South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Multicenter Study
Sisonke phase 3B open-label study: Lessons learnt for national and global vaccination scale-up during epidemics.
Sisonke is a multicentre, open-label, single-arm phase 3B vaccine implementation study of healthcare workers (HCWs) in South Africa, with prospective surveillance for 2 years. The primary endpoint is the rate of severe COVID‑19, including hospitalisations and deaths. ⋯ We discuss 10 lessons learnt to strengthen national and global vaccination strategies:(i) consistently advocate for vaccination to reduce public hesitancy; (ii) an electronic vaccination data system (EVDS) is critical; (iii) facilitate access to a choice of vaccination sites, such as religious and community centres, schools, shopping malls and drive-through centres; (iv) let digitally literate people help elderly and marginalised people to register for vaccination; (v) develop clear 'how to' guides for vaccine storage, pharmacy staff and vaccinators; (vi) leverage instant messaging platforms, such as WhatsApp, for quick communication among staff at vaccination centres; (vii) safety is paramount - rapid health assessments are needed at vaccination centres to identify people at high risk of serious adverse events, including anaphylaxis or thrombosis with thrombocytopenia syndrome. Be transparent about adverse events and contextualise vaccination benefits, while acknowledging the small risks; (viii) provide real-time, responsive support to vaccinees post vaccination and implement an accessible national vaccine adverse events surveillance system; (ix) develop efficient systems to monitor and investigate COVID‑19 breakthrough infections; and (x) flexibility and teamwork are essential in vaccination centres across national, provincial and district levels and between public and private sectors.
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Multicenter Study
Sisonke phase 3B open-label study: Lessons learnt for national and global vaccination scale-up during epidemics.
Sisonke is a multicentre, open-label, single-arm phase 3B vaccine implementation study of healthcare workers (HCWs) in South Africa, with prospective surveillance for 2 years. The primary endpoint is the rate of severe COVID‑19, including hospitalisations and deaths. ⋯ We discuss 10 lessons learnt to strengthen national and global vaccination strategies:(i) consistently advocate for vaccination to reduce public hesitancy; (ii) an electronic vaccination data system (EVDS) is critical; (iii) facilitate access to a choice of vaccination sites, such as religious and community centres, schools, shopping malls and drive-through centres; (iv) let digitally literate people help elderly and marginalised people to register for vaccination; (v) develop clear 'how to' guides for vaccine storage, pharmacy staff and vaccinators; (vi) leverage instant messaging platforms, such as WhatsApp, for quick communication among staff at vaccination centres; (vii) safety is paramount - rapid health assessments are needed at vaccination centres to identify people at high risk of serious adverse events, including anaphylaxis or thrombosis with thrombocytopenia syndrome. Be transparent about adverse events and contextualise vaccination benefits, while acknowledging the small risks; (viii) provide real-time, responsive support to vaccinees post vaccination and implement an accessible national vaccine adverse events surveillance system; (ix) develop efficient systems to monitor and investigate COVID‑19 breakthrough infections; and (x) flexibility and teamwork are essential in vaccination centres across national, provincial and district levels and between public and private sectors.
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People with spinal cord injury (SCI) experience preventable secondary health conditions (SHCs) that worsen the disability, reduce the quality of life and affect health and wellbeing. There is limited information on the prevalence of SHCs and the associated factors to inform planning and practice in South Africa (SA). ⋯ Secondary health conditions were prevalent among patients with SCI. People with SCI experience multimorbidity that requires multiple management strategies. These findings point to the need for prevention strategies to minimise the occurrence of SHCs.
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Efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor, has been a component of first-line antiretroviral therapy (ART) in the South African HIV/AIDS programme since 2004. It is extensively used in ART programmes in other low- and middle-income countries. The natural history of the previously recognised EFV drug-induced liver injury (DILI) is not known. ⋯ EFV DILI is a severe drug complication of ART with appreciable mortality and significant inpatient morbidity, requiring prolonged hospitalisation and follow-up.
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There is a need to retain medical doctors in rural areas to ensure equitable access to healthcare for rural communities. Burnout, depression and anxiety may contribute to difficulty in retaining doctors. Some studies have found high rates of these conditions in medical doctors in general, but there is little research available on their prevalence among those working in the rural areas of South Africa (SA). ⋯ Our study found high rates of burnout, depression and anxiety in rural doctors in northern KZN, all of which were associated with the intention to leave the public sector in the next 2 years. Of particular concern was that CSMOs as a group had high burnout and anxiety rates and female gender was associated with burnout. We recommend that evidence-based solutions are urgently implemented to prevent burnout and retain rural doctors.