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Item Acceptability and effectiveness of rapid ART initiation: patients’ and healthcare workers’ perspectives.(2022) Govere, Sabina May.; Chimbari, Moses John.The Joint United Nations Programme on HIV/AIDS is leading the global effort to end AIDS as a public health threat by 2030. In achieving these goals, emphasis has been on the 95–95–95 targets that by 2030, 95% of people living with HIV know their HIV status. However, the focus is on achieving the second 95 and third 95; having 95% of people diagnosed with HIV initiating on treatment within the expected timeframe and 95% of those on treatment obtaining a suppressed viral load. Commendable efforts have been made in increasing HIV testing numbers however, same day initiation on treatment and achieving viral load suppression remains a challenge. According to the WHO recommendations; same day (ART) initiation should be offered to all people living with HIV following a confirmed diagnosis. This study determined the factors influencing the acceptability and implementation of Universal Test and Treat by both patients and healthcare workers. Universal Test and Treat is a prevention strategy encourages that if a person tests HIV positive, irrespective of the persons CD4 count and clinical staging at the time of testing they will have to begin treatment immediately. Furthermore, patient’s clinical outcomes following test and treat in eThekwini municipality in KwaZulu-Natal were determined. This study was cross-sectional and used prospective - mixed methodology to collect data from 403 patients who either accepted or deferred same day ART initiation from June 2020 to May 2021. A structured questionnaire was used to collect demographic information, sexual behaviour, acceptance of same day ART initiation and knowledge of Universal Test and Treat on the day of HIV diagnosis. Key informant in-depth interviews were conducted with healthcare workers and patients were followed up at 6 months after HIV diagnosis to determine clinical outcomes for both groups, rapid and deferred ART initiators using medical charts and electronic databases. Two different analysis univariate and multivariate logistic regression were performed to examine associations between same day ART initiation and several explanatory factors. Logistic regression was performed to examine associations between same day ART initiation and several explanatory factors, retention in care, clinical outcomes and facility related factors. Thematic analysis was used to assess experiences, knowledge and observations of healthcare workers in implementing the Universal Test and Treat policy. Among the 403 participants same-day initiation was 69.2% (n=279). In an adjusted analysis (age, gender, level of education were adjusted at 0.5 significance level in univariate level) number of sexual partners (aOR: 0.35; 95% CI: 0.15-0.81), HIV status of the partner (aOR: 5.03; 95% CI: 2.74-9.26), knowledge of universal test and treat (aOR: 1.97; 95% CI: 1.34-2.90), support from non-governmental organizations (chi-square = 10.18; p-value= 0.015 and provision of clinic staff (chi-square = 7.51; p value = 0.006) were identified as major factors influencing uptake of same-day ART initiation. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141) and partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) were significantly associated with viral load detection and retention in care. (All variables that were significant at e.g. 0.5 level in univariate). Our results suggest a steady increase in uptake of same day ART initiation with poor retention in care. The results also emphasise a vital need to not only streamline processes to increase immediate ART uptake further but also ensure retention in care in order to meet the 95-95-95 targets. The findings of the study contribute to knowledge useful for strengthening rapid ART initiation implementation by considering individual patient factors, healthcare workers’ perspectives and facility level factors. The qualitative findings revealed variations in UTT knowledge, experiences and observations among diverse healthcare workers from the four clinics in different geographical settings. While training on UTT and SDI of ART initiation was conducted at the inception of the implementation phase, the understanding and interpretation varied especially between clinicians and non-clinical healthcare providers. Denial, feeling healthy, fear of disclosure, limited knowledge about ART, fear of ART side effects, fear of stigma and discrimination were some of the factors HCW observed as hindering uptake of SDI. These findings relate to some of the reasons given by patients with fear of disclosure frequently mentioned by those who deferred SDI of ART.Item Contraceptive use among adolescent girls in Zambia: a study on adolescents’ needs, preferences and perspectives on contraception methods=Ukusetshenziswa kwezivimbelakukhulelwa ngamantombazane angamatshitshi eZambia: Ucwaningo ngezidingo zamatshitshi, okukhethwayo nemibomo kwezindlela zezivimbelakukhulelwa.(2023) Chola, Mumbi.; Ginindza, Themba Geoffrey.; Hlongwana, Khumbulani Welcome.The fertility rate in Africa is among the highest in the world, and this trend is projected to continue unless drastic interventions are put in place to avert the situation. Contraceptive use among adolescents in sub-Saharan Africa remains very low despite various interventions to improve the uptake. The study aimed to examine the key determinants of contraceptive use among adolescent girls in Zambia; specifically, i) examining patterns, trends and factors that drive poor usage of contraceptives; ii) exploring the motivators and influencers of decision-making regarding contraceptive use among adolescent girls; and finally, iii) understanding their perspectives on existing contraceptive methods. The study examined patterns, trends and factors associated with contraceptive use among adolescents in Zambia, using data from 1996, 2001/2, 2007 and 2013/14 Zambia Demographic and Health Surveys. Qualitative data was collected through focus group discussions and analysed using thematic analysis. Permission to conduct the study was obtained from the Ministry of Health and the National Health Research Authority. Ethical approvals were provided by the Biomedical Research Ethics Committees (BRECs) of the University of Zambia and the University of KwaZulu-Natal in South Africa. Results revealed that contraceptive use among adolescent girls in Zambia remained low over the 18 years and increased by only 3%, particularly among younger, uneducated, and unmarried sexually active adolescent girls. Marriage or living with a partner contributed the most to the change in contraceptive use (44%), while living in a rural area accounted for approximately 20%. Adolescent girls' experience with contraceptives was affected by various factors such as knowledge of contraceptives, including sources of information and contraceptives, experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives. The interaction of factors related to their personal experience, their community and the environment in which they access contraceptive services all contribute to the overall patient experience and influence the adolescent girls’ contraceptive decision. Most of the motivators for the use and/or non-use of contraceptives are intrapersonal and interpersonal. Contraceptive use among adolescent girls remains low and is determined by various factors. Key influencers and motivators for contraceptive use involve people in their lives, such as partners, family and community members. Interventions targeting increasing demand, access and use of contraceptives among adolescents must be innovative, participatory and implemented within the context of local cultural norms. IQOQA Izinga lokuvunda e-Afrika libalelwa kweliphezulu emhlabeni wonke, futhi le nkombamvama ihlelelwe ukuqhubeka ngaphandle uma kunokungenelela okunamandla okumele kufakwe ukuze kugwenywe isimo. Izimvimbelakukhulelwa ezisetshenziswa phakathi kwamatshitshi ase-Saharan Africa ziyohlala ziphansi ngale kokungenelela okwahlukene ukuze kuthuthukiswe lokho okukhona okuzosetshenziswa. Ucwaningo lwaluhlose ukuhlola izinkombamthelela ezisemqoka zokusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane eZambia; ngokucacile i) ukuhlola izinhlelo, izinkombamvama noma izinto eziqhuba ukusetshenziswa kabi kwezivimbelakukhulelwa; ii) ukuhlola abagqugquzeli nabanomthelela ekuthathweni kwezinqumo ezimayelana nokusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane angamatshitshi; ekugcineni, iii) ukuqonda imicabango yabo mayelana nezindlela ezikhona zezivimbelakukhulelwa. Ucwaningo lwahlola izinhlelo, izinkombamvama nezici ezihlobene nezivimbelakukhulelwa ezisetshenziswa phakathi kwamantombazane eZambia, lusebenzisa imininingo esukela onyakeni wowe-1996, 2001/2, 2007 kanye nowezi-2013/14 eZambia Demographic and Health Surveys. Kwaqoqwa imininingo yocwaningo lobunjalo botho kugxilwe ezingxoxweni zeqoqo okwakucwaningwa ngalo lahlaziywa kusetshenziswa uhlaziyongqikithi. Imvume yokwenza ucwaningo yatholakala kuNgqongqoshe WeZempilo kanye NeZiphathimandla Zocwaningo LweZempilo KuZwelonke. Isiqinisekiso SeNqubonhle sanikezelwa Amakomidi eBiomedical Research Ethics (BRECs) aseNyuvesi yaseZambia kanye neNyuvesi YakwaZulu-Natali eNingizimu Afrika. Imiphumela yocwaningo yaveza ukuthi ukusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane angamatshitshi aseZambia kwahlala kuphansi esikhathini esingaphezu kweminyaka eyi-18 kwase kukhula ngama-3%, kwabancane, abangafundile kanye nakumantombazane abangamatshitshi angaganile kodwa alwenzayo ucansi. Umshado noma ukuhlala nomlingani wakho kube neqhaza elikhulu ezinguqukweni ezisetshenziswayo zokuvimbela ukukhulelwa (44%), ngenkathi ukuhlala endaweni yasemakhaya kubalelwa esilinganisweni esingama-20%. Lokho amantombazane asengamatshitshi aseke edlula kukho mayelana nokusetshenziswa kwezivimbelakukhulelwa kwaphazanyiswa yizinto eziningi njengolwazi lwezivimbelakukhulelwa kubandakanya nemithombo yolwazi nezivimbelakukhulelwa, odlula kukho uma usebenzisa izivikelakukhelwa, izingqinamaba zokusebenzisa izivimbelakukhulelwa kanye nemibono engemihle ngezivimbelakukhulelwa. Ukuxhumanakunikezelana kwezinto ezihlobene kulokho umuntu nomuntu adlule kukho, umphakathi wabantu kanye nendawo lapho abakwazi ukuthola khona izivimbelakukhulelwa konke kunomthelela kukho lokho isiguli esedlule kukho nalokho okuthinta izinqumo zokuvimbela ukukhulelwa ezithathwa ngamantombazane angamatshitshi. Abagqugquzeli abaningi bokusetshenziswa nokungasetshenziswa kwezivimbelakukhulelwa banobudlelwane bomuntu kanye nobudlelwane kubantu. Ukusetshenziswa kwezivimbelakukhulelwa amantombazane angamatshitshi kuhlale kuphansi futhi lokhu kudalwa yizinto ezahlukene. Abagqugquzeli nabakhuthaza ukusetshenziswa kwezivikelakukhulelwa basemqoka kufaka abantu ezimpilweni zabo, njengabalingani, umndeni namalunga omphakathi. Ukungenelela okuqonde ekukhuliseni isidingo, ukufinyelela nokusetshenziswa kwezivimbelakukhulelwa phakathi kwamatshitshi kumele kufake izindlela ezintsha, kubambe iqhaza futhi kuqaliswe engqikithini yenkambisonqubo yokuyisiko endaweni.Item Effect of HIV-1 subtype C Transactivator of transcription (Tat) A21P variant on TAR binding ability, nuclear levels of active positive transcription elongation factor b (P-TEFb) and viral latency.(2023) Mkhize, Zakithi Zinhle.; Madlala, Paradise Zamokuhle.The HIV-1 Transactivator of transcription (Tat) enhances the ability of the viral promoter 5’ long terminal repeat (LTR) to drive viral gene transcription and is important for HIV-1 pathogenesis. Tat binds to the transactivator RNA (TAR) element of the 5’LTR and subsequently recruits the host positive transcription elongation factor b (P-TEFb) for efficient viral gene transcription. Inter- and intra-subtype Tat genetic variation that translates to functional differences has been reported. Specifically, HIV-1 subtype C (HIV-1C) exhibiting Alanine at position 21 of the Tat protein (TatA21) was reported to be associated with reduced LTR transcriptional activity compared to Tat exhibiting Proline at position 21 mutation (TatP21). However, the effect of Tat variation on its ability to recruit P-TEFb is unknown. Therefore, this study seek to determine the effect of HIV-1 subtype C TatA21 mutant on the ability of Tat to recruit P-TEFb to 5’ LTR to enhance viral gene transcription. To this effect, site-directed mutagenesis (SDM) was performed on the Plasmid pcDNA3.1(+) HIV-1C BL43/02 TatA21 to introduce TatP21 alone or together with other mutations using designed primers and the Q5 DNA polymerase kit. The effect of Tat mutations was measured using Tat transactivation assay where the luciferase activity was the measured output in TZM-bl cell lines and the impact of TatA21 was further assessed on ability of the LTR to drive GFP and Gag expression in Jurkat and A72 cells respectively. Next, protein modelling was performed using Hdock software, followed by RNA immunoprecipitation (RNA IP) was performed using stably expressing TatA21 and TatP21 in Jurkat cells. Lastly, co-immunoprecipitation of TatA21 and associated with significantly reduced LTR transcription activity compared to TatP21 (p = 0.0004). TatA21 resulted in had significantly lower GFP expression Jurkat cells (p = 0.0439) and lower Gag expression in A72 cells compared to TatP21. Although TatA21 reduced the LTR transcription activity compared to TatP21, protein modelling using Hdock software revealed that TatA21 and TatP21 protein structures were the same. Consistently, molecular docking showed that TatA21 had a lower binding affinity than TatP21. The RNA IP showed that TatA21 had significantly reduced affinity to bind to TAR compared to TatP21 (p = 0.0151). Moreover, TatA21 and TatP21 formed a complex with cycT1 and CDK9. Taken together, our data shows that HIV-1C TatA21 significantly reduced its transactivation activity but does not affect its ability to recruit P-TEFb. Interestingly, TatP21 is able to bind TAR more efficiently than TatA21 thus revealing a possible mechanism but which the reduced functionality of SDMs and patient derived TatA21 variants was observed. The effect of TatA21 and TatP21 on the propensity of HIV-1 latency development or reversal. To this effect, a recombinant viral vector exhibiting either TatA21 (C731CTatA21C) or TatP21 (C731CTatP21C) were generated. The C731CTatA21C or C731CTatP21C were separately co-transfected together with VSV-G and R8.91 into Jurkat cells for virus production. This virus was then used to infect Jurkat cells for 3 days. Followed by cell sorting of GFP- cells, which represented either truly negative or latently infected cells was then performed. We were able to successfully generate C731CTatA21C virus and characterized it to a 1.2% reactivation. However, the generation of C731CTatP21C recombinant viral vector was unsuccessful and thus could not be used for comparison. Future studies should involve the characterization of TatP21 in the propensity of latency development and/ or reactivation.Item The effects of a lung cancer awareness intervention in KwaZulu-Natal (KZN): a stratified cluster based study in five representative communities=Imithelela yokungenelela ngokuqwashisa mayelana nomdlavuza wamaphaphu KwaZulu-Natali (KZN):Ucwaningo lwamaqoqo ngokohlelomikhakha emiphakathini emihlanu eqokelwe ucwaningo.(2022) Dlamini, Siyabonga Blessing.; Ginindza, Bonginkosi Mfundza.Abstract Background Lung cancer is the leading cause of cancer mortality worldwide, accounting for approximately 1.8 million cancer deaths in 2020. In South Africa, lung cancer is among the top four ranking cancers in terms of morbidity and mortality after breast, prostate, and cervical cancers. The objective of the study was, therefore, to investigate the level of awareness about lung cancer and its screening among communities in KZN, in an attempt to increase awareness of this disease across the province. Methodology A quasi-experiment study was conducted among the selected communities in KZN. In total, forty out of 879 clusters were selected, where a comparison between two cross-sectional surveys was done. An intervention employing community health workers aimed at raising awareness of lung cancer was developed, implemented and evaluated in these communities. A binary logistic regression model was used to measure the effects of the intervention. Results At baseline, approximately 59.9% (95% CI 52.0 - 67.3) of the participants had heard of lung cancer. About 5.7% (95% CI 3.9 - 8.1) were screened for lung cancer at the time. Coughing up blood was the most recognised symptom (61.0%, 95% CI 52.1 - 69.1). Post-intervention, the mean knowledge score increased to 59.9 (95% CI 53.8 – 66.0) (p<0.001). There was a reduction in the number of cigarettes smoked per day (p<0.001) and the number of packs smoked per week (p=0.026). However, the prevalence of smoking remained relatively the same before and after the intervention, at approximately 18% (p=0.958). The intervention had a statistically significant effect (aOR 4.370, 95% CI 1.477-12.928) on lung cancer knowledge in these communities (p<0.001). Conclusion The intervention in this study demonstrated the ability to raise awareness of lung cancer at a community level. It also reduced the number of cigarettes smoked among smokers. Therefore, integration into smoking cessation programmes should be explored. A national lung cancer screening programme should be introduced to encourage health-seeking behaviour. The integration of a lung cancer awareness intervention into the already existing community health worker programmes, such as the tuberculosis response strategy, is recommended. Iqoqa Isendlalelo Umdlavuza wamaphaphu ungenye yezimbangela eziphambili zokubulawa umdlavuza emhlabeni wonke jikelele. Kubantu ababulawa umdlavuza ngonyaka wezi-2020, bayi-1.8 wezigidi zabantu ababulawa umdlavuza wamaphaphu. ENingizimu Afrika umdlavuza wamaphaphu ungolunye lwezinhlobo ezine zomdlavuza ezihamba phambili eziphatha abantu futhi zibabulale emva komdlavuza webele, umdlavuza wamankwahlwa (iprostate), kanye nowesibeletho. Inhloso yalolu cwaningo kwakunguphenya ngamazinga olwazi mayelana nomdlavuza wamaphaphu kanye nokuhlolwa kwawo emiphakathini yaKwaZulu-Natali ngenjongo yokuqwashisa kabanzi ngalesi sifo esifundazweni jikelele. Indlelakwenza Kwenziwa ucwaningo oluyisingalinge emiphakathini eqokelwe ucwaningo KwaZulu-Natali. Esewonke kwakhethwa amaqoqwana angama-879 lapho kwaqhathaniswa khona amasaveyi amabili across-sectional. Kwathuthukiswa, kwasetshenziswa kwaphinda kwahlolwa ukungenelela konompilo ngenhloso yokuqwashisa ngomdlavuza wamaphaphu kule miphakathi. Kwasetshenziswa imodeli yesilinganisobudlelwane ukulinganisa imithelela yalokhu kungenelela. Imiphumela Ukusuka phansi, bangacishe babe ngama-59.9% (95% CI 52.0 - 67.3)kubabambiqhaza abake bezwa ngomdlavuza wamaphaphu. Okungenani u-5.7% (95% CI 3.9 - 8.1) wahlolwa umdlavuza wamaphaphu ngaleso sikhathi. Ukukhwehlela igazi yikhona okwakuyinkomba eyaziwayo (61.0%, 95% CI 52.1 - 69.1). Emva kokungenelela, imini yobungako bolwazi yanyukela ku-59.9% (95% CI 53.8 – 66.0) (p<0.001). Kwaba nokuncipha kwesibalo sosikilidi ababhenywa ngosuku (p<0.001) kanye namaphakethe abhenywa ngesonto (p=0.026). Kodwa-ke, ukuvama kokubhema akuzange kwehle ngaphambi kanye nasemuva kokungenelela; kwakumi ku-18% (p=0.958). Ukungenelela kwaba nomthelela omkhulu ngokwezibalomidanti (aOR 4.370, 95% CI 1.477-12.928)maqondana nolwazi ngomdlavuza wamaphaphu kule miphakathi (p<0.001). Isiphetho Ukungenelela kulolu cwaningo kwakhombisa okungenzeka uma kuqwashiswa abantu ngomdlavuza wamaphaphu ezigabeni semiphakathi. Kwaphinda kwanciphisa isibalo sikasikilidi obhenywayo kubantu ababhemayo. Ngakho-ke kumele kuhlolwe izindlela zokuhlanganiswa kwezinhlelo zokuyekiswa ukubhema. Kumele kuqaliswe ngohlelo lukazwelonke lokuhlola umdlavuza wamaphaphu kubantu ukuze kukhuthazwe umkhuba wokufuna usizo lwezempilo. Kuphakanyiswa ukuthi kuhlanganiswe ukungenelela ngokuqwashisa abantu ngomdlavuza wamaphaphu ezinhlelweni zonompilo ezikhona emiphakathini ezifana namaqhinga okuhlangabezana nesifo sofuba.Item Experience of forgiving in Indian marriages: a qualitative inquiry.(2022) Essop, Karshila.; Hlengwa, Wellington Mthokozisi.This research study concentrated on understanding the experience of forgiving in Indian marriages in Durban, KwaZulu Natal. The qualitative research study involved eight participants who were interviewed using a semi-structured interview schedule. With the consent of each participant, every interview was recorded utilising an audio recorder and then later transcribed by the researcher. The ecological systems theory was utilised as a framework for the study. The data that was obtained during the data collection period was evaluated, analysed and organised through thematic analysis. This assisted the researcher to organise data into themes, sub-themes and sub-sub-themes. The five themes that were discovered and discussed are: Understanding forgiveness, the experience of forgiving, the psycho-social influences of forgiving, dominant cultural influence and improvement of forgiveness in Indian marriages. The research study found that the participants experienced forgiving more positively than negatively. Forgiveness allowed for trust to be rebuilt in marriages and paved the way for harmony in both spousal and/or family systems. The research study found that reconciliation in Indian marriages plays a vital role and affects every participant’s family system, spousal system, psychological health and well-being. A strong correlation between forgiveness and personality was drawn indicating that personality is one of the more significant influences on forgiving. More so, social, cultural and theological influences were seen as strong motivators of forgiving in Indian marriages. Participants recommended marital counselling and face-to-face conversations about transgressions created between spouses to assist marital forgiveness in Indian marriages. Through the limitations of the research study discussed in chapter six, it is proposed that further research on the experience of forgiving in Indian marriages should be conducted.Item Immune biomarkers of pulmonary tuberculosis treatment response and disease severity among HIV-infected and uninfected individuals from Kwazulu-Natal, South Africa.(2023) Rambaran, Santhuri.; Sivro, Aida.; Naidoo, Kogieleum.Background: Tuberculosis is one of the major causes of morbidity and mortality worldwide. The COVID -19 pandemic has had a devastating impact on TB, contributing to increased incidence of both TB and drug-resistant TB. Identification of host immune biomarkers of TB risk, treatment outcome and disease severity are key to the development of more efficient diagnostics and treatment modalities. There is an urgent need for accurate and easily detectable non-sputum-based biomarkers that can correlate with the activity or burden of Mycobacterium tuberculosis. Here, we characterised soluble and cellular phenotypes during active TB and TB/HIV co-infection and assessed their associations with time to negative culture conversion and disease severity. Methods: The study was performed utilizing stored plasma and peripheral blood mononuclear cells from the Improving Retreatment Success (IMPRESS) trial. Multiplex immunoassays and ELISAs were used to evaluate 24 cytokine and chemokine expression during active TB (n=132). Flow cytometry was used to evaluate phenotypic profiles of monocytes, dendritic cells (n=90) and CD4+ T cells (n=75). A Cox proportional hazards and logistic regression models were used to assess the associations between the measured cytokines and chemokines, phenotypic profiles of monocytes, dendritic cells and CD4+ T cells and time to negative culture conversion and lung cavitation in individuals with TB and TB/HIV co-infection. Results: We identified soluble inflammatory signatures of treatment response and disease severity. IP-10 expression during active TB was associated with increased odds of sputum culture conversion by 8-weeks in the total cohort and among the HIV-infected individuals. Increased MCP-3 expression was associated with a shorter time to culture conversion in the total cohort. While among the HIV-infected individuals, higher expression of IL-1RA, IP-10 and IL-1α associated with a shorter time to culture conversion. Higher expression of IL-6 was significantly associated with shorter time to culture conversion and increased risk of lung cavitation in the overall cohort and among TB/HIV co-infected individuals. Additionally, higher IL-1RA expression was associated with the presence of lung cavitation in the total cohort and in HIV-infected individuals. We observed distinct monocyte and dendritic cell profiles in TB/HIV co-infection. Individuals with TB/HIV co-infection had a significantly higher percentage of total monocytes and dendritic cells compared to healthy controls. Increase in CCR2, CD11b and CD40 was associated with active TB while decrease in CX3CR1 and increase in CD163 was associated with HIV infection. Expression of CX3CR1 on non-classical monocytes was associated with longer time to culture conversion while expression of CD86 on intermediate monocytes was associated with presence of lung cavitation. With respect to CD4+ T cells HIV positive individuals with active TB had significantly lower percentage of CD4+ T cells and significantly higher proportion of activated CD4+ T cells compared to TB and healthy control groups. Percentage of CD4+ T cells was significantly associated with increased risk, while the percentage of activated CD4+ T cells was associated with decreased risk of lung cavitation. Integrin α4β7 expressing CD4+ T cells were increased in TB/HIV compared to TB group and was associated with longer time to TB culture conversion in co-infected individuals. Conclusion: The data from this study provides valuable insight into the role that plasma immune biomarkers, monocytes, dendritic and CD4+ T cells play in TB treatment response and disease severity in active TB and TB/HIV co-infection.Item Mapping the integration of the fields of mental health and psychosocial support with peacebuilding through co-creation.(2022) Dlamini, Noxolo Zanele.; Sliep, Yvonne.; Makhakhe, Nosipho Faith.Protracted conflict, combined with the resultant psychological scarring have been a part of present life for many societies. Historically Peace Building and MHPSS (Mental Health and Psychosocial Support) have been used to address the effects of conflict separately, yet they offer different yet complementary solutions to the problem. The purpose of this research was to explore the integration of MHPSS and PB from the viewpoint of the participants of cocreation workshops conducted in 2019 and 2021 on the same topic. A qualitative descriptive design was utilised in this study as it allowed the researcher to explore how the participants responded to the co-creation methodology used in the workshops while gaining insight into their opinions on integration. The study was conducted using documented reports and transcripts of the co-creation workshops, followed by in-depth online interviews. A thematic analysis was used, and findings show that changing funding mandates were necessary as these impact on what humanitarian work is done. Through advocacy, information sharing, and policy change, the way in which donors approach this work could be changed. Much needs to be done to capacitate those working in the field and to raise awareness of the value of linking these disciplines. Greater understanding between the two fields and knowledge of the language, theories and tools used will need to be shared. The co-creation method that was used for the present study seems to have benefitted the process of integration in the participating organisations, through reflection, information sharing, research and writing.Item Molecular epidemiology of Antibiotic-Resistant Escherichia coli from companion animals attending veterinary practices in Durban, KwaZulu-Natal, South Africa.(2023) Ntuli, Nondumiso Lungile.; Essack, Sabiha Yusuf.; Mbanga, Joshua.; Abia Akebe, Luther King.Background: Companion animals are globally documented to harbour antibiotic-resistant E. coli. This study aimed to investigate the molecular epidemiology of antibiotic-resistant E. coli from companion animals presenting at veterinary practices in Durban, KwaZulu-Natal, South Africa. Methods: E. coli were isolated on selective media from rectal swabs sampled from dogs and cats attending veterinary practices in Durban, KwaZulu-Natal, South Africa. All isolates were confirmed using real-time polymerase chain reaction (PCR) of the uidA gene. Antibiotic susceptibility testing was done against 20 antibiotics using the Kirby-Bauer disk diffusion method. Selected antibiotic-resistance genes (ARGs) that confer resistance to third-generation cephalosporins (blaTEM, blaSHV, and blaCTX-M), tetracycline (tetA, and tetB), and tigecycline (tetX/X2, tetX3, and tetX4), were detected using conventional PCR. PCR amplicons were confirmed by DNA sequencing and bioinformatics analysis. Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) was carried out to determine the clonality of E. coli (101) isolates that showed resistance to at least one antibiotic. Results: A total of 330 E. coli isolates from dogs (234) and cats (96) formed the study sample. Overall resistance was high in tetracycline (24.2%), ampicillin (18.8%), trimethoprim-sulfamethoxazole (14%), cephalexin (11.2%) and nalidixic acid (9.7%). Whilst lower resistance was observed in amikacin (0.3%), ceftazidime (0.3%), and piperacillin-tazobactam (0.6%). Third-generation cephalosporin-resistant E. coli retrieved from cats (26%) was more prevalent compared to dogs (9.8%). E. coli from dogs (2.1%) and cats (2%) were resistant to forth-generational cephalosporins. E. coli (3%) retrieved from dogs was resistant to tigecycline, which is regarded as a medically important antimicrobial (MIA) in human medicine. No resistance was observed against carbapenems. Thirty-five (10.6%) E. coli were multidrug-resistant (MDR) and exhibited twenty-two different phenotypic patterns. Amongst the E. coli that were not susceptible to third-generation cephalosporin, and tetracycline, it was observed that the blaCTX-M-15 (8%), and tetA (24%) were the most prevalent resistance genes. Thirty-one (9.3%) isolates were non-susceptible to third-generation cephalosporins and had the corresponding extended-spectrum beta-lactamase (ESBL) genes. The blaCTX-M-15 type gene was prevalent in all 25 E. coli isolates that tested positive for the blaCTX-M. The blaTEM-1 (17) was the second most prevalent β-lactamase gene. A total of 80/330 (24%) isolates were phenotypically not susceptible to tetracycline and carried either one, or both of tetA and tetB resistance genes. Only one tetracycline-resistant E. coli isolate did not harbour either tetA, or tetB genes. The blaSHV, tetX/X2, tetX3, and tetX4 were not detected in all the isolates. Using a 75% similarity cut-off, forty-eight clusters with isolates from both dogs and cats were identified. The ERIC-PCR types depicted a variety of clusters within veterinary practices in Durban, indicating that a high diversity of E. coli is in circulation in Durban, South Africa. Conclusion: Companion animals are reservoirs of antibiotic-resistant E. coli and ARGs. However, there was no evidence of transmission of antibiotic-resistant E. coli in Durban, South Africa. Resistance of E. coli from companion animals to MIA for humans is of particular concern and requires measures to control the spread of antibiotic-resistant bacteria, and ARGs between companion animals, veterinary practice personnel, and owners.Item Pneumatization of the temporal bone, its petromastoid part and related vasculature in a South African population from early childhood to early adulthood: an anatomical and radiological study.(2023) Aladeyelu, Okikioluwa Stephen.; Rennie, Carmen Olivia.; Sibiya, Lindokuhle Andile.; Mbatha, Wonder-boy Eumane.Introduction: The pneumatization of the temporal bone is important in various clinical settings. These include serving as a prognostic factor in middle ear surgeries and acting as a shock absorber in patients sustaining lateral skull trauma. The size and growth rate of its air cell system have been associated with middle-ear pathology. The degree of temporal bone pneumatization is highly relevant when planning temporal bone-related surgeries and has been hypothesized to influence anatomical variations of temporal bone-related vessels. This study aimed to investigate the size of temporal bone pneumatization (air cell volume) with age, the association between temporal bone pneumatization and the morphologies of some temporal bone-related vessels, as well as their morphometrical relationship with ear regions, and to propose a simple and concise classification of the degree of temporal bone pneumatization using reference structures and landmarks. Materials and Methods: A retrospective review of 496 temporal bone computed tomography (CT) images of 248 head and neck/brain CTs of patients from public hospitals in KwaZulu-Natal, South Africa, was conducted. The sample consisted of 133 males and 115 females, 0 to 35 years old (median age 13.0 years) of three population groups (202 South African Black, 28 South African Indian, and 18 South African White). The age range of 0 to 35 years was further divided as follows: 0-2 (infant); 3-5 (young child); 6-9 (middle child); 10-14 (early adolescent); 15-18 (middle adolescent); 19-25 (young adult stage I); 26-35 (young adult stage II). High-resolution CT images with fine slices of ≤ 0.625 mm were analyzed using IntelliSpace Portal (ISP) Version 11.1 viewer software. The volume of temporal bone pneumatization was achieved using three dimensional (3D) volumetric rendering technique. At the same time, the morphologies of the sigmoid sinus, jugular bulb, and internal carotid artery and their morphometrical relationships with ear regions were analyzed using the measuring tools on the ISP. Additionally, an inter-observer assessment was conducted among otologists to classify the degree of temporal bone pneumatization utilizing temporal bone CT images at two levels (landmarks): the malleoincudal junction and the lateral semicircular canal using sigmoid sinus as a reference. Results: Size (volume) of temporal bone pneumatization with age: The volume of temporal bone pneumatization increased significantly (p<0.001) with age up to the adult stage I (19-25 years), followed by a significant decline in young adult stage II (26-35 years). Females showed a significant early increase compared to males. Regarding population groups, Black South Africans (SA) showed a higher increase in volume with age than the SA Whites and Indian population groups. Influence of pneumatization on temporal bone-related vessels: Four degrees of pneumatization (hypo, moderate, good, and hyper) were analyzed. Hyper-pneumatization was observed to be more common. Vascular variants such as high jugular bulb, jugular bulb dehiscence, and internal carotid artery dehiscence were observed and significantly associated (p<0.01) with hyper-pneumatization. Also, as pneumatization increases, sigmoid sinus and jugular bulb distances to ear regions were observed to increase significantly (p<0.01, p<0.05). The sigmoid sinus and its variant shapes were also observed but were not significantly associated with the degrees of pneumatization (right- p=0.070; left- p= 0.645). Classification of degree of pneumatization: In the survey conducted among cohort otologists, the percentage of participants that correctly rated temporal bone CT images taken at the level of lateral semicircular canal according to their respective degrees of pneumatization was significantly higher (p < 0.05) regardless of their year of experience compared to those that correctly rated corresponding images taken at the level of malleoincudal junction. A 76% positivity in their agreement with the use of sigmoid sinus in evaluating mastoid pneumatization was observed. Discussion and Conclusion: This study concludes that the pneumatization of a healthy temporal bone is expected to show a significant linear increase from infant up until at least the early adult stage I (19-25 years) in the South African population. The high incidence of high JB, JB dehiscence, and internal carotid artery dehiscence, and the increase in distances of sigmoid sinus and JB to ear regions reported in this study population due to increased pneumatization validates temporal bone pneumatization as a factor that influences jugular bulb variants and internal carotid artery dehiscence as well as the distances of sigmoid sinus and jugular bulb to ear regions. The study also concludes that using the lateral semicircular canal as a landmark on axial CT, and evaluating air cells around the sigmoid sinus was suitable in classifying the degree of temporal bone pneumatization into hypo-, moderate, good, and hyper-pneumatization. This study proposes this classification system as an easier and quicker method for clinical applications. Iqoqa Isingeniso: Izikhala zomoya ezisethanjeni elaziwa ngetemporal bone zibalulekile kwezokwelapha ezihlukahlukene. Lokhu kubandakanya ukuba usizo kwalezi zikhala lapho kuhlinzwa indlebe futhi zinciphisa umonakalo odalekayo lapho umuntu eshaywa yinto ethile ekhanda. Ubukhulu nezinga lokukhula kwamangqamuzana omoya kuye kwahlotshaniswa nesifo sendlebe. Ubungako bezikhala zomoya ethanjeni itemporal bone kubaluleke kakhulu lapho kuhlelwa ukuhlinza okuzothinta leli thambo futhi kucatshangwa ukuthi kunomthelela oshintshweni oluba semithanjeni yegazi esondelene naleli thambo. Lolu cwaningo luhlose ukuthola ukuthi zinkulu kangakanani izikhala zomoya ezisethanjeni itemporal bone (umthamo wamangqamuzana omoya) kuye ngobudala bomuntu, ukuthola ukuhlobana phakathi kwezikhala zomoya ezisethanjeni itemporal bone noshintsho oluba khona emithanjeni yegazi esondelene naleli thambo, ukuthola indlela ubukhulu nokuma kwalezi zinto okuchaphazela ngayo ezinye izindawo eziseduze kwendlebe, kanye nokwenza iziphakamiso ezilula nokunikeza incazelo efingqiwe yokuthi zingakanani ubukhulu izikhala zomoya ethanjeni itemporal bone, kusetshenziswa izingxenye okuzobhekiselwa kuzo. Okuzosetshenziswa Nezinqubo: Kwacutshungulwa izithombe ezingama-496 zetemporal bone ezithwetshulwe ngomshini owaziwa ngecomputed tomography (CT) zamakhanda nezintamo/nobuchopho okungama-248 eziguli zasezibhedlela zikahulumeni KwaZulu-Natali, eNingizimu Afrika. Isampula lalihlanganisa abesilisa abayi-133 nabesifazane abayi-115, abaneminyaka esukela e-0 kuya kwengama-35 ubudala (iminyaka emaphakathi eyi-13.0) bezinhlanga ezintathu (abaNsundu baseNingizimu Afrika abangama-202, amaNdiya aseNingizimu Afrika angama-28, naBelungu baseNingizimu Afrika abayi-18). Iminyaka yobudala esukela e-0 kuya kuma-35 yaphinde yahlukaniswa ngale ndlela elandelayo: 0-2 (usana); 3-5 (ujahidada); 6-9 (ingane encane); 10-14 (ingane esizothomba noma esithomba); 15-18 (intsha); 19-25 (isigaba sokuqala sabantu abadala); 26-35 (isigaba sesibili sabantu abadala). Kwacutshungulwa izithombe ze-CT ezigqamile eziwugqinsana oluncane luka-≤ 0.625 mm kusetshenziswa uhlelo lwekhompyutha okuthiwa yi-IntelliSpace Portal (ISP) Version 11.1. Umthamo womoya osethanjeni itemporal bone watholakala ngokusetshenziswa kwendlela yokuhlola umthamo engumumo onxantathu, othree dimensional (3D). Ngesikhathi esifanayo, kwacutshungulwa ukwakheka kwesigmoid sinus, ijugular bulb, nomthambo i-internal carotid kanye nokuhlobana kwalezi zinto nezingxenye eziseduze kwendlebe kusetshenziswa amathuluzi okukala e-ISP, okuwuhlelo lwekhompuyutha. Ukwenezela kulokho, kwaqoqwa umbiko walokho okuphawulwe odokotela bezifo zendlebe ukuze kukalwe ubukhulu bezikhala zomoya ethanjeni itemporal bone kusetshenziswa izithombe ze-CT zethambo itemporal bone ezindaweni ezimbili: imalleoincudal junction kanye nelateral semicircular canal kusetshenziswa isigmoid sinus njengesibonelo. Imiphumela: Usayizi (umthamo) wezikhala zomoya ezisethanjeni itemporal bone kuya ngobudala bomuntu: Umthamo wezikhala zomoya ezisethanjeni itemporal bone ukhuphuka kakhulu (p<0.001) njengoba umuntu ekhula kuze kufike esigabeni sokuqala sabantu abadala (iminyaka eyi-19-25), bese wehla ngokuphawulekayo kubantu abadala besigaba sesibili (abaneminyaka engama-26-35). Kwabesifazane kwaphawulwa ukuthi ushesha kakhulu ukukhuphuka uma kuqhathaniswa nabesilisa. Ngokuphathelene nezinhlanga, kubantu abaNsundu base-South Africa (SA), umthamo unyuka kakhulu njengoba bekhula uma kuqhathaniswa naBelungu namaNdiya ase-SA. Umthelela wokwakheka kwezikhala zomoya emithanjeni yegazi ehlobene nethambo itemporal bone: Kwacutshungulwa amazinga amane obukhulu bezikhala zomoya (eliphansi, elilingene, elikahle neliphakeme). Ukwakheka kwezikhala zomoya ngezinga eliphakeme kwabonakala kuvame kakhulu. Kwaphawuleka izinkinga ezihlukahlukene zemithambo yegazi ezifana nenkinga yomthambo osuka ekhanda wehlele entanyeni obizwa ngehigh jugular bulb, inkinga yomthambo odlula engxenyeni engaphakathi yendlebe, ebizwa ngejugular bulb dehiscence, kanye nenkinga yomthambo omkhulu oyisa igazi ebuchosheni ebizwa nge-internal carotid artery dehiscence futhi lezi zinkinga zahlotshaniswa kakhulu (p<0.01) nokwakheka ngamandla kwezikhala zomoya. Kanti futhi njengoba zikhula izikhala zomoya, kwaphawuleka ukuthi ukuqhelelana phakathi kwesigmoid sinus nejugular bulb kanye nezindawo ezakhelene nendlebe nako kukhula ngokuphawulekayo (p<0.01, p<0.05). Kwaphawuleka nesikhala somoya okuthiwa yisigmoid sinus nezindlela ezihlukahlukene esakheke ngazo kodwa lokhu akuzange kuhlotshaniswe kakhulu nobukhulu bezikhala zomoya (kwesokudla- p= 0.070; kwesobunxele- p= 0.645). Ukuhlukaniswa ngezigaba kwamazinga ezikhala zomoya ezisemathanjeni: Kunhlolovo eyenziwa eqenjini lochwepheshe bezifo zendlebe, kulabo ababamba iqhaza ayephakeme kakhulu amaphesenti abanikeza isilinganiso esinembile sobukhulu bezikhala zomoya lapho behlola izithombe ze-CT zethambo itemporal bone ezathwetshulwa maqondana nengxenye engaphakathi yendlebe ebizwa ngokuthi yilateral semicircular canal (p <0.05), noma ngabe base bechithe isikhathi esingakanani bekulo mkhakha uma kuqhathaniswa nalabo ababekale kahle izithombe ezihambisanayo ezithathwe maqondana nemalleoincudal junction. Kwaphawuleka ukuthi abangamaphesenti angama-76 bavumelana nokuba kusetshenziswe isikhala somoya okuthiwa yisigmoid sinus lapho kuhlolwa isikhala somoya esisethanjeni imastoid. Ingxoxo nesiphetho: Lolu cwaningo luphetha ngokuthi izikhala zomoya ezisethanjeni eliphile kahle itemporal bone kulindeleke ukuba zikhule ngokuphawulekayo kusukela lapho umuntu eselusana kuze kufike okungenani esigabeni sokuqala sabantu abadala (iminyaka eyi-19-25) kubantu baseNingizimu Afrika. Amazinga aphakeme ezinkinga zemithambo yegazi njengenkinga okuthiwa yi-JB, inkinga ebizwa nge-JB dehiscence nenkinga ebizwa nge-internal carotid artery dehiscence kanye nokukhula kwezikhala ezihlukanise isigmoid sinus nejugular bulb nezingxenye ezisendlebeni ezibikiwe kubantu abahlolwe kulolu cwaningo ngenxa yokukhula kwezikhala zomoya emathanjeni kuqinisekisa ukuthi izikhala zomoya ezisethanjeni itemporal bone zinomthelela ekudalekeni kwezinkinga zemithambo yegazi ezihlukahlukene okuyijugular bulb ne-internal carotid artery dehiscence kuhlanganise nebanga eliphakathi kwesigmoid sinus nejugular bulb kanye nezinye izindawo esisendlebeni. Lolu cwaningo lufinyelele nesiphetho sokuthi ukusebenzisa ilateral semicircular canal lapho kwenziwa i-CT scan, nokuhlola amangqamuzana omoya ezindaweni eziseduze nesigmoid sinus kuyafaneleka lapho kubekwa ngezigaba ubukhulu bezikhala zomoya ezisethanjeni itemporal bone ngokwamazinga amane; izinga eliphansi, elilingene, elihle neliphakeme kakhulu lokwakheka kwezikhala zomoya. Lolu cwaningo luphakamisa ukuba kusetshenziswe le nqubo njengendlela elula nesheshayo kwezokwelapha.Item The development and feasibility of a community mental health education and detection (CMED) tool in the Amajuba District, KwaZulu-Natal, South Africa.(2022) Grant, Merridy.; Petersen, Inge.; Luvuno, Zamasomi.Background Poor mental health literacy, misinformation about treatment and stigma result in low demand for mental health services in low-and middle-income countries. Community-based interventions that raise mental health awareness and facilitate detection of mental health conditions, are instrumental in increasing demand of available mental health services. The CMED tool was developed to provide psychoeducation on mental health conditions and identify people with potential mental health problems at a household level who may benefit from available mental health interventions. Aims/Objectives Objectives of the study were 1) To develop the CMED Tool for adults for use by Ward-based Primary Health Care Outreach Teams (WBPHCOTs) in South Africa aligned with their roles of health promotion, screening and linkage to care; 2) To assess the accuracy of the CMED in identifying patients with a mental health problem and 3) to assess the feasibility of the CMED for use by WBPHCOTs and community members. Methods The research was made up of three sub-studies 1) Formative study, 2) an Accuracy study 3) and a Feasibility study. The Formative study (Objective 1) involved engagement with the KwaZulu-Natal Department of Health (KZN DoH) to ensure co-creation of the CMED tool and alignment with routine WBPHCOT activities; adaptation of the CMED tool; review of the CMED vignettes and illustrations by a panel of local and international mental health care experts to establish contextual and cultural relevance; and process mapping and focus group discussions with WBPHCOTs in one district to establish cultural and contextual appropriateness as well as coherence and compatibility with existing community-based services. The Accuracy study (Objective 2) involved assessing the accuracy of the newly developed CMED against the validated Brief Mental Health screening tool as the gold standard in identifying individuals in households with possible mental health conditions at a community level. The Feasibility study (Objective 3) was assessed using Bowen et al.’s (2009) framework which informed the study design, interview tools and analysis. The feasibility study involved four phases: (1) observations of the CMED consultation to evaluate the administration of the tool; (2) semi-structured interviews with household member/s after the CMED was administered to explore experiences of the visit; (3) follow-up interviews of household members referred using the CMED tool to assess uptake of referrals; (4) and weekly focus group discussions with the community health team to explore experiences of using the tool. Framework analysis was used to inform a priori themes and allow inductive themes to emerge from the data. Results The formative study resulted in a co-produced CMED tool consisting of five case vignettes and related illustrations to facilitate psychoeducation and detection of possible depression, anxiety, psychosis, harmful alcohol and drug use by WBPHCOTs. The tool was found to be culturally and contextually appropriate and aligned to the services provided by WBPHCOTs. The accuracy study found the CMED to perform at an acceptable level having a 79% sensitivity and 67% specificity. The feasibility study found the CMED to be acceptable to both community health teams and household members, demand for the tool was evident, implementation, practicality and integration within the existing health system were also indicated. Conclusion Collectively, the formative, accuracy and feasibility studies that make up this thesis, provide a valid and feasible tool that enables community health workers to perform their functions at a household level of health promotion, screening and linkage to care in relation to mental health. It enables mental health to be practically integrated at a community level as part of primary health care services through a people-centered, task sharing approach. This approach is aligned to international guidelines (Sustainable Development Goals) and National policy (South African Mental Health Act and the National Mental Health Framework and Strategic Plan) which call for the integration of mental health into primary health care), as well as the South African District Health System model through the PHC re-engineering strategy and the community-oriented primary care model where care extends from primary health care facilities into the community.Item Type I, II, and III interferon responses in the female genital tract.(2024) Ngubane, Slindile Brilliant Lyzeth.; Sivro, Aida.Abstract available in PDF.Item Waist circumference, waist-to height ratio, or body mass index: which is the better predictor of hypertension in patients living with diabetes mellitus in low-to-middle-income countries?(2022) Konar, Kylie Divashnee.; Pillay, Somasundram.Background Hypertension (HPT) in low and middle-income countries (LMICs) remains a leading preventable factor for death and disability. Approximately 20-60% of patients living with diabetes (PLWD) have HPT which doubles the mortality risk and accelerates the progression of complications. Obesity is a well-known preventable risk factor for HPT. Despite this, countries in Sub-Saharan Africa (SSA) faces an increasing challenge of obesity. Current evidence on anthropometric indices as a predictor for HPT in PLWD remain unclear. Methods A scoping review was performed to determine the association between anthropometry and HPT in PLWD in LMICs in SSA, by using PubMed, Google, Scopus and Cochrane between 2011- 2021. A total of 4590 records were identified. The associations between body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WTHR) in PLWD and HPT in LMICs in SSA were assessed. Results We analyzed 21 studies with 11 057 patients included in this review. BMI was the most common anthropometric index used with more than 80% of studies suggesting a positive association with HPT. Varying associations between other anthropometric indices and HPT were found. Conclusions Our scoping review highlighted a positive association between HPT and anthropometry in most studies. Limited data was available comparing the different anthropometric indices. We found that additional studies are warranted to evaluate anthropometric indices in PLWD.Item Zulu cultural perspectives and experiences of mental health and occupational therapy in KwaZulu Natal, South Africa.(2022) Moonsamy, Ashira.; Lingah, Thanalutchmy.; Gurayah, Thavanesi.Background: Healthcare systems are formulated utilising worldviews, specifically in mental health, where norms are created dictating what is normal versus abnormal. The era of coloniality promoted western dogma over collectivist cultures. Occupational therapy practice must consider the client’s context during assessment and intervention for the process to be client centred. Methods: A qualitative descriptive design was utilised. Purposive sampling was used to recruit 10 participants. Data was collected through semi-structured interviews. Analysis was guided by utilising Braun and Clark’s six phases of thematic analysis. Findings: Three themes emerged from the data, personal perceptions, cultural perceptions, and health-seeking behaviour. Sub-themes accompanied each. Personal perceptions explored how Zulu people made sense of mental illness or related behaviours through a modern or traditional lens. It also explored the importance of the strength of the Zulu individual. A dissonance occurs when faced with cultural norms and personal needs. Finally, their perspectives were altered through their experience with mental illness. Cultural perceptions were that problems were solved internally in families or communities, and progress was promoted as necessary for the Zulu individual. It also explored spiritual beliefs regarding mental illness, which could range between God, Ancestors or both and could be causal factors or healing mechanisms. Suicidality is seen as a weakness in the culture, and stigma was attached to mental illness. The final theme concerns the experience of the Zulu mental health care user dealing with their mental illness. Cognitive dissonance is prevalent in all three aspects not merely due to the difference between westernised mental health treatment and traditional healing systems but also due to the value found in each. The method of sharing vulnerability or issues with an individual outside the family contradicts cultural norms. However, participants expressed that being understood in group discussions and sharing vulnerability significantly improved their healing. Conclusion: Zulu individuals create their sense of self in an interdependent manner. The family and community are intertwined in their participation, reputation, and healing. There is an emphasis on strength and the following of norms in the Zulu culture, perpetuated by the importance of consulting elders or close family when faced with conflict. Disregarding these norms can outcast the Zulu individual who thrives on being included in the community. The study was conducted with a limited sample size and in an urban area. Further research within rural communities and diverse facilities would be beneficial. Occupational therapists working in communities such as KwaZulu Natal should understand the causal factors of mental illness for the Zulu mental health care user and their personal beliefs around healing when designing an intervention.