Initial studies had highlighted a possible link between DTG and neural tube defects (birth defects of the brain and spinal cord that cause conditions such as spina bifida) in infants born to women using the drug at the time of conception. This potential safety concern was reported in May 2018 from a study in Botswana that found 4 cases of neural tube defects out of 426 women who became pregnant while taking DTG. Based on these preliminary findings, many countries advised pregnant women and women of childbearing potential to take efavirenz (EFV) instead.

New data from two large clinical trials comparing the efficacy and safety of DTG and EFV in Africa have now expanded the evidence base. The risks of neural tube defects are significantly lower than what the initial studies may have suggested.

The guidelines group also considered mathematical models of the benefits and harms associated with the two drugs; the values and preferences of people living with HIV, as well as factors related to implementation of HIV programmes in different countries, and cost.

DTG is a drug that is more effective, easier to take and has fewer side effects than alternative drugs that are currently used. DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to EFV and nevirapine-based regimens. In 2019, 12 out of 18 countries surveyed by WHO reported pre-treatment drug resistance levels exceeding the recommended threshold of 10%.

All of above findings informed the decision to update the 2019 guidelines.

In 2019, 82 low- and middle-income countries reported to be transitioning to DTG-based HIV treatment regimens. The new updated recommendations aim to help more countries improve their HIV policies.

As for any medications, informed choice is important. Every treatment decision needs to be based on an informed discussion with the health provider weighing the benefits and potential risks.

WHO also stresses the importance of providing information and options to help women make an informed choice. To this end WHO has convened an advisory group of women living with HIV from diverse backgrounds to advise on policy issues related to their health, including sexual and reproductive health. WHO highlights the need to continually monitor the risk of neural tube defects associated with DTG.

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Legend Hotel Lagos Airport is located at Murtala Muhammed International Airport, which serves more than eight million passengers each year . The stylish hotel is adjacent to the airport’s private jet terminal and has an exclusive immigrations and customs desk in the hotel for private jet passengers. Handpicked to be part of the exclusive collection of one-of-a-kind hotels and resorts celebrated for their individuality, the hotel joins more than 60 Curio Collection hotels around the world. This is Hilton’s first hotel in Lagos and its second in Nigeria, with an additional seven hotels in its development pipeline for the country.

Speaking ahead of the Africa Hotel Investment Forum (AHIF) in Nairobi, Hilton’s President and CEO, Chris Nassetta, said: “We continue to innovate in Africa with new brands and products, and we are pleased to introduce our Curio Collection brand here with the opening of Legend Hotel Lagos Airport. As the continent continues to undergo rapid urbanization, with the UN forecasting that the world’s 10 fastest-growing cities will all be in Africa by 2035, this hotel is a part of our strategy to connect guests to key cities and airport locations across the region.”

Hilton is seeing strong demand for its brands across the continent and expects to open eight hotels in total across Africa this year, three of which will fly under the Hilton Garden Inn flag. This brand appeals to the rising tide of middle class travelers into and across Africa and the company expects to open at least 16 Hilton Garden Inn hotels in the coming five years, including brand entries in Kampala, Ghana, Malawi, eSwatini (formerly Swaziland) and many other strategic locations across sub-Saharan Africa.

Last year, Hilton launched the Hilton Africa Growth Initiative, which will support the conversion of existing hotels to Hilton brands with an investment of US$50 million over five years. During that period, Hilton expects to secure 100 conversion opportunities with some 15-20,000 rooms added to its portfolio to meet the growing need for quality branded hotels across the continent.

Hilton is committed to growth and opportunity across Africa and has been a continuous presence on the continent since 1959. With 41 open hotels and 53 in its development pipeline in Africa, Hilton expects to double its footprint across the continent in the next five years. This includes market entries in 13 countries where it does not currently operate including Botswana, Ghana, eSwatini (formerly Swaziland), Uganda, Malawi and Rwanda.

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Compared to previous years, a modest increase in cases in the Kruger National Park and private reserves in the area has been confirmed. This follows a very busy 2017 malaria season in the entire southern African region, which peaked in April and May and extended into June.

High rainfall, humidity and ambient temperatures provided ideal conditions for malaria mosquito breeding and contributed to an increase in malaria cases. Unusually mild winter temperatures in malaria areas have allowed for ongoing mosquito and parasite development and led to an early and busy malaria season which started already in August 2017.

The key prevention strategy of the malaria control programmes in endemic areas is spraying of households with long acting residual insecticides (IRS) which target indoor feeding mosquitos. This IRS programme is in progress in both Limpopo and Mpumalanga and is planned to target a larger area than in 2016. Early treatment of malaria cases is a key strategy. The antimalarial drug, Coartem remains highly effective in the treatment of uncomplicated malaria, provided there is early diagnosis and urgent commencement of treatment.

Travellers from, or residents of malaria transmission areas in Limpopo and Mpumalanga, and the far northern KwaZulu-Natal and neighbouring countries such as Mozambique, Botswana, Zimbabwe and Namibia who present with fever and ‘flu-like’ illness must have an urgent blood test and malaria treated as a medical emergency. Misdiagnosis of malaria as influenza is not uncommon with disastrous consequences in a number of persons.

The Department of Health in South Africa is ensuring universal coverage of key interventions. This includes Indoor Residual Spraying, effective case management and ensuring that health promotion messages reach communities at risk of contracting the disease. All travellers to malaria risk areas must take precautions to prevent mosquito bites and medication to prevent malaria should be highly considered.

• Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected Anopheles mosquitoes, which generally bite at night.
• Malaria is preventable, treatable and curable.
• Travelers from non-endemic areas to malaria endemic areas and countries are vulnerable to the disease and need to take reventative measures.
• Malaria symptoms appear within 10-15 days after the infective mosquito bite.
• The symptoms include, fever, headache, chills and vomiting.
• Early malaria diagnosis and treatment reduces disease severity and prevents deaths.
• If people suspect that they have having malaria, they should immediately consult their health service provider to be tested and treated.
• If not treated within 24 hours, malaria can progress to severe illness and death. Individuals are therefore advised to take personal protection methods when visiting malaria endemic areas within and outside South Africa.
• Everyone is at risk of contracting malaria in malarious areas (see attached malaria risk map for south Africa), but there are some higher risk groups including, children under five years of age, pregnant women, people with compromised immune systems, travellers from non-endemic areas and immigrant workers.

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