Journal Article > Pre-PrintFull Text
Sci Rep. 8 March 2024; DOI:10.21203/rs.3.rs-3967595/v1
Bulti AB, Dumicho AY, Shigayeva A, van Cutsem G, Steele SJ, et al.
Sci Rep. 8 March 2024; DOI:10.21203/rs.3.rs-3967595/v1
BACKGROUND
Tuberculosis (TB) among hospitalized patients is underdiagnosed. This study assessed systematic TB-screening, followed by an enhanced TB-diagnostic package for hospitalized patients implemented by trained lay health workers in KwaZulu-Natal, South Africa.
METHODS
In this before-and-after study we included patients ≥ 18 years. The intervention consisted of systematic clinical screening for TB, HIV and diabetes mellitus by lay health workers and provision of an enhanced TB-diagnostic package including sputum Xpert MTB/Rif Ultra, urine lateral-flow lipoarabinomannan assay (LF-LAM), chest x-ray, and sputum culture. We compared TB case findings with people hospitalized one year preceding the intervention.
RESULTS
In the pre-intervention phase, 5217 people were hospitalized. Among 4913 (94.2%) people not on TB treatment, 367 (7.5%) were diagnosed with TB. In the intervention phase, 4015 eligible people were hospitalized. Among 3734 (93.0%) people not on TB treatment, 560 (15.0%) were diagnosed with TB. The proportion of patients diagnosed with TB was higher in the intervention phase (15.0% vs. 7.5%, p < 0.001). Overall in-hospital mortality was lower in the intervention phase [166/3734(4.5%) vs. 336/4913(6.8%), p < 0.001].
CONCLUSION
Lay health worker-led implementation of systematic TB-screening, coupled with provision of an enhanced TB-diagnostic package significantly improved TB case detection and mortality among hospitalized adults.
Tuberculosis (TB) among hospitalized patients is underdiagnosed. This study assessed systematic TB-screening, followed by an enhanced TB-diagnostic package for hospitalized patients implemented by trained lay health workers in KwaZulu-Natal, South Africa.
METHODS
In this before-and-after study we included patients ≥ 18 years. The intervention consisted of systematic clinical screening for TB, HIV and diabetes mellitus by lay health workers and provision of an enhanced TB-diagnostic package including sputum Xpert MTB/Rif Ultra, urine lateral-flow lipoarabinomannan assay (LF-LAM), chest x-ray, and sputum culture. We compared TB case findings with people hospitalized one year preceding the intervention.
RESULTS
In the pre-intervention phase, 5217 people were hospitalized. Among 4913 (94.2%) people not on TB treatment, 367 (7.5%) were diagnosed with TB. In the intervention phase, 4015 eligible people were hospitalized. Among 3734 (93.0%) people not on TB treatment, 560 (15.0%) were diagnosed with TB. The proportion of patients diagnosed with TB was higher in the intervention phase (15.0% vs. 7.5%, p < 0.001). Overall in-hospital mortality was lower in the intervention phase [166/3734(4.5%) vs. 336/4913(6.8%), p < 0.001].
CONCLUSION
Lay health worker-led implementation of systematic TB-screening, coupled with provision of an enhanced TB-diagnostic package significantly improved TB case detection and mortality among hospitalized adults.
Journal Article > ResearchFull Text
Public Health Action. 1 August 2023; Volume 13 (Issue 2(Suppl 1)); 19-24.; DOI:10.5588/pha.23.0009
Abdourahimi D, Yehadji D, Briskin E, Khine EM, Arias C, et al.
Public Health Action. 1 August 2023; Volume 13 (Issue 2(Suppl 1)); 19-24.; DOI:10.5588/pha.23.0009
CONTEXTE
Une unité soutenue par Médecins Sans Frontières (MSF) qui prend en charge les patients avec un VIH avancé à l’Hôpital National de Donka, Conakry, Guinée.
OBJECTIF
Déterminer les facteurs liés à la survenue du décès chez les patients hospitalisés dans l’unité entre 2017 et 2021.
SCHÉMA
Ceci est une analyse rétrospective de données de routine des patients hospitalisés pour le VIH avancé.
RÉSULTATS
Au total, 3,718 patients étaient inclus, d’âge médian de 40 ans (IQR 33–51), dont 2,241 (60,3%) femmes. Le taux de moyen de décès était de 33,6% (n = 1,240). Il était passé de 40% en 2017 à 29% en 2021, sans être statistiquement significatif. La période la plus à risque de décès était les 25 premiers jours d’hospitalisation. Chez ces patients décédés, la TB (43,8%) et la toxoplasmose (11,4%) étaient les diagnostics les plus fréquents. Après analyse multivariée par régression de Cox, les facteurs associés au décès étaient un âge compris entre 25–49 ans (hazard ratio ajusté [HRa] 1,60 ; P = 0,002) ou 50 ans (HRa 1,80 ; P < 0,001), la présence de signes respiratoires (HRa 1,23 ;
P = 0,001) ou abdominaux (HRa 1,26 ; P < 0,001) et une réadmission (HRa 0,54 ; P < 0,001).
CONCLUSION
Les patients âgés de 25–49 ans, ou plus, ou présentant des signes respiratoires ou abdominaux requièrent une surveillance accrue car ils sont les plus à risque de décéder de la maladie, surtout pendant les 25 premiers jours d’hospitalisation.
Une unité soutenue par Médecins Sans Frontières (MSF) qui prend en charge les patients avec un VIH avancé à l’Hôpital National de Donka, Conakry, Guinée.
OBJECTIF
Déterminer les facteurs liés à la survenue du décès chez les patients hospitalisés dans l’unité entre 2017 et 2021.
SCHÉMA
Ceci est une analyse rétrospective de données de routine des patients hospitalisés pour le VIH avancé.
RÉSULTATS
Au total, 3,718 patients étaient inclus, d’âge médian de 40 ans (IQR 33–51), dont 2,241 (60,3%) femmes. Le taux de moyen de décès était de 33,6% (n = 1,240). Il était passé de 40% en 2017 à 29% en 2021, sans être statistiquement significatif. La période la plus à risque de décès était les 25 premiers jours d’hospitalisation. Chez ces patients décédés, la TB (43,8%) et la toxoplasmose (11,4%) étaient les diagnostics les plus fréquents. Après analyse multivariée par régression de Cox, les facteurs associés au décès étaient un âge compris entre 25–49 ans (hazard ratio ajusté [HRa] 1,60 ; P = 0,002) ou 50 ans (HRa 1,80 ; P < 0,001), la présence de signes respiratoires (HRa 1,23 ;
P = 0,001) ou abdominaux (HRa 1,26 ; P < 0,001) et une réadmission (HRa 0,54 ; P < 0,001).
CONCLUSION
Les patients âgés de 25–49 ans, ou plus, ou présentant des signes respiratoires ou abdominaux requièrent une surveillance accrue car ils sont les plus à risque de décéder de la maladie, surtout pendant les 25 premiers jours d’hospitalisation.
Journal Article > ResearchFull Text
PLOS One. 12 March 2019; Volume 14 (Issue 3); e0212405.; DOI:10.1371/journal.pone.0212405
Hwang B, Shroufi A, Gils T, Steele SJ, Grimsrud A, et al.
PLOS One. 12 March 2019; Volume 14 (Issue 3); e0212405.; DOI:10.1371/journal.pone.0212405
BACKGROUND
HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.
METHODS
We conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.
RESULTS
Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.
INTERPRETATION
There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.
HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.
METHODS
We conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.
RESULTS
Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.
INTERPRETATION
There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.
Journal Article > ResearchFull Text
BMC Infect Dis. 30 July 2019; Volume 19 (Issue 1); DOI:10.1186/s12879-019-4287-6
Wilkinson LS, Grimsrud A, Cassidy T, Orrell C, Voget J, et al.
BMC Infect Dis. 30 July 2019; Volume 19 (Issue 1); DOI:10.1186/s12879-019-4287-6
BACKGROUND:
The antiretroviral therapy (ART) adherence club (AC) differentiated service delivery model, where clinically stable ART patients receive their ART refills and psychosocial support in groups has supported clinically stable patients' retention and viral suppression. Patients and health systems could benefit further by reducing visit frequency and increasing ART refills. We designed a cluster-randomized control trial comparing standard of care (SoC) ACs and six-month ART refill (Intervention) ACs in a large primary care facility in Khayelitsha, South Africa.
METHODS:
Existing ACs were randomized to either the control (SOC ACs) or intervention (Intervention ACs) arm. SoC ACs meet five times annually, receiving two-month ART refills with a four-month ART refill over year-end. Blood is drawn at the AC visit ahead of the clinical assessment visit. Intervention ACs meet twice annually receiving six-month ART refills, with a third individual visit for routine blood collection anytime two-four weeks before the annual clinical assessment AC visit. Primary outcomes will be retention in care, annual viral load assessment completion and viral load suppression. (<400copies/mL) after 2 years. Ethics approval has been granted by the University of Cape Town (HREC 652/2016) and the Medecins Sans Frontieres (MSF) Ethics Review Board (#1639). Results will be published in peer-reviewed journals and made widely available through presentations and briefing documents.
DISCUSSION:
Evaluation of an extended ART refill interval in adherence clubs will provide evidence towards novel model adaptions that can be made to further improve convenience for patients and leverage health system efficiencies.
The antiretroviral therapy (ART) adherence club (AC) differentiated service delivery model, where clinically stable ART patients receive their ART refills and psychosocial support in groups has supported clinically stable patients' retention and viral suppression. Patients and health systems could benefit further by reducing visit frequency and increasing ART refills. We designed a cluster-randomized control trial comparing standard of care (SoC) ACs and six-month ART refill (Intervention) ACs in a large primary care facility in Khayelitsha, South Africa.
METHODS:
Existing ACs were randomized to either the control (SOC ACs) or intervention (Intervention ACs) arm. SoC ACs meet five times annually, receiving two-month ART refills with a four-month ART refill over year-end. Blood is drawn at the AC visit ahead of the clinical assessment visit. Intervention ACs meet twice annually receiving six-month ART refills, with a third individual visit for routine blood collection anytime two-four weeks before the annual clinical assessment AC visit. Primary outcomes will be retention in care, annual viral load assessment completion and viral load suppression. (<400copies/mL) after 2 years. Ethics approval has been granted by the University of Cape Town (HREC 652/2016) and the Medecins Sans Frontieres (MSF) Ethics Review Board (#1639). Results will be published in peer-reviewed journals and made widely available through presentations and briefing documents.
DISCUSSION:
Evaluation of an extended ART refill interval in adherence clubs will provide evidence towards novel model adaptions that can be made to further improve convenience for patients and leverage health system efficiencies.
Journal Article > ResearchFull Text
PLOS One. 6 September 2017; Volume 12 (Issue 9); DOI:10.1371/journal.pone.0183656
Rick F, Niyibizi AA, Shroufi A, Onami K, Steele SJ, et al.
PLOS One. 6 September 2017; Volume 12 (Issue 9); DOI:10.1371/journal.pone.0183656
Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho.
Journal Article > ResearchFull Text
PLOS One. 31 July 2019; Volume 14 (Issue 7); DOI:10.1371/journal.pone.0216449
Steele SJ, Abrahams N, Duncan K, Woollett N, Hwang B, et al.
PLOS One. 31 July 2019; Volume 14 (Issue 7); DOI:10.1371/journal.pone.0216449
BACKGROUND:
Estimates for the prevalence of rape and other forms of sexual violence (SV) vary in South Africa. This survey aimed to provide clarity by quantifying the prevalence of SV (forced sex or sexual acts) by 1) sexual partners, and 2) non-partners, and to describe factors associated with these outcomes among women (18-49 years) living in Rustenburg Municipality.
MATERIALS AND METHODS:
We conducted a cluster-randomized household survey (November-December 2015). Women were asked about their experiences of SV, associated attitudes and behaviours, and access to services. Logistic regression was used to determine factors associated with partner and non-partner SV.
RESULTS:
Of eligible households, 83·1% (1700/2044) participated. Of 966 women invited, 836 participated (86·5%). Average age of participants was 31.6 years (95%CI: 30·9, 32·4) with 45% having completed at least secondary school, and 60% unemployed or looking for work. Lifetime prevalence of SV was 24.9% (95%CI: 21·7-28·5), reaching 9.0% (95% CI: 6·6-12·1) by age 15. Almost one third told no one of their SV experiences. Factors related to financial dependence were associated with SV by a partner. History of termination of pregnancy increased the likelihood of SV by a non-partner as an adult. Women who experienced SV in childhood or as an adult were more likely to experience SV from a different type of perpetrator than those who did not.
CONCLUSIONS:
We found a high prevalence of SV, including during childhood, in this setting, with limited access to care. This and the high morbidity attributed to SV calls for increased service provision.
Estimates for the prevalence of rape and other forms of sexual violence (SV) vary in South Africa. This survey aimed to provide clarity by quantifying the prevalence of SV (forced sex or sexual acts) by 1) sexual partners, and 2) non-partners, and to describe factors associated with these outcomes among women (18-49 years) living in Rustenburg Municipality.
MATERIALS AND METHODS:
We conducted a cluster-randomized household survey (November-December 2015). Women were asked about their experiences of SV, associated attitudes and behaviours, and access to services. Logistic regression was used to determine factors associated with partner and non-partner SV.
RESULTS:
Of eligible households, 83·1% (1700/2044) participated. Of 966 women invited, 836 participated (86·5%). Average age of participants was 31.6 years (95%CI: 30·9, 32·4) with 45% having completed at least secondary school, and 60% unemployed or looking for work. Lifetime prevalence of SV was 24.9% (95%CI: 21·7-28·5), reaching 9.0% (95% CI: 6·6-12·1) by age 15. Almost one third told no one of their SV experiences. Factors related to financial dependence were associated with SV by a partner. History of termination of pregnancy increased the likelihood of SV by a non-partner as an adult. Women who experienced SV in childhood or as an adult were more likely to experience SV from a different type of perpetrator than those who did not.
CONCLUSIONS:
We found a high prevalence of SV, including during childhood, in this setting, with limited access to care. This and the high morbidity attributed to SV calls for increased service provision.
Journal Article > ResearchFull Text
PLOS One. 2 May 2019; Volume 14 (Issue 5); e0215454.; DOI:10.1371/journal.pone.0215454
Moore HA, Metcalf CJ, Cassidy T, Hacking D, Shroufi A, et al.
PLOS One. 2 May 2019; Volume 14 (Issue 5); e0215454.; DOI:10.1371/journal.pone.0215454
INTRODUCTION:
HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST.
METHODS:
Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available.
RESULTS:
Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS.
CONCLUSIONS:
HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.
HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST.
METHODS:
Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available.
RESULTS:
Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS.
CONCLUSIONS:
HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.
Journal Article > ResearchFull Text
PLOS One. 18 May 2017; Volume 12 (Issue 5); e0178054.; DOI:10.1371/journal.pone.0178054
Mohr E, Daniels J, Beko B, Isaakidis P, Cox V, et al.
PLOS One. 18 May 2017; Volume 12 (Issue 5); e0178054.; DOI:10.1371/journal.pone.0178054
BACKGROUND
Daily directly-observed therapy (DOT) is recommended for rifampicin-resistant tuberculosis (RR-TB) patients throughout treatment. We assessed the impact of self-administered treatment (SAT) in a South African township with high rates of RR-TB and HIV.
METHODS
Community-supported SAT for patients who completed the intensive phase was piloted in five primary care clinics in Khayelitsha. We compared final treatment outcomes among RR-TB patients initiating treatment before (standard-of-care (SOC)-cohort, January 2010-July 2013) and after the implementation of the pilot (SAT-cohort, January 2012-December 2014). All patients with outcomes before January 1, 2017 were considered in the analysis of outcomes.
RESULTS
One-hundred-eighteen patients in the SOC-cohort and 174 patients in the SAT-cohort had final RR-TB treatment outcomes; 70% and 73% were HIV-co-infected, respectively. The proportion of patients with a final outcome of loss to follow-up (LTFU) did not differ whether treated in the SOC (25/118, 21.2%) or SAT-cohort (31/174, 17.8%) (P = 0.47). There were no significant differences in the time to 24-month LTFU among HIV-infected and uninfected patients (HR 0.90, 95% CI: 0.51-1.6, P = 0.71), or among patients enrolled in the SOC-cohort versus the SAT-cohort (HR 0.83, 95% CI: 0.49-1.4, P = 0.50) who received at least 6-months of RR-TB treatment.
CONCLUSION
The introduction of SAT during the continuation phase of RR-TB treatment does not adversely affect final RR-TB treatment outcomes in a high TB and HIV-burden setting. This differentiated, patient-centred model of care could be considered in RR-TB programmes to decrease the burden of DOT on patients and health facilities.
Daily directly-observed therapy (DOT) is recommended for rifampicin-resistant tuberculosis (RR-TB) patients throughout treatment. We assessed the impact of self-administered treatment (SAT) in a South African township with high rates of RR-TB and HIV.
METHODS
Community-supported SAT for patients who completed the intensive phase was piloted in five primary care clinics in Khayelitsha. We compared final treatment outcomes among RR-TB patients initiating treatment before (standard-of-care (SOC)-cohort, January 2010-July 2013) and after the implementation of the pilot (SAT-cohort, January 2012-December 2014). All patients with outcomes before January 1, 2017 were considered in the analysis of outcomes.
RESULTS
One-hundred-eighteen patients in the SOC-cohort and 174 patients in the SAT-cohort had final RR-TB treatment outcomes; 70% and 73% were HIV-co-infected, respectively. The proportion of patients with a final outcome of loss to follow-up (LTFU) did not differ whether treated in the SOC (25/118, 21.2%) or SAT-cohort (31/174, 17.8%) (P = 0.47). There were no significant differences in the time to 24-month LTFU among HIV-infected and uninfected patients (HR 0.90, 95% CI: 0.51-1.6, P = 0.71), or among patients enrolled in the SOC-cohort versus the SAT-cohort (HR 0.83, 95% CI: 0.49-1.4, P = 0.50) who received at least 6-months of RR-TB treatment.
CONCLUSION
The introduction of SAT during the continuation phase of RR-TB treatment does not adversely affect final RR-TB treatment outcomes in a high TB and HIV-burden setting. This differentiated, patient-centred model of care could be considered in RR-TB programmes to decrease the burden of DOT on patients and health facilities.
Journal Article > ResearchFull Text
AIDS Behav. 2 March 2022; Online ahead of print; DOI:10.1007/s10461-022-03586-9
Hacking D, Cassidy T, Ellman T, Steele SJ, Moore HA, et al.
AIDS Behav. 2 March 2022; Online ahead of print; DOI:10.1007/s10461-022-03586-9
In South Africa, where an estimated 34% of nearly 7-million HIV-positive people were not on antiretroviral therapy (ART) in 2019, innovative strategies to diagnose and link people to care are needed. HIV self-testing (HIVST) is one such strategy. However, there is concern that access to HIVST might result in re-testing among people on ART, with a risk of false negative results and disengagement from care. Between November 2017 and December 2018, HIVST kits were distributed at a private pharmacy and at HIV testing outreach events. Each participant was instructed to report their result via SMS and those who did not were followed-up telephonically 10 days later. Electronic medical records of participants were searched for evidence of HIV services 6 months before and after enrollment. Of 1482 participants, 163 (11%) were previously diagnosed HIV-positive prior to taking the test. Of these, 123 reported a result, however 87% reported a negative result. Of the 163 previously diagnosed, 84 were not in ART care prior to the test, with 15 (18%) linking to care post-test. Of 79 who were in ART care prior to the test, 76 (96%) remained in care, even though 51 (67%) had reported a negative result. Overall, 29% of participants reported their result via SMS, and 48% when telephoned. Despite efforts to dissuade them, some previously diagnosed HIV-positive utilised HIVST. For those disengaged from care this may facilitate re-engagement. Self-testing among those already in care, regardless of the reported result, did not disrupt their treatment, and their reasons for doing the test remain unclear.
Journal Article > ResearchFull Text
Eur Respir J. 3 May 2018; Volume 51 (Issue 6); 1800017.; DOI:10.1183/13993003.00017-2018
Mohr E, Hughes J, Reuter A, Trivino Duran L, Ferlazzo G, et al.
Eur Respir J. 3 May 2018; Volume 51 (Issue 6); 1800017.; DOI:10.1183/13993003.00017-2018
Experience with delamanid (Dlm) is limited, particularly among HIV-positive individuals. We describe early efficacy and safety data from a programmatic setting in South Africa. This was a retrospective cohort study of patients receiving Dlm-containing treatment regimens between November 2015 and August 2017. We report 12-month interim outcomes, sputum culture conversion (SCC) by months 2 and 6, serious adverse events (SAEs) and QT intervals corrected using the Frederica formula (QTcF). Overall, 103 patients were initiated on Dlm; 79 (77%) were HIV positive. The main indication for Dlm was intolerance to second-line anti-tuberculosis (TB) drugs (n=58, 56%). There were 12 months of follow-up for 46 patients; 28 (61%) had a favourable outcome (cure, treatment completion or culture negativity). Positive cultures were found for 57 patients at Dlm initiation; 16 out of 31 (52%) had SCC within 2 months and 25 out of 31 (81%) within 6 months. There were 67 SAEs reported in 29 patients (28%). There were four instances of QTcF prolongation >500 ms in two patients (2%), leading to permanent discontinuation in one case; however, no cardiac arrhythmias occurred. This large cohort of difficult-to-treat patients receiving Dlm for rifampicin-resistant TB treatment in a programmatic setting with high HIV prevalence had favourable early treatment response and tolerated treatment well. Dlm should remain available, particularly for those who cannot be treated with conventional regimens or with limited treatment options.