Journal Article > ReviewFull Text
Int J Epidemiol. 2016 May 20; Volume 46 (Issue 2); e21.; DOI:doi.org/10.1093/ije/dyw057
Stinson K, Goemaere E, Coetzee D, van Cutsem G, Hilderbrand K, et al.
Int J Epidemiol. 2016 May 20; Volume 46 (Issue 2); e21.; DOI:doi.org/10.1093/ije/dyw057
Journal Article > LetterFull Text
Clin Infect Dis. 2014 April 23; Volume 59 (Issue 3); DOI:10.1093/cid/ciu288
Patten GE, Cox V, Stinson K, Boulle AM, Wilkinson LS
Clin Infect Dis. 2014 April 23; Volume 59 (Issue 3); DOI:10.1093/cid/ciu288
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2015 November 1; Volume 19 (Issue 11); 1300-1304.; DOI:10.5588/ijtld.15.0015
Cox V, De Azevedo V, Stinson K, Wilkinson LS, Rangaka MX, et al.
Int J Tuberc Lung Dis. 2015 November 1; Volume 19 (Issue 11); 1300-1304.; DOI:10.5588/ijtld.15.0015
BACKGROUND
The World Health Organization recommends tuberculin skin tests (TSTs) where feasible to identify individuals most likely to benefit from isoniazid preventive therapy (IPT). The requirement for TST reading after 48–72 h by a trained nurse is a barrier to implementation and increases loss to follow-up.
METHODS
Patients with human immunodeficiency virus (HIV) infection were recruited from a primary care clinic in South Africa and trained by a lay counsellor to interpret their own TST. The TST was placed by a nurse, and the patient was asked to return 2 days later with their self-reading result, followed by blinded reading by a trained nurse (reference).
RESULTS
Of 227 patients, 210 returned for TST reading; 78% interpreted their test correctly: those interpreting it as negative were more likely to be correct (negative predictive value 93%) than those interpreting it as positive (positive predictive value 42%); 10/36 (28%) positive TST results were read as negative by the patient.
CONCLUSIONS
Patients with HIV in low-resource settings can be trained to interpret their own TST. Those interpreting it as positive should return to the clinic within 48–72 h for confirmatory reading and IPT initiation; those with a negative interpretation can return at their next scheduled visit and initiate IPT at that time if appropriate.
The World Health Organization recommends tuberculin skin tests (TSTs) where feasible to identify individuals most likely to benefit from isoniazid preventive therapy (IPT). The requirement for TST reading after 48–72 h by a trained nurse is a barrier to implementation and increases loss to follow-up.
METHODS
Patients with human immunodeficiency virus (HIV) infection were recruited from a primary care clinic in South Africa and trained by a lay counsellor to interpret their own TST. The TST was placed by a nurse, and the patient was asked to return 2 days later with their self-reading result, followed by blinded reading by a trained nurse (reference).
RESULTS
Of 227 patients, 210 returned for TST reading; 78% interpreted their test correctly: those interpreting it as negative were more likely to be correct (negative predictive value 93%) than those interpreting it as positive (positive predictive value 42%); 10/36 (28%) positive TST results were read as negative by the patient.
CONCLUSIONS
Patients with HIV in low-resource settings can be trained to interpret their own TST. Those interpreting it as positive should return to the clinic within 48–72 h for confirmatory reading and IPT initiation; those with a negative interpretation can return at their next scheduled visit and initiate IPT at that time if appropriate.
Journal Article > ResearchFull Text
J Int AIDS Soc. 2017 April 10 (Issue 1)
de Waal R, Cohen K, Fox MP, Stinson K, Maartens G, et al.
J Int AIDS Soc. 2017 April 10 (Issue 1)
Tenofovir has been associated with decline in kidney function, but in patients with low baseline kidney function, improvements over time have been reported. Additionally, the magnitude and trajectory of estimated glomerular filtration rate (eGFR) changes may differ according to how eGFR is calculated. We described changes in eGFR over time, and the incidence of, and risk factors for, kidney toxicity, in a South African cohort.
Journal Article > ResearchFull Text
Trop Med Int Health. 2015 January 7; Volume 20 (Issue 4); DOI:10.1111/tmi.12454
Dallatomasinas S, Crestani R, Squire JS, Declerck H, Caleo GNC, et al.
Trop Med Int Health. 2015 January 7; Volume 20 (Issue 4); DOI:10.1111/tmi.12454
To describe Ebola cases in the district Ebola Management Centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalization characteristics, treatment outcomes and time from symptom onset to admission.
Journal Article > LetterFull Text
Clin Infect Dis. 2014 February 5; Volume 58 (Issue 9); 1344-1345.; DOI:10.1093/cid/ciu072
Stinson K, Ford NP, Cox V, Boulle AM
Clin Infect Dis. 2014 February 5; Volume 58 (Issue 9); 1344-1345.; DOI:10.1093/cid/ciu072
Journal Article > ResearchFull Text
J Infect Dis. 2015 May 22; Volume 212 (Issue 11); DOI:10.1093/infdis/jiv304
Fitzpatrick G, Vogt F, Gbabai O, Decroo T, Keane M, et al.
J Infect Dis. 2015 May 22; Volume 212 (Issue 11); DOI:10.1093/infdis/jiv304
This paper describes patient characteristics, including Ebola viral load, associated with mortality in an MSF Ebola case management centre. Out of 780 admissions between June and October 2014, 525 (67%) were positive for Ebola with a known outcome. The crude mortality rate was 51% (270/525). Ebola viral load (whole blood sample) data was available on 76% (397/525) of patients. Univariate analysis indicated viral load at admission, age, symptom duration prior to admission and distance travelled to the CMC were associated with mortality (p value<0.05). The multivariable model predicted mortality in those with a viral load at admission greater than 10 million copies per millilitre (p value<0.05, Odds Ratio>10), aged 50 years or more (p value=0.08, Odds Ratio=2) and symptom duration prior to admission less than 5 days (p value=0.14). The presence of confusion, diarrhoea and conjunctivitis were significantly higher (p value<0.05) in Ebola patients who died. These findings highlight the importance viral load at admission has on mortality outcomes and could be used to cohort cases with viral loads greater than 10 million copies into dedicated wards with more intensive medical support to further reduce mortality.
Journal Article > CommentaryFull Text
PLOS Med. 2015 April 7; Volume 12 (Issue 4); e1001811.; DOI:10.1371/journal.pmed.1001811
van den Berg W, Brittain K, Mercer G, Peacock D, Stinson K, et al.
PLOS Med. 2015 April 7; Volume 12 (Issue 4); e1001811.; DOI:10.1371/journal.pmed.1001811
SUMMARY POINTS
-- Involving male partners in programmes to prevent mother-to-child transmission of HIV may improve programme coverage and infant outcomes.
-- Rates of male partner involvement remain low worldwide, and detailed guidelines to increase involvement are lacking in South Africa.
-- We recommend that South African national and provincial guidelines and policies for preventing mother-to-child HIV transmission be adjusted to explicitly include a focus on increasing male partner involvement and that they include concrete descriptions of how to achieve this.
-- We propose recommendations for improving male partner involvement at a policy, facility, and community level.
-- Challenges to improving male partner involvement include the nature of relationships and family structures in South Africa and the capacity of health systems to implement recommendations.
-- Involving male partners in programmes to prevent mother-to-child transmission of HIV may improve programme coverage and infant outcomes.
-- Rates of male partner involvement remain low worldwide, and detailed guidelines to increase involvement are lacking in South Africa.
-- We recommend that South African national and provincial guidelines and policies for preventing mother-to-child HIV transmission be adjusted to explicitly include a focus on increasing male partner involvement and that they include concrete descriptions of how to achieve this.
-- We propose recommendations for improving male partner involvement at a policy, facility, and community level.
-- Challenges to improving male partner involvement include the nature of relationships and family structures in South Africa and the capacity of health systems to implement recommendations.
Journal Article > ResearchFull Text
PLOS One. 2017 February 13 (Issue 2)
Fortuin-de Smidt M, de Waal R, Cohen K, Technau KG, Stinson K, et al.
PLOS One. 2017 February 13 (Issue 2)
There are a limited number of paediatric antiretroviral drug options. Characterising the long term safety and durability of different antiretrovirals in children is important to optimise management of HIV infected children and to determine the estimated need for alternative drugs in paediatric regimens. We describe first-line antiretroviral therapy (ART) durability and reasons for discontinuations in children at two South African ART programmes, where lopinavir/ritonavir has been recommended for children <3 years old since 2004, and abacavir replaced stavudine as the preferred nucleoside reverse transcriptase inhibitor in 2010.
Journal Article > ResearchFull Text
J Acquir Immune Defic Syndr. 2015 July 7; Volume 70 (Issue 3); DOI:10.1097/QAI.0000000000000748
Koller M, Fatti G, Chi BH, Keiser O, Hoffman CJ, et al.
J Acquir Immune Defic Syndr. 2015 July 7; Volume 70 (Issue 3); DOI:10.1097/QAI.0000000000000748