ABSTRACT Cystic fibrosis (CF) is an autosomal recessive disorder that occurs in all ethnic groups. Mutations in the cystic fibrosis transmembrane regulator (CFTR) gene are responsible for pulmonary obstruction, chronic lung infections, pancreatic insufficiency, meconium ileus, failure to thrive and infertility. Genetic testing for CF at the DNA level is available. A diagnosis of CF in an individual has implications for other family members and so genetic counselling should form part of CF management. Genetic counselling has been offered by the Clinical Unit of the Division of Human Genetics, National Health Laboratory Service and the University of the Witwatersrand, Johannesburg, for many years. At the beginning of 2006, genetic services were introduced into the CF Clinics of Johannesburg Hospital by way of specialist Genetic Counselling Clinics. The study aimed to determine who utilises the CF genetic counselling services and why, to estimate the number of at-risk relatives per family, and how many of them had mutation testing and genetic counselling. Finally, the study explored what impact the specialist Genetic Counselling Clinics had on the overall service of genetic counselling. The files of 153 families seen for CF genetic counselling from 1990 to 2006 were analysed. The majority of counsellees (93%) were white. Most counsellees were parents of CF probands (35%). Relatives with carrier risks of 67% (siblings) and 50% formed only 7% and 6% of all counsellees respectively. Most individuals attended genetic counselling in order to gather information. On average, 5.9 ± 3.45 families were seen for CF genetic counselling per year from 1990 to 2005, whereas in 2006, 58 families were seen. Paediatrician, physician and nurse referrals increased notably during 2006 compared to prior years. In 140 unrelated CF-affected families, 1991 at-risk relatives, with carrier risks above 25%, were identified. Only 11% of these relatives had mutation testing and only 8% attended genetic counselling. Uptake of genetic counselling is greater when the service is integrated into CF treatment clinics than when it is offered externally. The low uptake of mutation testing and genetic counselling by at-risk relatives suggests that new methods of educating individuals for cascade screening and testing are required.

MSc (Med), Faculty of Health Sciences, University of the Witwatersrand, 2008

A research report submitted to the School of Public Health, University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Public Health. June 2018. / Introduction Southern Africa forms the epicentre of the HIV epidemic and young people commonly get diagnosed long after infection. Despite the evidence that HIV Counselling and Testing (HCT) can reduce risky sexual behaviors and prevent HIV, uptake of testing in young people remains limited and this is especially true in Southern Africa. In the last few years, effective interventions for HIV prevention have been implemented, including treatment as prevention and pre-exposure prophylaxis. In the context of very high prevalence of HIV among young people in Southern Africa, it is critical that countries attain higher levels of HCT. Demand creation is one of the means to increase uptake of HCT. This study investigated the relationship between exposure to a mass media campaign and uptake of HIV counselling and testing among young people in five countries of Southern Africa (Lesotho, Mozambique, South Africa, Swaziland and Zambia) for the period 2008 to 2012. A secondary data analysis from a multi-country study was undertaken. Methods: Secondary data on young people aged 15-24 years from a post-only cross-sectional observational multi-country study that was undertaken in 2012 to evaluate the One Love Campaign, a regional behavior change media campaign coordinated by Soul City Institute for Development Communication was undertaken. The exposure variable was exposure to One Love campaign (in the form of television film series; locally produced radio drama series, television public service announcements and a television series in South Africa. In other participating countries the programme also comprised talk shows broadcast by national- and community broadcasters; booklets, billboards used to trigger discussion during community dialogues and community outreach events) with the outcome of interest being HIV testing, with a number of covariates such as socio-demographic characteristics (e.g age, education level, nationality, sex, marital status, socio-economic status (defined as wealth quintile), whether respondent had children or not, and country of residence. Bivariate and multivariate analysis was conducted to establish the relationship between exposure to One Love campaign and HIV testing among the study population. Results: A total of eight-thousand-six-hundred and thirteen young people (n=8613) participated in the study. There was nearly equal distribution of respondents between those that had had an HIV test (52.0%) and those that had not (48.0%). Exposure to One Love through multiple media, was positively associated with HIV testing (aOR=2.34, 95% CI 1.94-2.81), and there was a dose response. Other factors associated with having an HIV test included being female (aOR= 1.95, 95% CI 1.75 - 2.18); having living child (aOR=4.23, 95% CI 3.57-5.01); being the aged 18-20 years (aOR=2.24, 95% CI 1.95 - 2.58) or group 20-24 years (aOR=4.14, 95% CI 3.57 - 4.81) and having secondary or tertiary education ( aOR= 2.67, 95% CI 1.92 - 3.68). Increased wealth until quintile 4 was negatively associated with having an HIV test, (aOR= 0.93, 95% CI 0.77 - 1.12). Conclusion: Overall the findings of this study show that exposure to more than one medium in the campaign has greater odds of testing. The results of this study provide important information on the relationship between exposure to a media campaign and HIV testing among young people. Social and behaviour change communication strategies that use multi-media are necessary to achieve improved HIV testing among young people. / LG2018

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