National Institute for Occupational Health

Abstract Purpose: The current National Cancer Strategic Framework for South Africa (NCSF 2017–2022) identifies the “top five plus one” priority cancers as breast, cervix, prostate, lung, colorectal, and childhood cancers. We aimed to explore the differences by gender, age group and ethnicity (population group) in the incidence of the most diagnosed cancers. Methods: De-identified data on pathologically diagnosed cancer cases in the most recently published report (2022) from the National Cancer Registry (NCR) were analyzed. The Age Standardized Incidence Rates (ASIR/100,000 population) were used to rank the most diagnosed cancers overall and stratified by gender and by population group. Results: Of the 41,860 males diagnosed with cancer, prostate cancer was the most common cancer (ASIR=52/100,000) followed by the following: colorectal (ASIR=11/100,000), lung (ASIR=7/100,000), melanoma (ASIR=5/100,000) and Non-Hodgkin’s lymphoma (NHL) (5/100,000). The ranking in 45,707 females with cancer was as follows: breast (ASIR (ASIR=36/100,000), cervical (ASIR=24/100,000), colorectal (ASIR=7/100,000), uterine (ASIR=6/100,000), and then both melanoma and NHL (ASIR=3/100,000). Melanoma ranked second in White females. Cervical cancer ranked top among Black females whereas breast cancer ranked top in White, Asian and Coloured female population groups. Oesophageal cancer and NHL ranked third and fifth in Black males and females respectively. Stomach cancer ranked fourth and fifth among Coloured and Asian males respectively. Uterine cancer ranked second among Asian females. There were more females than males diagnosed with cancer in those below 45 years old, with breast cancer and cervical cancer being diagnosed most. Cervical cancer was most common in the age group 30–44 years while breast cancer was most common among those above 50 years old. Prostate cancer was most common among 50-year-olds and above. Leukaemias and lymphomas were the most diagnosed cancers among children (0–14 years old). There were more boys than girls diagnosed with lymphomas and the reverse was true for cancers of the central nervous system. Conclusion: The disparities could be driven by socioeconomic factors, access to diagnostic services, healthcare provider/patient knowledge. There is need for more in-depth analysis of priority cancers by population group to inform priority settings for the NCSF, the National Health Insurance and cancer prevention and control programs for tailor-made interventions. Citation Format: Judith Mwansa-Kambafwile, Nkhensani Mhlanga, Ann Chao, Bilqees Sayed, Makandwe Nyirenda, Natasha Abraham, Mazvita Muchengeti. Beyond “Top Five Plus One” Cancers in South Africa: An Analysis of the 2022 Pathology-Based Registry Data [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 90.

People who inject drugs (PWID) are disproportionately burdened with hepatitis C virus (HCV) infection in South Africa (SA). Transmission dynamics can be inferred using phylogenetic clustering to inform prevention interventions. We utilized Core-E2 sequences and demographic data to investigate factors associated with HCV phylogenetic clustering among PWID and men who have sex with men (MSM) who inject drugs in SA. Previously genotyped samples (n = 285) that met the selection criteria were extracted, amplified, and Sanger sequenced. Phylogenetic trees were inferred using maximum likelihood implemented in RAxML (Cipres Gateway). Transmission clusters were determined in Clusterpicker using a 90% bootstrap threshold and a genetic distance cut-off on genetic similarity of ≤3.5%. Factors associated with clustering were assessed using logistic regression. Phylogenetic clustering of Core-E2 sequences was observed for 55% (78 of 141) of participant samples that were successfully sequenced, including 50 (64.1%) with genotype 1a and 28 (35.9%) with genotype 3a. Twelve clusters were identified, including six clusters each for genotypes 1a and 3a. Among genotype 1a, the cluster size ranged from 3 to 15 participants. Among genotype 3a, the cluster size ranged from 3 to 9 participants. Clustering among the mixed ancestry group in Cape Town was noted for ages 18-55. Factors independently associated with phylogenetic clustering included sharing a needle (adjusted odds ratio [aOR] 4.02, 95% confidence interval [CI] 1.08-14.87, p = 0.037), age ≥ 29 years (aOR 3.00, 95% CI 1.22-7.37, p = 0.016), and mixed ancestry race (aOR 6.11, 95% CI 1.87-19.95, p = 0.003). These data highlight the urgent need to reduce transmission by providing sufficient sterile needles and syringes and tailored education to prevent HCV transmission among older, experienced PWID.

Background: Environmental surfaces are key reservoirs for pathogen transmission, with the survival of bacteria on fomites influenced by factors such as temperature, humidity, and microbial interactions. This study aimed to determine microbial surface contamination and to determine the antimicrobial resistance profile of bacteria isolated from the indoor surface where the presence of cockroaches was observed in households of the Greater Letaba Municipality (GLM), South Africa. Methods: Swab samples were collected from kitchen countertops and food storage areas with visible cockroach activity. Bacteria were isolated and identified using standard microbiological methods, and antimicrobial susceptibility testing (AST) was conducted with the Vitek® Automated 2 system. Results: Of the 120 samples collected, 82 (68%) showed bacterial growth, resulting in 190 isolates. The majority of isolates (93%) were Gram-negative, comprising Klebsiella, Pseudomonas, Enterobacter, Escherichia, Serratia, Stenotrophomonas, Pantoea, Raoultella, and Salmonella species, with 98% demonstrating multidrug resistance (MDR) to multiple antibiotics. Resistance was particularly high against gentamicin (94%), fluoroquinolones (88%) and amikacin (77%). Among Gram-positive isolates, all belonged to the Enterococcus species, with 22% being resistant to one or two of the tested antimicrobial agents and 78% exhibiting MDR. Conclusions: The study revealed a high prevalence of antibiotic resistance in both Gram-positive and Gram-negative bacteria isolated from household surfaces. The spread of antibiotic-resistant pathogens via environmental surfaces presents a significant risk to human health, safety, and well-being.

Early antiretroviral therapy (ART) improves uptake, retention, and viral suppression. However, there is limited real-world data for high HIV burden settings, including South Africa. We conducted a retrospective cohort study using linked clinical CD4 and viral load (VL) data from South Africa's HIV treatment database (TIER.Net) and National Health Laboratory Service (NHLS). Our analysis included ART non-naive individuals entering HIV care between January 2010 and March 2017 in 4 provinces (KwaZulu-Natal, Northern Cape, Limpopo, and Mpumalanga). We estimated days from entry into HIV care (same day, 2-6 days, 7-89 days, and ≥90 days). Outcome measures included retention, viral suppression (VL <50 copies/mL), and CD4 recovery at 12 months. A Poisson regression model with adjusted Risk Ratios (aRR) was used to identify factors associated with rapid ART initiation (<7 days) at 5% significance level. Among 1,211,966 individuals (median age 31 years, 69.6% female), 30% initiated ART on the day of diagnosis, 4.2% within 2-6 days, 26% within 7-89 days, and 39.8% after ≥90 days. Rapid ART initiation increased over time, with same-day initiations rising from 24.6% in 2010 to 60% in 2017. Factors associated with rapid ART initiation included female gender (aRR: 1.04; 95% CI: 1.03 to 1.04) and a lower CD4 count at entry. At 12 months, 77.6% of same-day initiators were retained, with 28.4% having a VL test and 61.2% achieving viral suppression. Rapid ART initiation has increased because of policy changes and healthcare worker efforts in South Africa, but addressing late entry into care and treatment nonadherence remains crucial.

ABSTRACT Malaria is treatable with several combinations of drugs, the most well‐known and currently most effective being artemisinin‐based therapies. Gastrointestinal absorption of these drugs can be poor and erratic if not taken with a fatty meal. Nausea and the loss of appetite, common symptoms of even mild malaria, can therefore jeopardize the effectiveness of the treatment. To enhance the bioavailability of artemisinin‐based combination therapies, several lipid‐based formulations and delivery systems have been investigated. In this study, we synthesized oligochitosan conjugates of the antimalarial drugs dihydroartemisinin and lumefantrine and examined their physical stability and biological activities. The hydrodynamic properties of both conjugates varied unpredictably under pH conditions like those found at different stages along the gastrointestinal tract and in plasma. The viability of Caco‐2 cells exposed to the conjugates was also investigated in comparison to the free drugs. Both conjugates demonstrated significantly lower cytotoxicity compared to the free drugs at concentrations up to 0.5 mg/mL, particularly during the first 24 h of exposure. Despite this, they retained their antiplasmodial effect against Plasmodium falciparum in an in vitro assay at 1 µg/mL and 5 µg/mL. These new chitosan biomaterials hold great potential for further development into oral therapeutics that would not require fatty meal intake due to the intrinsic mucoadhesiveness of chitosan.

Performance management focused on development enhances individual and organisational performance and enables improved services. Achieving performance management objectives is vital for addressing healthcare worker shortages and ensuring equitable, quality healthcare. A weakened South African district-based primary health care system links to inadequate leadership and governance. This study aimed to explore how doctors in primary health care perceive performance management and development systems. The objectives examined what medical officers understand about it and their experiences. Emerging themes may provide insights into enhancing implementation. This study used a qualitative, interpretive, and phenomenological research design. Stratified purposive sampling based on PMDS completion and employment duration led to four focus group discussions with 17 participants. A thematic analysis was performed. The overarching theme was the Performance Management and Development System as a necessary evil, with benefits and challenges. The subthemes included understanding components, comprehending clinic systems to improve outcomes, nurturing employee-supervisor interactions, fostering performance and learning culture, and facilitating personal and professional growth. Additional subthemes included ambiguity in fairness, lack of management capacity, and need for a bottom-up approach and realistic implementation. Effective implementation of a Performance Management and Development System requires managers and supervisors to drive this process strategically. Those responsible for clinical governance should invest in personal development to understand the process and consider appropriate implementation tools.

BackgroundThere is an urgent need to improve interventions for HIV and syphilis in pregnancy to achieve elimination.ResultsThe tenets of vertical transmission strategies for HIV and syphilis overlap but have varying success due to differences in their transmission dynamics, diagnoses, and treatment. Key principles include prevention of maternal infection, screening and diagnosis early and throughout antenatal care, curative treatment (syphilis), viral load suppression (HIV), early infant diagnosis and treatment (HIV and congenital syphilis). We recommend improved guidelines, provider training and focused research and surveillance, including implementation studies to align HIV and syphilis screening and treatment during pregnancy. Opportunities to integrate syphilis screening and treatment into antenatal and HIV care enable providers to offer comprehensive maternal care.ConclusionIntegrated HIV/syphilis services ensure a cohesive and person-centered approach, improving health outcomes through streamlined, efficient, and family-centered care pathways. We recommend key interventions to reduce HIV and syphilis in pregnancy and prevent vertical transmission.

ObjectivesEvidence regarding interventions to engage men and boys to improve sexual and reproductive health and rights (SRHR) has grown rapidly across subtopics such as HIV, family planning and gender-based violence (GBV). We conducted a review of the effectiveness of interventions to engage men and boys across SRHR domains, lessons learnt about successful programming, and about harms/unintended consequences, in low- and middle-income countries (LMIC).DesignSystematic review of reviews following Cochrane guidelines.Data sourcesPubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane were searched (18 October–9 November 2022; 9 September 2024).Eligibility criteriaEligible reviews were published since 2015, covered WHO-defined SRHR domain(s) and focused mostly on LMIC.Data extraction and synthesisData extraction by multiple reviewers focused on intervention effectiveness, implementation best practices, unintended consequences, and quality/risk of bias.ResultsThirty-five systematic reviews were included, comprising ~960 primary studies. Reviews focused on HIV prevention/care, reproductive health, maternal and newborn health, and GBV. Reviews consistently concluded that men were successfully engaged, yielding benefits to both women and men’s SRHR outcomes; no adverse intervention impacts on prevalence of SRHR outcomes were reported. We summarised the interventions most consistently found to be effective across reviews, in a programmer-friendly visual mapped onto a framework of men as clients, partners and agents of change. Person-centred, gender-transformative, multilevel approaches were most effective. Remaining evidence gaps include engaging men as contraceptive users, sexually transmitted infections other than HIV, preventing unsafe abortion and SGBV as experienced by men and boys.ConclusionsThere is substantial evidence supporting a range of successful interventions to engage men and boys to improve SRHR, with markedly similar principles and approaches emerging across SRHR domains. It is time to scale up and integrate these strategies, monitoring for any potential harms and tailoring as needed to socio-cultural contexts and for specific vulnerable subpopulations.