Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study

Poor knowledge and adherence to point-of-care (POC) HIV testing standards have been reported in rural KwaZulu-Natal (KZN), a high HIV prevalent setting. Improving compliance to HIV testing standards is critical, particularly during the gradual phasing out of lay counsellor providers and the shifting of HIV testing and counselling duties to professional nurses. The main objective of this study was to identify priority areas for development of POC diagnostics curriculum to improve competence and adherence to POC diagnostics quality standards for primary healthcare (PHC) nurses in rural South Africa. Method: PHC clinic stakeholders were invited to participate in a co-creation workshop. Participants were purposely sampled from each of the 11 KwaZulu-Natal Districts. Through the Nominal Group Technique (NGT), participants identified training related challenges concerning delivery of quality point of care diagnostics and ranked them from highest to lowest priority. An importance ranking score (scale 1–5) was calculated for each of the identified challenges. Results: Study participants included three PHC professional nurses, one TB professional nurse, one HIV lay councilor, one TB assistant and three POC diagnostics researchers, aged 23–50. Participants identified ten POC diagnostics related challenges. Amongst the highest ranked challenges were the following:absence of POC testing Curriculum for nurses, absence of training of staff on HIV testing and counselling as lay counsellor providers are gradually being phased out,. absence of Continuous Professional Development opportunities and lack of Staff involvement in POC Management programs. Conclusion: Key stakeholders perceived training of PHC nurses as the highest priority for the delivery of quality POC diagnostic testing at PHC level. We recommend continual collaboration among all POC diagnostics stakeholders in the development of an accessible curriculum to improve providers’ competence and ensure sustainable quality delivery of POC diagnostic services in rural PHC clinics.

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Depression symptoms, HIV testing, linkage to ART, and viral suppression among women in a high HIV burden district in KwaZulu-Natal, South Africa: A cross-sectional household study

Journal of Health Psychology ◽

10.1177/1359105320982042 ◽

2020 ◽

pp. 135910532098204

Author(s):

Kaymarlin Govender ◽

Dick Durevall ◽

Richard G Cowden ◽

Sean Beckett ◽

Ayesha BM Kharsany ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Hiv Testing ◽

Viral Suppression ◽

Hiv Positive ◽

Depression Symptoms ◽

Cross Sectional ◽

Lower Odds ◽

Hiv Positive Women ◽

Kwazulu Natal

Achieving the UNAIDS 90-90-90 targets by 2020 is contingent on identifying and addressing mental health challenges that may affect HIV testing and treatment-related behaviors. This study is based on survey data from KwaZulu-Natal, South Africa (2014–2015). HIV positive women who reported higher depression scores had a lower odds of having tested previously for HIV (15–25 years: AOR = 0.90, 95% CI [0.83, 0.98]; 26–49 years: AOR = 0.90, 95% CI [0.84, 0.96]). Because HIV testing behavior represents a gateway to treatment, the findings suggest mental health may be one challenge to attaining the UNAIDS 90-90-90 targets.

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The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa

Scientific Reports ◽

10.1038/s41598-021-94057-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Aditi Kuber ◽

Anna Reuter ◽

Pascal Geldsetzer ◽

Natsayi Chimbindi ◽

Mosa Moshabela ◽

...

Keyword(s):

South Africa ◽

Blood Pressure ◽

Body Mass Index ◽

Antiretroviral Therapy ◽

Body Mass ◽

Treatment Guidelines ◽

Causal Effect ◽

Regression Discontinuity Design ◽

National Treatment ◽

Kwazulu Natal

AbstractWe use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.

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Comparing effectiveness of first‐line antiretroviral therapy between peri‐urban and rural clinics in KwaZulu‐Natal, South Africa

HIV Medicine ◽

10.1111/hiv.13231 ◽

2022 ◽

Author(s):

Jaysingh Brijkumar ◽

Johnathan A. Edwards ◽

Brent A. Johnson ◽

Claudia Ordonez ◽

Henry Sunpath ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

First Line ◽

Kwazulu Natal ◽

Rural Clinics

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PIMATM point-of-care testing for CD4 counts in predicting antiretroviral initiation in HIV-infected individuals in KwaZulu-Natal, Durban, South Africa

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v17i1.444 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 2

Author(s):

Mandisa Skhosana ◽

Shabashini Reddy ◽

Tarylee Reddy ◽

Siphelele Ntoyanto ◽

Elizabeth Spooner ◽

...

Keyword(s):

South Africa ◽

T Cells ◽

T Cell ◽

Antiretroviral Therapy ◽

Cell Count ◽

Point Of Care ◽

Cd4 T Cell ◽

Cell Counts ◽

Kwazulu Natal ◽

Cd4 T Cell Count

Introduction: Limited information is available on the usefulness of the PIMATM analyser in predicting antiretroviral treatment eligibility and outcome in a primary healthcare clinic setting in disadvantaged communities in KwaZulu-Natal, South Africa.Materials and methods: The study was conducted under the eThekwini Health Unit, Durban, KwaZulu-Natal. Comparison of the enumeration of CD4+ T-cells in 268 patients using the PIMATM analyser and the predicate National Health Laboratory Services (NHLS) was undertaken during January to July 2013. Bland-Altman analysis to calculate bias and limits of agreement, precision and levels of clinical misclassification at various CD4+ T-cell count thresholds was performed.Results: There was high precision of the PIMATM control bead cartridges with low and normal CD4+ T-cell counts using three different PIMATM analysers (%CV < 5). Under World Health Organization (WHO) guidelines (≤ 500 cells/mm3), the sensitivity of the PIMATM analyser was 94%, specificity 78% and positive predictive value (PPV) 95%. There were 24 (9%) misclassifications, of which 13 were false-negative in whom the mean bias was 149 CD4+ T-cells/mm3. Most (87%) patients returned for their CD4 test result but only 67% (110/164) of those eligible (≤ 350 cells/mm3) were initiated on antiretroviral therapy (ART) with a time to treatment of 49 days (interquartile range [IQR], 42–64 days).Conclusion: There was adequate agreement between PIMATM analyser and predicate NHLS CD4+ T-cell count enumeration (≤ 500 cells/mm3) in adult HIV-positive individuals. The high PPV, sensitivity and acceptable specificity of the PIMATM analyser technology lend it as a reliable tool in predicting eligibility and rapid linkage to care in ART programmes.Keywords: HIV; Point of Care; PIMATM CD4+ T cell counts; antiretroviral therapy; prediction/eligibility; South Africa

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