scholarly journals THE ROLE OF HIV IN THE PATHOGENESIS OF ADULT-ONSET VERNAL KERATOCONJUNCTIVITIS: A DEMOGRAPHIC AND EPIDEMIOLOGICAL STUDY

2019 ◽  
Author(s):  
Anine Kritzinger ◽  
Anthony Grant Zaborowski ◽  
Wilbert Sibanda ◽  
Linda Visser
Keyword(s):  
Cd4 Count ◽  
Vernal Keratoconjunctivitis ◽  
Hiv Positive ◽  
P Value ◽  
Adult Onset ◽  
Atopic Diseases ◽  
Hiv Status ◽  
Chi Squared ◽  
History Of ◽  
New Onset

Abstract Background: Very few studies in the literature describe adult-onset vernal keratoconjunctivitis (VKC). HIV has many associated ocular pathologies and an association with VKC has not been described yet. The aim is to identify and describe patients who present with new-onset VKC after puberty, with no prior history of atopic diseases or allergies. Methods: The study consisted of two parts: the first part was a prospective observational descriptive study of patients with adult-onset VKC, detailing the epidemiological and demographic characteristics of these patients, including their HIV status. The second was a case-control study to determine the relationship of a CD4 count with adult-onset VKC in the setting of HIV. Patients were recruited between January 2016 and November 2017 from McCord Provincial Eye hospital, one of two large referral hospitals for the province of KwaZulu-Natal, South Africa. Patients presenting to the Eye clinic were screened at the Primary Eye Care Unit. Inclusion criteria were age 15 years and older with signs and symptoms of new-onset VKC. Exclusion criteria were a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who refused HIV testing. Data collected included HIV status, CD4 count where appropriate, anti-nuclear antibodies and total serum immunoglobulin E. Results: 33 patients were included in this study; females n=16, males n=17. The mean age at presentation was 32.45±9.93 years, 95% CI=28.94-35.97. All of the patients were black Africans. One patient tested ANA positive. 51.5% of patients had a raised IgE level. A total of 13 of 25 HIV positive patients (52%) had a raised IgE. The proportion of HIV positive patients was statistically different from the HIV negative group, with Chi-squared = 21.866, p-value <0.0001. 72% of the HIV positive patients were grouped as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of having VKC (chi-squared=4.992, p-value=0.0255). Conclusion: In this cohort a statistically significant association was found between adult-onset vernal keratoconjunctivitis and an HIV positive status. This association calls for more research on the subject, but could imply that patients presenting with adult-onset VKC should be offered an HIV test. Key words: Vernal keratoconjunctivitis, New-onset VKC Adult-onset VKC Ocular manifestations of HIV Allergy Immunocompromised.

scholarly journals 1371. Tuberculosis and HIV Coinfection in the Bahamas: A Retrospective Review of Cases Diagnosed Between 2014 and 2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S496-S497
Author(s):  
Javardo McIntosh ◽  
Kevin Moss ◽  
Nikkiah Forbes ◽  
M Anthony C Frankson
Keyword(s):  
Risk Factor ◽  
Antiretroviral Therapy ◽  
Cd4 Count ◽  
World Health ◽  
Public Health Issue ◽  
Hiv Positive ◽  
Hiv Status ◽  
The Bahamas ◽  
Radiologic Findings ◽  
Hiv Coinfection

Abstract Background Tuberculosis (TB) is one of the oldest diseases known to man, yet the world health organization reports that TB is one of the top 10 causes of death worldwide. HIV infection is the most potent biologic risk factor for developing tuberculosis. The HIV epidemic has been responsible for increasing the burden of TB worldwide and The Bahamas has been no exception. The aim of this study was to determine the HIV testing rate as well as prevalence of TB-HIV coinfection for The Bahamas and compare cases of TB based on HIV status for clinical presentation, radiologic findings, TST results and Smear and Culture results. We also evaluated cases of TB-HIV for degree of immunosuppression and compliance to antiretroviral therapy. Methods A retrospective chart review of cases of Tuberculosis diagnosed at the Princess Margaret Hospital, Nassau, Bahamas. 189 cases of active tuberculosis diagnosed between 2014 and 2016 and all cases were evaluated for demographics, risk factors, HIV status, clinical manifestation, radiologic findings, and smear and culture results. Results Of the 189 cases of notified tuberculosis between 2014 and 2016, 109 (59.9%) were HIV negative and 73 (40.1%) were HIV positive. For patients who were HIV positive, 54(74%) were previously diagnosed with HIV and 19(26%) were newly diagnosed. Of the patients who were previously diagnosed with HIV, 14(25.9%) were on antiretroviral (ARV) medications and compliant, 34(63.0%) were on ARVs and noncompliant and 6(11.1%) were not on ARVs. 4(8.2%) patient had a CD4 count ≥500, 8(16.3%) patients had a CD4 count between 499–200 and 37(75.5%) had a CD4 counts 1000. Conclusion HIV is a major risk factor for Tuberculosis in the Bahamas and it is advised that all patients diagnosed with TB be tested for HIV. Routine screening of HIV patients for TB is recommended. Noncompliance with antiretroviral therapy remains a public health issue as it increases susceptibility to TB infection. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

2020 ◽  
Vol 8 (4) ◽  
pp. 283-290
Author(s):  
A. Amoko ◽  
P.O. Ajiboye ◽  
F.A. Olagunju ◽  
R.O. Shittu
Keyword(s):  
Family Medicine ◽  
Cell Count ◽  
Teaching Hospital ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Prevalence Of Depression ◽  
Cd4 Cell

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with  cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of < 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302). Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

scholarly journals Recurrent Miscarriage and Consanguinity among Omani Women– A Cross Sectional Study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Fatma Al Hoqani ◽  
Wadha Al Ghafri ◽  
Saneya El tayeb ◽  
Yahya Al Farsi ◽  
Vaidyanathan Gowri
Keyword(s):  
Recurrent Miscarriage ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Control Group ◽  
P Value ◽  
Cross Sectional ◽  
Recurrent Miscarriages ◽  
Sultan Qaboos University ◽  
Chi Squared ◽  
History Of

Objective: to determine the prevalence of explained and unexplained recurrent miscarriages (RM) and to find out if there is a significant relationship between recurrent miscarriages and consanguinity. Methods: A cross sectional in which the cases group included all women with RM attending the outpatient clinic at Sultan Qaboos University Hospital from July 2006 to April 2012 and the controls group included women with no history of RM after matching them with cases for age (case to control ratio was 1:1). The main outcome measures were the prevalence of consanguinity in women with or without recurrent miscarriages. Results: During study period a total of 290 women with RM were seen. Of which, 150 (51.7%) women had unexplained RM. Control group with no history of RM were 300 women. Consanguinity rate among cases (49.5%) %) was less than the controls (52.7 %%). Both first cousin and second cousin marriages were more common in the controls than the cases and it was not statistically significant (p value 0.476, chi squared test). Conclusion: In this study we found that more than half of RM cases were unexplained and there was no significant association between RM and consanguinity.

scholarly journals Clinical Characteristics of Incident Lymphoma in Malawi before and after Implementation of Universal Anti-Retroviral Therapy

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1445-1445
Author(s):  
Yolanda Gondwe ◽  
Evaristar Kudowa ◽  
Tamiwe Tomoka ◽  
Cara Randall ◽  
Amy Lilly ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
B Cell Lymphoma ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Proliferation Index ◽  
Hiv Positive ◽  
Hiv Status ◽  
Time Period ◽  
The Us ◽  
Sub Saharan

Abstract Purpose: In 2016, Malawi implemented a universal test and treat (UTT) policy, expanding eligibility for antiretroviral therapy (ART) to anyone with confirmed HIV infection. Prior to 2016, Malawi restricted ART initiation to HIV-positive individuals with CD4 count ≤500 cells/µL, with WHO staging ≥III who were pregnant or breastfeeding, or who were younger than 5 years old. Here, we assess the impact on distribution of lymphoma presentation and baseline clinical characteristics at Kamuzu Central Hospital, Lilongwe, Malawi. Methods: Participants with newly diagnosed, pathologically confirmed lymphoproliferative disorders were enrolled from 2013 - 2020. We categorized participants as pre-universal ART (pre-UART) if enrolled during 2013-June 2016 or post-universal ART (post-UART) if enrolled during July 2016-2020 and evaluated clinical characteristics. Findings: Of 412 total participants, 156 were pre-UART and 256 were post-UART. The most common diagnoses were diffuse large B-cell lymphoma (DLBCL) (45%), low-grade lymphoma (11%), Burkitt lymphoma (10%), Hodgkin lymphoma (9%), and multicentric Castleman disease (7%) and there was no significant difference in distribution of diagnoses between pre-UART and post-UART periods (Figure 1). HIV prevalence was 50%, mean age 43, and 62% male. Sixty-six percent (48/73) of pre-UART HIV-positive participants knew their HIV status, for median 5 years (IQR 2-8) and 71% (41/58) were on ART for median 4 years (IQR 2-7). Eighty percent (94/117) of post-UART HIV positive participants knew their HIV status (p=0.02), for median 4 years (IQR 2-9) and 84% (89/106) were on ART (p=0.05) for median 4 years (IQR 2-8). HIV was suppressed &lt;1000 copies/mL in 56% (33/59) pre-UART and 71% (73/103) post-UART (p=0.05). Among DLBCL participants, 61% (23/38) of pre-UART HIV-positive participants knew their HIV status, for median 5 years (IQR 2-9), 61% (19/31) were on ART for median 4 years (IQR 2-6). Eighty-two percent (n=51/63) of post-UART DLBCL HIV-positive participants knew their HIV status (p=0.02) for median 5 years (IQR 2-9) and 89% (47/53) were on ART (p &lt; 0.01) for median 5 years (IQR 2-9). Post-UART DLBCL participants had median HIV viral load of 0 log copies/mL (IQR 0-10) compared to pre-UART (6.2; IQR 0-10) (p=0.09). CD4 count, age adjusted-IPI and Ki67 proliferation index were similar for DLBCL patients in the two groups. Interpretation: There were no significant differences in lymphoma subtypes diagnosed or in traditional DLBCL prognostic factors after implementation of universal ART in Malawi. However, HIV was better controlled in the post-UART period and differences in immunological status may have implications for therapy and prognosis. Strengths of this study include a deeply characterized cohort, both clinically and pathologically. As opposed to epidemiological data from the US and Europe, we did not see a major shift in diagnoses over this time period with increasing access to ART. However, possible explanations for the differences include that this is not a epidemiological survey as cancer registration data is not comprehensively collected in Malawi and that the roll out of ART across sub-Saharan Africa has been much more gradual than the abrupt increase in access that was seen in the US and Europe. Therefore, epidemiological chances may also be more gradual. In summary, this is some of the most comprehensive data on lymphoma presentation from sub-Saharan Africa across periods of increasing access to ART and despite improved HIV control among incident lymphoma cases, there was no change in the distribution of diagnoses in this time period. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Neurocysticercosis: a commonest neuroimaging abnormalitiy in children with first afebrile seizure in central India

2016 ◽  
Vol 4 (1) ◽  
pp. 241
Author(s):  
Agarwal G. ◽  
Lazarus M. ◽  
Roy A. ◽  
Ajmariya M.
Keyword(s):  
Parietal Lobe ◽  
Central India ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Abnormal Chest ◽  
First Onset ◽  
History Of ◽  
Afebrile Seizure ◽  
New Onset

Background: Seizures are the commonest neurological ailments in paediatrics in ~10%, even though the role of emergent neuroimaging in first onset afebrile seizure is not well defined.Methods: A prospective observational study was conducted in NSCB Medical College, Jabalpur, Madhya Pradesh, India to determine the incidence of neuroimaging abnormalities in children with first onset afebrile seizure and to make specific recommendations for use of routine neuroimaging in the new onset afebrile seizure. A total of 75 children (1 month to 14 years of age) with the new-onset afebrile seizure were enrolled and underwent clinical examination & neuroimaging. We defined first seizure using the international league against epilepsy (ILAE). The data were recorded and analysed by Student ‘t’ test for continuous variables, Fisher’s Exact Test or Chi square test for categorical variables. The critical level of significance was considered at P < 0.05 level.Results: Neuroimaging abnormalities were found in 66.7% of the cases, mostly in the children above 2 years of age (72.6 %) (P value <0.05). A significant relationship (P <0.001) was observed between focality (partial seizures (83.8%)) and abnormal neuroimaging, among these neurocysticercosis (26.7%) were in highest proportion with parietal lobe as the commonest involvement. The cases with contact history of tuberculosis /mantoux positivity/abnormal chest radiography were found significantly interrelated with tuberculoma (P <0.05).Conclusions: In developing countries like India the prevalence of neurocysticercosis and tuberculoma is high, hence neuroimaging in all cases of first onset afebrile seizure/ focal seizure with mantoux positive/ history of Contact /abnormal chest radiograph can be kept in a view for better management of child.

scholarly journals Association between Attention Deficit Hyperactivity Disorder and Suicide Attempts in Patients with Bipolar Disorder

2019 ◽  
Author(s):  
Jafar Fili ◽  
Marzieh Nojomi ◽  
Katayoon Razjouyan ◽  
Mojgan Kahdemi ◽  
Rozita Davari- Ashtiani
Keyword(s):  
Bipolar Disorder ◽  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Suicide Attempts ◽  
P Value ◽  
Hyperactivity Disorder ◽  
Significant Difference ◽  
Chi Squared ◽  
History Of

Objective: The present study aimed to examine the association between ADHD and suicide attempts among adolescents with bipolar disorder. Method: Participants were 168 adolescents who fulfilled DSM-IV-TR criteria for bipolar disorder. They were divided into 2 groups: The first group of patients with bipolar disorder with a history of suicide attempts (n = 84) and the second group without a history of suicide attempts (n = 84). ADHD and other variables were analyzed using a chi-squared test and logistic regression model. Results: No significant difference was observed between the 2 groups in comorbidity of ADHD and other psychiatric disorders (P value > 0/05). In the logistic regression model, and after controlling for other factors, gender (OR = 3.9, CI 95%: 1.5-9.6) and history of sexual abuse (OR = 3.4; CI 95%: 1.06-11.3) were the only 2 factors associated with a history of suicide attempts. Conclusion: No significant association was found between ADHD and suicide attempts in adolescents with bipolar disorder.

scholarly journals Performance of COVID-19 associated symptoms and temperature checking as a screening tool for SARS-CoV-2 infection

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257450
Author(s):  
Benjamin Demah Nuertey ◽  
Kwame Ekremet ◽  
Abdul-Rashid Haidallah ◽  
Kareem Mumuni ◽  
Joyce Addai ◽  
...  
Keyword(s):  
Public Space ◽  
Roc Analysis ◽  
Screening Tool ◽  
Clinical Symptoms ◽  
Effective Means ◽  
Final Diagnosis ◽  
P Value ◽  
Social Distancing ◽  
Chi Squared ◽  
History Of

Introduction Coronavirus disease-19 (COVID-19), which started in late December, 2019, has spread to affect 216 countries and territories around the world. Globally, the number of cases of SARS-CoV-2 infection has been growing exponentially. There is pressure on countries to flatten the curves and break transmission. Most countries are practicing partial or total lockdown, vaccination, massive education on hygiene, social distancing, isolation of cases, quarantine of exposed and various screening approaches such as temperature and symptom-based screening to break the transmission. Some studies outside Africa have found the screening for fever using non-contact thermometers to lack good sensitivity for detecting SARS-CoV-2 infection. The aim of this study was to determine the usefulness of clinical symptoms in accurately predicting a final diagnosis of COVID-19 disease in the Ghanaian setting. Method The study analysed screening and test data of COVID-19 suspected, probable and contacts for the months of March to August 2020. A total of 1,986 participants presenting to Tamale Teaching hospital were included in the study. Logistic regression and receiver operator characteristics (ROC) analysis were carried out. Results Overall SARS-CoV-2 positivity rate was 16.8%. Those with symptoms had significantly higher positivity rate (21.6%) compared with asymptomatic (17.0%) [chi-squared 15.5, p-value, <0.001]. Patients that were positive for SARS-CoV-2 were 5.9 [3.9–8.8] times more likely to have loss of sense of smell and 5.9 [3.8–9.3] times more likely to having loss of sense of taste. Using history of fever as a screening tool correctly picked up only 14.8% of all true positives of SARS-CoV-2 infection and failed to pick up 86.2% of positive cases. Using cough alone would detect 22.4% and miss 87.6%. Non-contact thermometer used alone, as a screening tool for COVID-19 at a cut-off of 37.8 would only pick 4.8% of positive SARS-CoV-2 infected patients. Conclusion The use of fever alone or other symptoms individually [or in combination] as a screening tool for SARS-CoV-2 infection is not worthwhile based on ROC analysis. Use of temperature check as a COVID-19 screening tool to allow people into public space irrespective of the temperature cut-off is of little benefit in diagnosing infected persons. We recommend the use of facemask, hand hygiene, social distancing as effective means of preventing infection.

HPV-mediated anal squamous cell carcinoma and precancerous lesions in HIV positive patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3520-3520
Author(s):  
Omar Bushara ◽  
Brian Finkelman ◽  
Sam Weinberg ◽  
Katrina Krogh ◽  
Aparna Kalyan ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Precancerous Lesions ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Hiv Status ◽  
Anal Lesions ◽  
Intraepithelial Lesions ◽  
Hiv Negative

3520 Background: Anal cancer affects over 8,000 patients per year in the United States and the incidence is increasing. A significant risk factor for anal cancer and precancerous lesions is human papilloma virus (HPV), with up to 90% of cases being associated with HPV infection. Another emerging risk factor is HIV co-infection. In the present study, we further address if CD4 count is a significant factor for driving higher-grade HPV-mediated anal squamous lesions in HIV/HPV co-infection patients with a single institution large cohort. Methods: A retrospective cohort of HPV-positive patients with anal biopsies was obtained from 2002-2020. Information on the grade of their anal lesion, HIV status, and CD4 count (cells/mm3) were collected. In patients with HIV, the most recent CD4 count up to one year prior to or one month after their biopsy was utilized in our analysis. Lesions were grouped into low grade squamous intraepithelial lesions (LSIL) and higher grade squamous intraepithelial lesions (HSIL), carcinoma in situ (CIS), or squamous cell carcinoma (SCC). The Center for Disease Control CD4 count levels to define HIV status were utilized in our sub-analyses. The distribution of lesion grades was compared between HIV-negative and -positive patients, and between HIV-negative and three subgroups of HIV-positive patients using the Fisher’s exact test. Results: Our cohort comprised of 3,354 total HPV-positive patients. 2,036 of these patients were HIV-negative and 1318 were HIV-positive. The proportion of higher grade lesions was significantly higher in HIV/HPV co-infected patients regardless of CD4 count (Table). The full cohort of HIV-positive patients had lower rates of LSIL (60.8% vs. 74.0%) and higher rates of higher-grade lesions (39.2% vs. 26.0%) (p<0.001) compared to HIV-negative patients. The distribution of lesion grades was also significantly different between HIV-negative patients and all HIV-positive patient subgroups, with all subgroups having higher rates of higher-grade lesions than HIV-negative patients (all p<0.001). Conclusions: Our data show that HIV-HPV co-infection is a risk factor for higher grade anal lesions, regardless of CD4 status. This suggests that CD4 count is not the only factor responsible for the increased risk of higher-grade anal lesions, as the groups of HIV-positive patients with CD4 counts between 200-499 and above 499 still had a higher rate of higher-grade lesions than HIV-negative patients. Further research into other HIV-related immunologic changes that increase risk for higher-grade HPV-driven anal lesions is warranted.[Table: see text]

scholarly journals Study of prevalence of ocular manifestations in HIV positive patients

2019 ◽  
Vol 11 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Nishtha Saini ◽  
Sonia Hasija ◽  
Prempal Kaur ◽  
Manpreet Kaur ◽  
Vishal Pathania ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Opportunistic Infections ◽  
Optic Tract ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
Multiple Systems ◽  
Ocular Manifestations ◽  
Ocular Symptoms ◽  
Ophthalmic Manifestations

Introduction: HIV/AIDS is a disorder which affects multiple systems in our body but ophthalmic manifestations do occur in 70-80% of patients sometime during their lifetime. Eye is affected either directly by HIV virus or indirectly through various opportunistic infections. HIV related ophthalmic manifestations are wide and can affect any part of eye from a dnexal disorders to posterior segment diseases including the optic nerve and the optic tract. This study was done to know the prevalence of ocular manifestations in the known HIV positive case & to correlate the ocular manifestations in HIV positive patients with their CD4+ lymphocyte count and duration of disease. Material & Methods: In the present study, we examined 200 known cases of HIV infection who attended the Out Patient Department of Government Eye Hospital, Amritsar, Punjab. Detailed ocular examination was done and the findings were correlated with CD4+ count and duration of the disease. Result: In the present study it was found that dry eye and HIV retinopathy were amongst the most common ocular manifestations accounting for 20.5% and 20% of the total cases. Next in the series was neuro ophthalmic complications which include dpapilledema, optic nerve atrophy, papillitis and also third nerve abnormalities. It consisted of 5.5% of the total cases. Almost equal in incidence was anterior uveitis consisting of 5% of the total. Next of importance was CMV retinitis of which 5 cases were seen which constituted 2.5% of the total and all these cases were observed in the patients with CD4+ count less than 50/mm3. p value for this was 0.008 which was statistically significant. Few cases of blephar it is, conjunctivitis, cellulitis, herpes zoster ophthalmic us and keratitis were also found which consisted of 2.5%, 0.5%, 1%,3%, and 2% respectively. Conclusion: Any HIV-infected person who at any stage experiences ocular symptoms also should get competent ophthalmologic care at the earliest. Any delay in treatment can lead to permanent visual loss. An improved coordination between two branches of ophthalmology and HIV medicine will need long coordination against this dreadful disease.

scholarly journals Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa

2021 ◽  
Vol 6 (5) ◽  
pp. e005250
Author(s):  
Jody Boffa ◽  
Sizulu Moyo ◽  
Jeremiah Chikovore ◽  
Angela Salomon ◽  
Benjamin Daniels ◽  
...  
Keyword(s):  
South Africa ◽  
Cape Town ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Clinical Practices ◽  
History Of ◽  
Knowledge And Practice ◽  
The Difference

BackgroundSouth Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs).MethodsSixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1, typical TB symptoms, HIV-positive; case 2, TB-specified laboratory report, HIV-negative and case 3, history of incomplete TB treatment, HIV-positive. Clinical practices were recorded in standardised exit interviews. Ideal management was defined as relevant testing or public sector referral for any reason. The difference between knowledge and practice (know-do gap) was assessed through case 1 vignettes among 25% of GPs. Factors associated with ideal management were assessed using bivariate logistic regression.Results511 SP visits were completed with 212 GPs. Respectively, TB and HIV were ideally managed in 43% (95% CI 36% to 50%) and 41% (95% CI 34% to 48%) of case 1, 85% (95% CI 78% to 90%) and 61% (95% CI 73% to 86%) of case 2 and 69% (95% CI 61% to 76%) and 80% (95% CI 52% to 68%) of case 3 presentations. HIV status was queried in 35% (95% CI 31% to 39%) of visits, least with case 1 (24%, 95% CI 18% to 30%). The difference between knowledge and practice was 80% versus 43% for TB and 55% versus 37% for HIV, resulting in know-do gaps of 37% (95% CI 19% to 55%) and 18% (95% CI −1% to 38%), respectively. Ideal TB management was associated with longer visit time (OR=1.1, 95% CI 1.1 to 1.2), female GPs (3.2, 95% CI 2.0 to 5.1), basic symptom inquiry (2.0, 95% CI 1.7 to 2.3), HIV-status inquiry (OR=11.2, 95% CI 6.4 to 19.6), fewer medications dispensed (OR=0.6, 95% CI 0.5 to 0.7) and Cape Town (OR=2.2, 95% CI 1.5 to 3.1). Similar associations were observed for HIV.ConclusionsPrivate providers ideally managed TB more often when a diagnosis or history of TB was implied or provided. Management of HIV in the context of TB was less than optimal.

Sign in / Sign up

Export Citation Format

Share Document