organic phase embedded within a three-dimensional crosslinked network

Materials

Poly-L-lactic acid (PLA), palmitic acid (PA), poly(vinyl alcohol) (PVA), dichloromethane (DCM), methanol, 5Fluorouracil (5-FU), ethylene glycol (EG), ethanol, dimethyl sulfoxide (DMSO), N-(Isopropyl Acrylamide) (NIPAM), sebacic acid (SA), 1,3 4-(carboxyphenoxy) propane (CPP), sodium dodecyl sulfate (SDS), methylene bis-acrylamide (MBA), and ammonium persulfate (APS) were purchased from Sigma-Aldrich Inc. (St. Louis, MO, USA).

Discussion

SLNs assembled into TNO variants were prepared and characterized for their in situ application to the cervix as a potential site-specific treatment for cervical cancer. In keeping with the objective of achieving stimuli-responsive site-specific and sustained release of 5-FU from the TNO variants, the formulations were augmented by introducing thermal (T) and/or ultrasound (U) responsivity to preferentially increased 5-FU release when applied to the site. Stable 5-FUloaded SLNs were successfully produced with desirable micromeritic and morphological stability before incorporation into three TNO variants to assess 5-FU release in the presence of single (T)/combined (TU) stimuli

Results

Results revealed that 5-FU was released from the TNO in a sustained release manner over 15 days in simulated cervical fluid The release rate was primarily influenced by the SLN:TO ratio to produce controlled drug release in tandem with system biodegradation and hydrodynamic influx Variants TNO 1 and 2 presented the most desired results in terms of controlled 5-FU release under combined thermo-sonic (TU) stimuli and are most promising for superior sitespecific delivery of 5-FU to cancerous cervical tissue

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A

conceptual framework for selecting appropriate populations for public health interventions

the intervention resources where the immediate need is most conspicuous, but there is a danger of stigmatization, and it comes relatively late (secondary prevention) In contrast, a population approach targets everyone irrespectively of risk profile in what can be perceived more as primary prevention, but the fundamental root causes are not addressed.

Additional approaches

Wits researchers involved: Jens Aagaard-Hansen

Irrespective of the public health issue in question, implicit or explicit choices are made regarding the target population for appropriate interventions. For instance, screening programs are based on the rationale of focusing on populations at risk defined by various biomedical markers; and health promotion interventions will emphasize various solutions with consequential age group, gender and potentially place implications. But there are other ways of defining who should benefit from a given intervention, i.e., which population segment should be targeted.

This paper explores the various criteria based on which target populations for public health interventions are chosen and suggests a conceptual framework based on four criteria biomedical, social, spatial, and temporal The researchers contend that this may guide strategic choices within public health planning and research

Whole populations or persons at risk?

In 1974, the Canadian Lalonde report recommended a focus on “populations at risk” characterized by either risk behavior or biomarkers Nine years later in 1985, Geoffrey Rose introduced the alternative “whole population approach” and interposed these two approaches to public health interventions According to Rose the overall sum of the impact on the “whole population” is larger than the total impact on the group of “individuals at risk ” There are pros and cons of both approaches A focus on individuals at risk concentrates

Notwithstanding Rose’s insights, there have been critical voices Based on the notion of “fundamental causes”, Frohlich and Potvin point out that a whole population approach does not address the underlying determinants, and that it is likely to increase health inequalities due to uneven distribution of risk factors as well as disparate ability to benefit from interventions

Adding the life-course perspective

For the past decades, biomedical research has highlighted the importance of the life-course perspective Building on epidemiological and epigenetic research, the life-course concept describes how positive and negative exposures affect individuals’ cumulative risk profiles throughout the life-course with consequences for a wide range of diseases and socioeconomic and educational achievements However, risk of disease accumulates not only throughout an individual’s life from the fetal stage onwards but is also passed on from one generation to the next Consequently, one can visualize the notion of life-course as a circle incorporating each stage of life: fetal life, infancy, early childhood, school age, adolescence, and fertile age (including the preconception period)

Discussion: from population selection to intervention

It is a key element of public health interventions to address either individual, behavioral change (“lifestyle”) or structural, environmental living conditions or a combination thereof This paper contends that a deliberate selection of intervention population segments will entail the best possible return of investment, which is essential within often resourcescarce health care systems in most parts of the world

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Severity of and associated triggers for acute asthma attack in patients presenting to an emergency department

Asthma is a major public health problem worldwide, which generates significant healthcare costs and has high morbidity and mortality rates. The World Health Organization (WHO) estimated that between 100 and 150 million people worldwide suffer from asthma, and over 180 000 deaths occur annually The Republic of South Africa (RSA), with 8.1% prevalence over all ages, ranked 25th worldwide, and the asthma case fatality rate in the country is reported as being the fourth highest in the world, with 1 5% deaths annually

Recently, it has been documented that South Africa has the highest prevalence of asthma in Africa. Adeloye et al. conducted a systematic review to ascertain an estimate prevalence of asthma in Africa in which they included 45 studies covering most parts of Africa (RSA: 11 studies, Nigeria: 8 studies, Ethiopia: 6 studies, Kenya: 5 studies, and 4 studies in each in Algeria, Morocco and Tunisia) Asthma morbidity and mortality are potentially preventable with optimal control of chronic asthma and appropriate management of asthma exacerbation.

Many triggers have been reported to cause patients with a poor asthma control status to increasingly frequent emergency departments (EDs)

Methods

This was a prospective, cross-sectional study in a district hospital in Johannesburg, South Africa Data

of consecutive samples of 239 adult patients aged ≥ 18 years with asthma exacerbation seen in the ED at Bertha Gxowa District Hospital (BGDH) between February 2015 and April 2015, collected through a survey questionnaire, were analysed. The chi-square test or Fisher's exact test was used to test the associations between variables and acute asthma severity Bivariate logistic regression was used to ascertain triggers associated with acute asthma attack. P-values < 0.05 were considered statistically significant

Results

Overall, 239 patients were enrolled (139 males, 100 females, and median age 31 years). The majority of them had moderate acute asthma attack (52 7%) Active cigarette smoking (p < 0 001) and/or passive cigarette smoking (p = 0.004) were identified to be potential associated triggers for acute asthma attack. There was no significant association between acute asthma attack severity and acute respiratory infection (p = 0 818), and use of medication-related asthma triggers (p = 0.942).

Conclusion

The study shows that the majority of patients present with moderate acute asthma attack in an ED Active and/or passive cigarette smoking is a potential associated trigger for asthma exacerbation.

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Wits researchers involved: Melaku Eyassu, John Musonda

Quantitative Self-Assessment of Exposure to Solvents among Formal and Informal Nail Technicians in Johannesburg, South Africa

diffusion samplers Therefore, comparisons of the central tendency of VOC exposure concentrations of a SAE nail technician group with a group of nail technicians for which exposures were measured under the conventional controlled assessment of exposure (CAE) regime

Study Population

Wits researchers involved: Derk Brouwer, Goitsemang

Keretetse, Gill Nelson

Participatory research, including self-assessment of exposure (SAE), can engage study participants and reduce costs. The objective of this study was to investigate the feasibility and reliability of a SAE regime among nail technicians.

Introduction

Citizen science, i e , a voluntary collaboration among scientists and non-specialists to achieve both scientific and societal goals, is an emerging form of scientific inquiry that is growing in popularity in the environmental sciences However, education and engagement of the public with scientific discoveries are other important objectives. Introducing citizen science into occupational health is considered a potentially innovative and economical approach, especially since resource constraints challenge this field From a measurement strategy perspective, daily monitoring of workers’ exposure is the optimum approach. However, currently, the selection of an appropriate measurement strategy is a compromise between statistical efficacy, i e , minimizing the variance of an unbiased estimate of the target exposure variable, and associated costs. Quantitative self-assessment of inhalation exposure relied mainly on passive sampling of volatile organic compounds (VOCs) and gases

To investigate the reliability of SAE, especially in the informal service sector, This study report on the results of a self-assessment study in which nail technicians in both formal and informal nail salons measured inhalation exposure to VOCs using passive

This comparative study had a cross-sectional design and was nested in a larger study in nail salons in the City of Johannesburg, hereafter referred to as the controlled assessment of exposure (CAE) study The formal nail salons were franchises of one of the largest local beauty therapy companies in South Africa, which permitted them to approach the salons in the northern suburbs of Johannesburg The informal nail salons comprised unregistered nail salons in the central Johannesburg Braamfontein area, some of which operated inside hairdressing salons.

If a nail technician agreed to participate in the study, i e , to self-assess their personal exposure on three consecutive workdays, oral instructions were given on how to open, attach, close, and store the passive samplers (diffusion tubes), as well as how to complete the worksheets The worksheets facilitated the participant to record information, such as the time the passive sampler was opened and donned, the number and types of nail applications performed, and the duration of the nail applications The researcher checked and noted the sampling tubes’ status and the worksheets’ completeness

Conclusions

Self-assessment of exposure in occupational settings, including informal workplaces, seems to be a feasible and economical method to contribute to the expansion of exposure data, which enables a more reliable interpretation of exposure variation In principle, SAE can be a citizen science tool in occupational health; however, passive sampling, requiring analytical costs and experts’ feedback, is not the ideal method to assess exposure. However, exposure science approaches and expertise to identify the exposure pathway and determinants of exposure are still needed to develop effective exposure control strategies

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The Composite Quality Score (CQS) as an Appraisal Tool for Prospective, Controlled Clinical

Therapy Trials: Rationale and Current Evidence

worded in a simplified and least restrictive manner, based on the rationale that the lower the stringency of an appraisal criterion, the higher the certainty of “high-bias risk” when such criterion is not met

CQS limitations

Despite its high epistemic rigour, evidence base and inter-rater reliability, the current version of the CQS has certain limitations that need to be taken into account when considering its application in systematic reviews of prospective controlled clinical therapy trials. These include the following items.

Verification of low-bias risk

Wits researchers involved: Steffen Mickenautsch

Systematic reviews of prospective controlled clinical therapy trials are one of the most important sources of information in modern medicine. Besides the systematic search for and statistical pooling of current clinical trial data for a particular type of therapy, systematic reviews also have the task of appraising the quality of trial results. The quality of trial results may be diminished by low internal trial validity, due to systematic error (bias) A high risk of bias may likely cause the reported trial results to be diverted from the actual true therapeutic effect and thus render it unsuitable for clinical guidance.

According to the Cochrane Collaboration, the risk of bias in clinical therapy trials should be assessed using its Risk of Bias tool, Version 2 (RoB 2).

The composite quality score

The development of the CQS as a possible trial appraisal tool started in 2019 with the epistemic consideration that regardless of how many trial Appraisal criteria a trial has fully complied with, the judgment of such a trial as being of “low-bias risk” cannot be justified but a single methodological error may render a trial to actually be of “high-bias risk”

Accordingly, three evidence-based criteria describing trial design requirements (random allocation sequence generation, allocation sequence concealment, minimum sample size) that are essential (albeit not sufficient) for the trial results to reflect therapeutic truth were established The criteria were intentionally

Trials that are awarded 1-scores for all four appraisal criteria may still have serious flaws in other aspects of their methodology This is a fully intended aspect of the CQS approach in line with the epistemic principles of deductive falsification

The discrepancy between not reported versus actual trial characteristics

Not all actual trial characteristics that were performed during the conduct of a trial, required by the CQS criteria, may have been reported by trial authors For example, trial randomisation may have included central allocation, but this was not made explicit in the published trial report.

The discrepancy between not performed trial methods and systematic error effect

The lack of essential trial characteristics may not always lead to systematic error Trial appraisal based on qualitative text analysis can assume whether a trial is susceptible to systematic error only when essential trial characteristics are missing Quantitative tests that can be applied during the systematic review of clinical trials may solve this problem

Conclusion

The CQS has been developed based on high epistemic rigour, meta-epidemiological evidence and inter-rater reliability However, like all trial appraisal tools, it has limitations that need to be considered during its application in systematic reviews of prospective controlled clinical therapy trials

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Introduction and integration of PrEP and sexual and reproductive health services for young people: Health provider perspectives from South Africa

Oral PrEP was introduced in the public sector in 2016 in a phased manner. Given the important role played by health providers, research was undertaken to understand their experiences of and attitudes towards the introduction of PrEP as a new HIV prevention method, and its integration within broader sexual and reproductive health (SRH) services for youth. A survey was undertaken with 48 purposively sampled health providers working in primary health care facilities and mobile clinics in three provinces in South Africa.

South Africa has one of the largest HIV epidemics in the world, with 38% of new infections in 2017 occurring among youth aged 15–24 years. Prevalence among adolescent girls and young women (AGYW) in this group is particularly high: nearly four times greater than that of young men This disparity is largely driven by cross-cutting factors such as poverty and unemployment, age-disparate sex, and transactional sex, against a background of harmful gender norms and unequal gender power dynamics, where the rights, safety and choices of AGYW are severely compromised.

Methods

Qualitative analysis was performed on free-text responses to open-ended questions in the survey, using an inductive approach to code the data in NVivo v 12 software Health providers expressed concerns about adding a new service to an already overburdened health system and worried that young people seeking PrEP would divert staff from other critical services While most recognised the benefits and opportunities afforded by HIV and SRH service integration, providers

highlighted the extra time and resources such integration would require Many were anxious that PrEP would encourage disinhibition and increase unprotected sex among AGYW and held judgemental attitudes about young people, seen as largely incapable of taking responsibility for their health

Introducing PrEP as an integrated service: Challenges and benefits

When health providers were asked how they felt about absorbing the provision of PrEP into existing services, many described PrEP as an extra, add-on service that was problematic in a context where the health system is already overburdened

Conclusion

The insights gained from this paper underscore the importance of firstly, providing channels to explore health providers attitudes, misgivings and misperceptions and consult about implementation design; secondly, ensuring training includes a purposeful, focused section on attitudes and values, and sensitisation with all staff clients encounter; thirdly, for programme planners and implementers to engage with managers and health providers about structuring and adapting health systems to support HIV prevention and SRH integration, and for integration to be cross cutting including HIV and SRH, and the embracing of HIV prevention as an integral part of PHC service provision; and fourthly, providing opportunities for the meaningful participation of young people, feedback mechanisms, and health provider-client dialogues These are important insights to guide the introduction of new HIV prevention methods as they are introduced into the future.

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Wits researchers involved (Wits RHi): Melanie Pleaner, Fiona Scorgie, Catherine Martin, Vusile Butler, Lorrein Muhwava, Maserame Mojapele, Saiqa Mullick

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.

Methods

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

Findings

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

Conclusion

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: Christine Njuguna, Pumla Pamella Sodo, Aviva Ruch, Joel Francis, Olufemi Babatunde Omole, Richard Cooke, Samuel Agbo, Laurel Baldwin-Ragaven

Association of alcohol use and multimorbidity among adults aged 40 years and above in rural South Africa

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.

Method

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

Discussion

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)

Conclusion

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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Witsies claim top spots in the battle for ideas

Two Wits students were ranked top in the Falling Walls Lab competition that also saw Nelson Mandela University feature in the top three.

The DAAD (German Academic Exchange Service), in partnership with Wits University, supported by the Embassy of the Federal Republic of Germany in South Africa, hosted solutions-orientated students on 2 June 2023. This was part of the Falling Walls Lab Johannesburg, a world-class pitch competition where students present innovative ideas in three minutes Open to all disciplines and students across the country, the winner of the regional competition proceeds to the international competition in Germany.

Kate Da Silva, a PhD student from the Wits Advanced Drug Delivery Platform (WADDP) Research Unit, scooped second place for her concept on how to assist the body to regenerate tissue after traumatic incidents This involves the utilisation of the native tissue secretome as a biotherapeutic agent for tissue trauma

The jury, comprising experts from academia, industry, government and DAAD, evaluated the presentations based on three main factors The breakthrough factor accounted for 50%, relevance and impact 40%, and structure and performance at 10% Judges use a standard rubic which prioritises originality, innovation and the ability to trigger other innovative processes The 2023 event attracted participants from the Universities of Free State, KwaZulu-Natal, Johannesburg, Pretoria, Central University of Technology and Mangosuthu University of Technology.

Each year, two Labs take place in South Africa The DAAD Information Centre in Johannesburg hosts one of the two (Lab Johannesburg/Lab Pretoria) in collaboration with a partner university in Gauteng, while the Friedrich Naumann Foundation and the University of Cape Town host the Falling Walls Lab Cape Town

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Kate Da Silva WADDP PhD student

Wities Named in MIPAD’s Global Top 100 Health & Wellness List

progressed to change the face of health care service provision one community after the other across all the provinces of South Africa

“What this translates to me is [that] more families and communities in the rural areas increasingly have access to a health care professional, who understands their ecosystem because she or he is from that same environment and this gives depth of meaning to the objective of access to equitable healthcare as a basic human right for all, especially the under-resourced” says Ugwuanyi

Congratulations to Faculty alumni Drs Anastasia Ugwuanyi and Stavros Nicolaou for making the Health & Wellness Edition of the Class of 2023 honorees in the global 100 lists announced by the Most Influential People of African Descent (MIPAD) MIPAD is a global civil society initiative in support of the International Decade for People of African Descent, proclaimed by the United Nations General Assembly resolution It highlights individuals, organizations and governments who have distinguished themselves in the advancement of people of African descent worldwide. Among this year’s honourees are South Africa’s Minister of Health, Dr Joe Phaahla and leaders of esteemed African health organisations All honourees will be hosted at the opening of the 78th United Nations General Assembly in New York City in September.

Dr Anastasia Ugwuanyi is a senior clinical educator within the Nelson Mandela Fidel Castro (NMFC) programme at the Wits School of Clinical Medicine This affords her the task of coordinating the integration of medical students in the academic and cultural transition from Cuba to South Africa Thus far, over 500 young graduate doctors, have gone through the NMFC programme at Wits University since the programme was introduced in 2018. However, the inception of the programme itself dates back to 1997 and has produced over 3000 medical doctors with a focus on primary healthcare training These professionals have

She says that she was “surprised, humbled, encouraged and overwhelmed, to say the least” to have been recognised at such a global level, especially as her focus is to break the paradigm of poverty and its effect on access to healthcare at a community level She further attests that “With this award, my commitment to medical education as a vehicle for improving the health systems indicators, is strengthened”

Dr Stavros Nicolaou is the Group Executive of Aspen Pharmacare Holdings Limited - one of South Africa’s most globalised multinational companies; as well as a Chairman of Aspen Pharma Group Dr Nicolaou has made immense contributions to the international pharmaceutical industry and South Africa

He played a key role in facilitating the introduction of the first generic ARVs to Africa, which have since saved hundreds of thousands of lives in the continent that is burdened by high HIV infection rates Alongside many esteemed accolades that he has received in his career, Dr Nicolaou is a former recipient of the South African Institute of Marketing Management (IMM) Health Care Marketer of the Year Award He is also a fellow of the Pharmaceutical Society of South Africa (PSSA) and holds an honorary doctorate in medicine from Wits University

The Faculty of Health Sciences - and the wider Wits University community extend proud congratulations to Witsies Dr Anastasia Ugwuanyi and Dr Stavros Nicolaou for featuring on this auspicious list!

RECORDING ALERT: Wits Health Sciences Alumni Lecture Series

The Faculty of Health is honoured to have hosted alumnus, Professor Avroy Fanaroff (MBBCh 1960, MD Honoris causa Wits 2004) for its maiden Wits Health Sciences Alumni Lecture Series. His talk titled "Glory Days and Disasters in Neonatology" kicked off an engaging initiative that aims to foster intellectual growth, facilitate knowledge exchange, and provide valuable insights to our alumni community.

The Alumni Lecture Series will feature distinguished alumni, accomplished professionals, and renowned experts who will share their expertise, experiences and unique perspectives on various topics of interest This series will provide a platform for our alumni to reconnect with the university, engage in lifelong learning, and expand their professional networks

As an internationally recognised master neonatal physician and a pioneer and leader in the field of neonatology, Professor Fanaroff’s shared reflections on

is career spanning the triumphs and disastrous interventions in neonatology When asked abouth the supposedly effective incubator that they used at the Chris Hani Baragwanath Hospital where he was trained as a Paediatrician (1965-1968) and later became a Padiatric Consultant (1968-1969); he said that “The incubator was a disaster When the put they sickest baby in the incubator, the baby wasn’t going to survive” Said Professor Fanaroff

Instead, he said they created an environment that mimicked an incubator describing that

the babies where all wrapped in cotton wool and they were swaddled The room temperature was such that the staff were uncomfortable [because the room was very warm” He closed-off his talk by stressing that “it’s the little things that make a big difference

Witsies Appointed to National Orders Advisory Council

President Ramaphosa appointed new members of the National Orders Advisory Council, who will process nominations for future National Orders recipients Among them are the Faculty of Health Sciences alumni Professor Glenda Gray (MBBCh 1986) and Dr Stavros Nicolaou (BPharm 1986, DSc honoris causa 2019

Dr Stavros Nicolaou is an influential player in the international pharmaceutical industry. He leads the Aspen Pharmacare Group which has a wide geographical and continent presence He serves on several industry and business structures He received the Order of the Lion of St Mark from the Greek Orthodox Pope and Patriarch, Theodoros II

Professor Grey is an acclaimed research professor and co- founder of the Perinatal HIV Research Unit at Wits University. She was also awarded the prestigious Order of Mapungubwe - a recognition of South Africans whose achievements not only has an international impact but is also of service to country

Congratulations!

Book alert “The Concealed Revealed: Searching for the Hidden Lymph Node”

Explore a memoir by a Witsie, Dr Saul Nathanson (MBBCh 1966) wherein he documents his contributions to the world of sentinel node biopsy

He writes about how surgical technique of sentinel lymph node biopsy (SLNB) has radically transformed the management of breast cancer and melanoma. “It all started in my lab in Detroit in the 1980’s using a mouse model of melanoma Ten years later the techniques were investigated in melanoma patients and twenty years later the standard surgical treatment of breast cancer patients changed,” says Dr Nathanson The technique of SLNB later came to change the experience of the surgery for millions of patients, doctors, and saved billions of dollars in health costs worldwide.

Nathanson is a leading expert on sentinel lymph node biopsy and the causes of lymph node metastases He is also a published author of three other books: ‘Ordinary miracles,’ an evaluation of the feelings and emotions of my breast cancer patients ‘Surviving arrogance,’ a memoir about my experiences as a surgeon ‘Cancer metastasis through the lymphovascular system,’ an 806 page textbook edited by me with two colleagues and now used by medical students, scientists and physicians all over the world

Dr Stavros Nicolaou

Professor Glenda Gray

OPPORTUNITIES

SCHOLARSHIPS: 2024 MSC, PHD & POST-DOCTORAL FELLOWSHIPS IN BIOSTATISTICS

The Wits Epidemiology & Biostatistics Division’s DELTAS Africa SSACAB II Programme is pleased to announce 2024 full-time MSc, PhD, and Post-Doctoral fellowships SSACAB II has received funding through the DELTAS Africa program, an initiative of Science for Africa Foundation (SFA) with funding support of Welcome & the United Kingdom’s Foreign, Commonwealth & Development Office (FCDO) The funding aims to develop and improve biostatistical skills among researchers in order to create biostatistical research nodes of excellence Candidates with a strong background in quantitative fields are encouraged to apply Fellowships are open to nationals in Sub-Saharan Africa

SCHOLARSHIP: 2024 CALL FOR SCHOLARSHIP FOR IMPLEMENTATION SCIENCE

The Wits School of Public Health invites applications for the award of TDR Postgraduate Training Scholarships for the 18-month Master of Science (MSc) Programme in Epidemiology in the field of Implementation Science The scholarship is provided by TDR, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases - based at the World Health Organization in Geneva, Switzerland. Nationals who are also residents in low- and middle-income countries (LMICs) of the WHO African Region are eligible to apply Individuals with an interest in a scientific career and health professionals with an interest in analytical approaches to programme implementation are welcome to apply

ASSESSMENT IN HIGHER EDUCATION

There exists an urgent need in higher education to rethink assessment practices This short course focuses on diversifying assessments and examining the critical role assessments play in learning The journey begins with theoretical fundamentals and travels through diversity, equity and inclusion considerations, an exploration of tools and methods, curriculum alignment, assessment design and feedback Who should attend? University teachers and anyone interested in exploring different ideas and options for assessment

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WITS PAEDIATRICS CONFERENCE UpToSPAED 2023

The 10th annual UpToSPAED conference takes place at the Public Health Auditorium, Wits Education Campus UpToSPAED focuses on the latest in paediatrics research and updates. This year’s conference has two brand new sessions - come listen to Dr Jaishree Naidoo talk about AI in paediatric radiology in the technology session, and Dr Tim de Maayer talk about The crumbling infrastructure in the non-urgent emergencies session There are 2 half day workshops this year: Paediatric pain and palliation, and a Resuscitation workshop UpToSPAED is both an educational event (which is CPD accredited and includes ethics points) and a fundraising event for the Wits Paediatric Fund Register today to learn and show your support Enquiries: rossella bandini@wits ac za

FACULTY OF HEALTH SCIENCES PRESTIGIOUS RESEARCH

LECTURE: UNLOCKING THE POTENTIAL OF GENOMICS FOR PRECISION MEDICINE IN AFRICA

The Faculty of Health Sciences invites you to the annual Prestigious Research Lecture, titled Unlocking the potential of genomics for precision medicine in Africa, presented by Professor Michèle Ramsay and Dr June Fabian at 17:30 in the School of Public Health Auditorium Focusing on African populations, Ramsay highlights the importance of local data and research in developing precision medicine approaches for the continent. Ramsay, from the Sydney Brenner Institute for Molecular Bioscience, emphasises population sub-structure in Africa and its impact on disease-associated traits The Africa Wits INDEPTH Partnership for Genomic Research (AWI-Gen) cohort, consisting of over 12,000 older adults from four African countries, serves as a foundation for collaboration within various international consortia Fabian's work centers on chronic kidney disease in African populations, showcases a pharmacogenomic precision medicine approach for treatment and highlighting the limitations of using European-derived equations and cut-offs for African populations Enquiries: Nomfundo.sibiya@wits.ac.za

INAUGURAL LECTURE OF PROFESSOR

Professor Joanne Potterton

Title: “Positive Childhoods: growing up with HIV in South Africa”

Joanne qualified as a physiotherapist at Wits in 1991 and went on to work at Baragwanath hospital where she very quickly moved into the paediatric team She has worked at Wits since 1995, lecturing undergraduate and post graduate paediatric physiotherapy and completed both her MSc and PhD in the field of paediatric HIV at Wits. Joanne’s research has contributed to understanding the complex interplay between HIV infection and social deprivation and the impact this has on infant and child development

Joanne has supervised over 50 post graduate students at masters and PhD level and has presented and published her work nationally and internationally She has held an NRF rating since 2010 Enquiries: Rechelle Tsunke@wits ac za

RSVP

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From Routine To Murder Anatomy IN NAZI GERMANY AND ITS LEGACIES FOR TODAY

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Professor Heleen van Aswegen is a Personal Professor in the department of Physiotherapy in the Faculty of Health Sciences She teaches cardiopulmonary physiotherapy at undergraduate and postgraduate levels and has supervised 28 postgraduate students (MSc and PhD) to completion of their degrees Her research interest is physiotherapy in the fields of critical care and trauma. She has published 65 articles in peer-reviewed journals and 10 book chapters Heleen edited a textbook titled ‘Cardiopulmonary Physiotherapy in Trauma: An Evidence-based Approach’ published in 2015 She has been an invited speaker at numerous physiotherapy, critical care and trauma congresses and has research collaborations with colleagues in Sweden, New Zealand and Australia

LECTURE OF PROFESSOR Professor Lisa Micklesfield

6 Title: “PhD to Prof: a lifecourse from birth to young adulthood”

Professor Lisa Micklesfield is a Research Professor and Deputy Director in the SAMRC/Wits Developmental Pathways for Health Research Unit at the University of the Witwatersrand, and leads the Adulthood and Ageing research programme She is a Visiting Professor in the School of Human Development and Health at the University of Southampton Her research addresses four major themes: (i) Epidemiology of noncommunicable diseases (NCDs) in African cohorts; (ii) Measurement of physical activity and other risk factors for NCDs; (iii) Aetiological understanding of mechanisms of NCDs; and (iv) Health messaging and impact.

WITS SCHOOL OF CLINICAL MEDICINE BIENNIAL RESEARCH DAY SEPT 28 Register

INAUGURAL

PHYSICIANS UPDATE & GP'S SYMPOSIUM 2023

We invite all General Practitioners, Specialist Physicians, and trainees in Internal Medicine to join us at the Wits School of Public Health After a 3-year hiatus, the Wits Physicians Update and GP's Symposium is back, in-person and better than ever Featuring expert speakers and cutting-edge topics from all sub-disciplines of Internal Medicine, the 2023 programme is not to be missed The Update is the premier event in the Gauteng medical calendar and offers an unparalleled opportunity for interaction with a broad spectrum of clinicians in private and state practice Click info button to register, submit abstract and for more info.

HIGHER EDUCATION LEARNING AND TEACHING ASSOCIATION OF SOUTHERN AFRICA (HELTASA) ANNUAL (UN)CONFERENCE

HELTASA invites you to participate in its annual (un)conference hosted by North-West University’s Vanderbijlpark Campus It will be a hybrid event The theme is Celebration of scholarship: Connecting the lights Enquiries: info@heltasa org za