Remco P H Peters

Foundation for Professional Development - University of Pretoria - Maastricht University Medical Centre · Clinical Research

This study aimed examin the factors associated with the uptake and non-acceptance of COVID-19 vaccine booster doses among healthcare workers (HCWs) in South Africa. We used a mixed-methods design with data from a web-based self-administered survey followed by semi-structured in-depth interviews (IDIs) with selected participants. Of the 6235 HCWs in...

Background There is a paucity of Neisseria gonorrhoeae antimicrobial resistance data from resource-constrained settings due to the lack of diagnostic testing and limited scale of surveillance programs. This study aimed to determine the antimicrobial resistance profile of N. gonorrhoeae in the rural Eastern Cape province of South Africa. Methods Sp...

Therapeutic options for Neisseria gonorrhoeae are limited due to emerging global resistance. New agents and treatment options to treat patients with susceptible and multi-extensively drug-resistant N. gonorrhoeae is a high priority. This study used an in vitro approach to explore the antimicrobial potential, as well as synergistic effects of Medici...

South Africa has a large burden of bacterial sexually transmitted infections (STIs) with high rates among men who have sex with men (MSM). Randomised controlled trials have recently demonstrated high effectiveness of doxycycline post-exposure prophylaxis (PEP) for prevention of bacterial STIs in MSM, with 70% – 85% reductions in Chlamydia trachomat...

In South Africa, HIV prevalence for gay, bisexual, and men who have sex with men (GBMSM) is as high as 49.5%, yet only 25.7% are taking treatment, resulting in transmission risk between partners and the need for dyadic interventions for men in relationships. Through our preliminary research, we identified the evidence-based intervention Healthy Rel...

Background Studies have shown that healthcare workers (HCWs) are considered trusted sources of coronavirus disease 2019 (COVID-19) information in their communities, ideally placing them as effective vaccine advocates. However, limited data exist on the role of HCWs in the promotion of vaccines, and whether they feel adequately equipped to fulfil th...

Background Studies have shown that healthcare workers (HCWs) are considered trusted sources of coronavirus disease 2019 (COVID-19) information in their communities, ideally placing them as effective vaccine advocates. However, limited data exist on the role of HCWs in the promotion of vaccines, and whether they feel adequately equipped to fulfil th...

BACKGROUND Transgender women have few interventions to support their HIV prevention and treatment outcomes in South Africa. Further, increased focus should be on intervention development that will reduce HIV transmission within HIV-discordant partnerships, especially for transgender women who navigate gender, sexuality, and relationship stigma as w...

Accurate and user-friendly rapid point-of-care diagnostic tests (POCT) are needed to optimize treatment of Neisseria gonorrhoeae, especially in low-resource settings where syndromic management is the standard of care for sexually transmitted infections. This study aimed to assess the acceptability and usability of a novel lateral flow assay and por...

Background: Vulvovaginal yeast infections in pregnancy are common and can cause extensive inflammation, which could contribute to adverse pregnancy outcomes. Symptomatic yeast infections are likely to cause more inflammation than asymptomatic. The objective of this study was to investigate associations between symptomatic and asymptomatic vulvovag...

In Mycobacterium tuberculosis, bedaquiline and clofazimine resistance occurs primarily through Rv0678 variants, a gene encoding a repressor protein that regulates mmpS5/mmpL5 efflux pump gene expression. Despite the shared effect of both drugs on efflux, little else is known about other pathways affected. We hypothesized that in vitro generation of...

Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts , vaccine uptake among HCWs has been slow, with several studies...

To the Editor —We would like to congratulate Asare et al [1] on their analysis of the outcomes of point-of-care testing for sexually transmitted infections (STIs) among women in South Africa during a human immunodeficiency virus (HIV) vaccine trial. They found that, in 1 clinic, 92% of women with a positive test result for Chlamydia trachomatis or...

[This corrects the article DOI: 10.4102/sajhivmed.v23i1.1450.].

This study aims to assess the potential association of MBL2 gene single nucleotide polymorphisms (SNPs) to Chlamydia trachomatis infection. We analysed a selected sample of 492 DNA and serum specimens from Dutch Caucasian women. Women were categorized into four groups of infection status based on the results of DNA and antibody tests for C. trachom...

Background Vaginal discharge syndrome (VDS) is a common condition. Clinical management targets sexually transmitted infections (STIs) and bacterial vaginosis (BV); there is limited focus on Candida infection as cause of VDS. Lack of Candida treatment coverage and, if present, antifungal resistance may result in VDS treatment failure. This study aim...

Objectives: Globally, there have been significant changes in utilisation of STI testing and treatment services during the period of the COVID-19 pandemic. The impact of COVID-19 in countries that use syndromic STI management is not documented. This study used routine STI surveillance data to evaluate the impact of COVID-19 on utilisation of STI sy...

Background Sexually transmitted infections (STIs) during pregnancy are associated with adverse birth outcomes, including preterm birth, low birth weight, perinatal death, and congenital infections such as increased mother-to-child HIV transmission. Prevalence of STIs among pregnant women in South Africa remains high, with most women being asymptoma...

Background Sexually transmitted infections (STIs) during pregnancy may increase the risk of adverse pregnancy outcomes. STI syndromic management is standard of care in South Africa but has its limitations. We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy and birth outcomes. Methods We combined d...

BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment (ART) adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. As a result, there is high HIV transmission within HIV-discordant partnerships: but an existi...

Background: Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. As a result, there is a high HIV transmission risk within HIV-discordant partnerships, but an exi...

Chronic obstructive pulmonary disease (COPD) is characterised by the occurrence of exacerbations triggered by infections. The aim of this study was to determine the composition of the lung microbiome and lung virome in patients with COPD in an African setting and to compare their composition between the stable and exacerbated states. Twenty-four ad...

Background. Reports have emerged globally of antimicrobial resistance (AMR) in Neisseria gonorrhoeae and Mycoplasma genitalium infections. In South Africa (SA), there are substantial differences between private and public healthcare with regard to antimicrobial drug prescribing practice, which could affect AMR patterns of private and public healthc...

Background The vaginal microbiota (VMB) are the set of microorganisms residing in the human vagina. During pregnancy, their composition is Lactobacillus -dominant in most Caucasian women. Previous studies suggest that the VMB of women with African ancestry is more likely to be non- Lactobacillus dominant (dysbiotic) compared to other populations, a...

Background Targeted metagenomics and IS-Pro method are two of the many methods that have been used to study the microbiome. The two methods target different regions of the 16 S rRNA gene. The aim of this study was to compare targeted metagenomics and IS-Pro methods for the ability to discern the microbial composition of the lung microbiome of COPD...

Background HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-...

Background The vaginal microbiome and genital tract inflammation play an important role in HIV transmission and birth outcomes in South Africa. Intravaginal practices (IVPs) such as cleansing may influence the microbiome and levels of inflammation. IVPs are commonly practiced by women in South Africa, however, studies generally only include collect...

Background The coronavirus (COVID-19) pandemic has severely impacted healthcare service delivery, including pre-exposure prophylaxis (PrEP) worldwide. COVID-19 may increase the vulnerability of adolescent girls and young women (AGYW). We investigated the impact of COVID-19 on HIV, STIs and pregnancy in a community-based PrEP programme for AGYW in S...

Background The coronavirus disease-2019 (COVID-19) pandemic has severely impacted South Africa. Healthcare service provision and utilisation have been affected by socio-economic factors, reduced mobility, and reprioritisation as well as interruption of services. The impact of the COVID-19 pandemic on STI services is unclear. Methods In this non-ra...

Background: There is a lack of research on technical assistance (TA) interventions in low- and middle-income countries. Variation in local contexts requires tailor-made approaches to TA that are structured and replicable across intervention sites whilst retaining the flexibility to adapt to local contexts. We developed a systematic process of TA u...

Provision of high-quality care and ensuring retention of children on antiretroviral therapy (ART) are essential to reduce human immunodeficiency virus (HIV)-associated morbidity and mortality. Virological non-suppression (≥1000 viral copies/ml) is an indication of suboptimal HIV care and support. This retrospective cohort study included ART-naïve c...

Introduction Facility‐based HIV testing services (HTS) have been less acceptable and accessible by adolescents, men and key populations in South Africa. Community‐based HIV counselling and testing (CBCT) modalities, including mobile unit and home‐based testing, have been proposed to decrease barriers to HIV testing uptake. CBCT modalities and appro...

We conducted an observational study of lymphogranuloma venereum (LGV) biovar Chlamydia trachomatis infection in HIV-infected women in South Africa. The LGV biovar was detected in vaginal specimens of 17 (20%) of 85 women with C. trachomatis infection; 29% were symptomatic. All cases were negative for the LGV biovar after single-dose azithromycin.

Background: Sexually transmitted infections (STIs) can be transmitted from mother to neonate. We determined the frequency of mother-to-child transmission (MTCT) of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis to the newborn nasopharynx. Methods: This study was nested in a cohort study of etiologic testing versus syndromic...

Background: Previous studies have described the association between dysbiosis of the vaginal microbiota (VMB) and related dysbiotic conditions, such as bacterial vaginosis (BV) and aerobic vaginitis (AV), and various adverse pregnancy outcomes. There is limited overview of this association from countries in sub-Saharan Africa (SSA), which bear a di...

https://theconversation.com/drug-resistant-gonorrhoea-is-a-growing-threat-a-south-african-case-study-148012

Objective: STIs during pregnancy increase adverse pregnancy and birth outcomes and may increase HIV risk. STI syndromic management is standard of care in South Africa. Our study evaluated the prevalence and incidence of STIs in pregnant women and the associated risk factors. Methods: We combined data from two prospective observational studies of...

Objectives. Neisseria gonorrhoeae antimicrobial drug resistance has emerged worldwide, however, the situation in Sub-Saharan Africa is not well-documented. We investigated the molecular epidemiology and occurrence of antimicrobial resistance in Neisseria gonorrhoeae infections in two core transmission groups of men in Johannesburg, South Africa. Me...

Aim To review the current literature and publications to assess the clinical features, recommended investigations and treatment for ocular tuberculosis in HIV infected patients. Methods Literature review. Results The human immunodeficiency virus (HIV) epidemic affects as many as 37.9 million people. Mycobacterium tuberculosis infection is common...

We conducted an observational study of lymphogranuloma venereum (LGV) biovar Chlamydia trachomatis infection in HIV-infected women in South Africa. The LGV biovar was detected in vaginal specimens of 17/85 (20%) women with C. trachomatis infection; 29% were symptomatic. All cases were negative for the LGV biovar following single dose azithromycin.

Syphilis and HIV infection may coexist in the same individual. Ocular syphilis and/or neurosyphilis may develop at any stage of coinfection, with a stronger association between ocular and neurosyphilis in individuals living with HIV, than in HIV-uninfected individuals. The diagnosis of ocular syphilis in HIV-infected and -uninfected patients remain...

Purpose: Overview of the evolving epidemiology of human immunodeficiency virus (HIV)-related ocular disease over time. Method: Narrative review. Results: HIV enhances susceptibility to opportunistic eye infections, has direct pathogenic effects, and places patients at risk of immune recovery inflammatory syndromes in previously infected eyes after...

Objectives Macrolide resistance in Mycoplasma genitalium is emerging globally. There is paucity of data from sub-Saharan Africa where syndromic management is used to treat sexually transmitted infections (STIs). We conducted a molecular epidemiological study to determine the prevalence of azithromycin resistance and epidemic diversity of M. genital...

Background: Great strides have been made in decreasing paediatric human immunodeficiency virus (HIV) infections, especially in sub-Saharan Africa. In South Africa, new paediatric HIV infections decreased by 84% between 2009 and 2015. This achievement is a result of a strong political will and the rapid evolution of the country’s prevention of mothe...

The objective of this study is to assess the predictors and frequency of persistent sexually transmitted infection (STI) positivity in human immunodeficiency virus (HIV)-infected pregnant women treated for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) or Trichomonas vaginalis (TV) infection. We enrolled HIV-infected pregnant women attendin...

Bacterial vaginosis (BV) is a common vaginal condition in women of reproductive age. During BV development, BV-associated bacteria may form a polymicrobial biofilm, which may predispose women to recurrent BV. The aim of the study was to investigate the growth forms of Gardnerella spp. and Lactobacillus spp. and to determine the association between...

Background: South Africa has one of the highest incidences of Tuberculosis (TB) globally. High co-morbid HIV prevalence complicates TB management and treatment outcomes. Growing evidence suggests that integrating the TB and HIV programmes will improve the overall results. Objectives: To describe how TB programme staff at various levels of the Sout...

Same-day initiation (SDI) of antiretroviral therapy (ART) has been recommended to improve ART programme outcomes in South Africa since August 2017. This study assessed implementation of SDI over time in two South African districts, describing the characteristics of same-day initiators and evaluating the impact of SDI on retention in ART care. Routi...

Objective Mycoplasma genitalium (MG) is a sexually transmitted organism associated with cervicitis and pelvic inflammatory disease in women and has been shown to increase the risk of HIV acquisition and transmission. Little is known about the prevalence and incidence of MG in pregnant women. Our study sought to evaluate the prevalence and incidence...

Introduction: Although pre-exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub-Saharan Africa, likely due to non-adherence. Adherence may be improved with the use of injectable long-acting PrEP methods currently being developed. We hypothesize that providing lon...

Background: Community health workers (CHWs) are an essential cadre in the health systems of many low- and middle-income countries. These workers provide a wide variety of services and are key to ongoing processes of task shifting within human immunodeficiency virus programmes in particular. Ward-based outreach teams (WBOTs) are South Africa's late...

Implementation of routine laboratory diagnostics is imperative to address the high burden of sexually transmitted infections (STI) in Sub-Saharan Africa. We demonstrate that logistical challenges of specimen storage, temperature and transport time are unlikely to impact on performance of routine STI diagnostics using the GeneXpert® platform impleme...

Background: The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives: To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a Sout...

Background: Despite widespread availability of antiretroviral therapy (ART) in South Africa, there remains a considerable burden of human immunodeficiency virus (HIV)-related morbidity and mortality. Objectives: To describe ART initiation and outcome trends over time, with a focus on clients presenting with advanced HIV-infection, so as to identif...

We observed a high rate of incident STDs within 55 days(median) of follow up(78% retention) among symptomatic MSM(n=78) in South Africa (188 per 100 person-years 95%CI 1.2-2.7)); 16 newly acquired and 10 with persistent positivity. This highlights the need to strengthen prevention efforts, whereas introduction of diagnostics is urgently warranted.

Background Neisseria gonorrhoeae drug resistance has emerged worldwide. There is limited data about the situation in South Africa where syndromic management is used for sexually transmitted infections (STIs). We investigated the antimicrobial resistance profile of Neisseria gonorrhoeae infections in high-risk men. Methods We conducted a cross-sect...

Background The occurrence of azithromycin resistance in M. genitalium infection is unknown in Africa, where diagnostic resources are limited and STIs are managed syndromically. This study aims to gain insight in the molecular epidemiology including antimicrobial resistance of M. genitalium infection in South Africa. Methods We collected 87 M . gen...

Objectives To determine the unmet need for care and barriers for consulting STI services at six primary healthcare (PHC) facilities in rural South Africa. Methods Cross‐sectional study using three community‐based strategies to mobilise adult individuals with STI‐associated symptoms to access care. Participants were mobilised through clinic posters...

Bedaquiline resistance within Mycobacterium tuberculosis may arise through efflux- ( rv0678 ) or target-based ( atpE ) pathway mutations. M. tuberculosis mutant populations from each of five sequential steps in a passaging approach, using a pyrazinamide-resistant ATCC strain, were subjected to MIC determinations and whole-genome sequencing. Exposur...

Background: Neisseria gonorrhoeae drug resistance has emerged worldwide, however, there is limited data about the situation in Africa. This paucity is due to weak surveillance systems in many African countries, the absence of routine diagnostics, and the use of syndromic management for sexually transmitted infections (STIs). We investigated the occ...

Background: Implementation of diagnostic testing is imperative to address the high burden of sexually transmitted infections (STI) in Africa, where these infections are currently managed syndromically. Logistical challenges, such as specimen storage and time required for transport to the laboratory, may potentially undermine the effectiveness of im...

Introduction: Extrapulmonary tuberculosis (TB) causes a significant burden of disease worldwide, especially among HIV-infected individuals and those with other immunosuppressive conditions. Cutaneous TB is an important manifestation of extrapulmonary TB but is uncommonly reported in South Africa despite the high burden of HIV and TB co-infection. T...

Adherence to antiretroviral therapy (ART) remains a challenge for HIV-infected children. In this cross-sectional study, we used structured interview-administered questionnaires and medical records to measure adherence levels and factors associated with adherence and viral suppression. We included 195 South African children aged 2.1-12.9 on ART. Adh...

Background: Mentoring is a required component of health systems strengthening technical assistance interventions in low- and middle-income countries (LMICs). Mentoring is useful because it does not necessarily compromise service delivery and promotes the sharing of newly acquired knowledge and skills. However, there is a lack of research on the imp...

We report a case of management failure of male urethritis syndrome due to macrolide-resistant Mycoplasma genitalium in South Africa. We detected mutations in 23S rRNA and one of the quinolone resistance-determining regions. This report confirms that drug-resistant M. genitalium infection can undermine the effectiveness of syndromic management in Af...

Six in-vitro clofazimine-resistant spontaneous mutants obtained from a wild-type or pyrazinamide-resistant ATCC reference strain were selected to evaluate bedaquiline cross-resistance. The reverse was conducted for bedaquiline mutants. All clofazimine mutants harbouring an rv0678 mutation displayed phenotypic cross-resistance. We observed the same...