Lessons learnt conducting minimally invasive autopsies in private mortuaries as part of HIV and tuberculosis research in South Africa

Current estimates of the burden of tuberculosis (TB) disease and cause-specific mortality in human immunodeficiency virus (HIV) positive people rely heavily on indirect methods that are less reliable for ascertaining individual-level causes of death and on mathematical models. Minimally invasive autopsy (MIA) is useful for diagnosing infectious diseases, provides a reasonable proxy for the gold standard in cause of death ascertainment (complete diagnostic autopsy) and, used routinely, could improve cause-specific mortality estimates. From our experience in performing MIAs in HIV-positive adults in private mortuaries in South Africa (during the Lesedi Kamoso Study), we describe the challenges we faced and make recommendations for the conduct of MIA in future studies or surveillance programmes, including strategies for effective communication, approaches to obtaining informed consent, risk management for staff and efficient preparation for the procedure.

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Modelling the epidemiologic impact of achieving UNAIDS fast-track 90-90-90 and 95-95-95 targets in South Africa

Epidemiology and Infection ◽

10.1017/s0950268818003497 ◽

2019 ◽

Vol 147 ◽

Cited By ~ 5

Author(s):

N. N. Abuelezam ◽

A. W. McCormick ◽

E. D. Surface ◽

T. Fussell ◽

K. A. Freedberg ◽

...

Keyword(s):

South Africa ◽

Human Immunodeficiency Virus ◽

Fast Track ◽

Viral Suppression ◽

Hiv Transmission ◽

Hiv Positive ◽

Agent Based ◽

Percentage Points ◽

Immunodeficiency Virus ◽

The Continuum

AbstractUNAIDS established fast-track targets of 73% and 86% viral suppression among human immunodeficiency virus (HIV)-positive individuals by 2020 and 2030, respectively. The epidemiologic impact of achieving these goals is unknown. The HIV-Calibrated Dynamic Model, a calibrated agent-based model of HIV transmission, is used to examine scenarios of incremental improvements to the testing and antiretroviral therapy (ART) continuum in South Africa in 2015. The speed of intervention availability is explored, comparing policies for their predicted effects on incidence, prevalence and achievement of fast-track targets in 2020 and 2030. Moderate (30%) improvements in the continuum will not achieve 2020 or 2030 targets and have modest impacts on incidence and prevalence. Improving the continuum by 80% and increasing availability reduces incidence from 2.54 to 0.80 per 100 person-years (−1.73, interquartile range (IQR): −1.42, −2.13) and prevalence from 26.0 to 24.6% (−1.4 percentage points, IQR: −0.88, −1.92) from 2015 to 2030 and achieves fast track targets in 2020 and 2030. Achieving 90-90-90 in South Africa is possible with large improvements to the testing and treatment continuum. The epidemiologic impact of these improvements depends on the balance between survival and transmission benefits of ART with the potential for incidence to remain high.

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Growth curve modelling to determine distinct BMI trajectory groups in HIV-positive adults on antiretroviral therapy in South Africa

AIDS ◽

10.1097/qad.0000000000002302 ◽

2019 ◽

Vol 33 (13) ◽

pp. 2049-2059

Author(s):

Alana T. Brennan ◽

Kaitlyn M. Berry ◽

Sydney Rosen ◽

Andrew Stokes ◽

Nigel J. Crowther ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Growth Curve ◽

Hiv Positive ◽

Hiv Positive Adults ◽

Growth Curve Modelling ◽

Bmi Trajectory

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Correction: The Impact of Gender Norms on Condom Use among HIV-Positive Adults in KwaZulu-Natal, South Africa

PLoS ONE ◽

10.1371/journal.pone.0129637 ◽

2015 ◽

Vol 10 (6) ◽

pp. e0129637 ◽

Cited By ~ 2

Author(s):

Kristin Fladseth ◽

Mitzy Gafos ◽

Marie Louise Newell ◽

Nuala McGrath

Keyword(s):

South Africa ◽

Condom Use ◽

Gender Norms ◽

Hiv Positive ◽

Kwazulu Natal ◽

Hiv Positive Adults ◽

The Impact

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Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a retrospective record review

BMC Public Health ◽

10.1186/s12889-019-7912-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Belisty Temesgen ◽

Getiye Dejenu Kibret ◽

Nakachew Mekonnen Alamirew ◽

Mamaru Wubale Melkamu ◽

Yitbarek Tenaw Hibstie ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Opportunistic Infections ◽

Preventive Therapy ◽

Hemoglobin Level ◽

Disease Stage ◽

Hiv Positive ◽

Immunodeficiency Virus ◽

Hiv Positive Adults ◽

Record Review

Abstract Background Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence and predictors of tuberculosis among people living with HIV. Thus, this study assessed the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy. Methods This study was a retrospective record review including 544 HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital between January 1, 2012 and December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from antiretroviral intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of tuberculosis. Results In the final analysis, a total of 492 HIV-positive adults were included, of whom, 83 (16.9%) developed tuberculosis at the time of follow-up. This study found that the incidence of tuberculosis was 6.5 (95% CI: 5.2, 8.0) per 100-person-years (PY) of observation. Advanced World Health Organization clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking Isonized Preventive Therapy (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of tuberculosis. Conclusion The study found that there was a high rate of tuberculosis occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking Isonized Preventive Therapy were found to be the predictors of tuberculosis. Therefore, early detection and treatment of opportunistic infections like tuberculosis should get a special attention.

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Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa100 ◽

2020 ◽

Vol 7 (4) ◽

Cited By ~ 3

Author(s):

Fiona V Cresswell ◽

Jayne Ellis ◽

Enock Kagimu ◽

Ananta S Bangdiwala ◽

Michael Okirwoth ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Odds Ratio ◽

Virus Disease ◽

Extrapulmonary Tuberculosis ◽

Hiv Positive ◽

Systematic Screening ◽

Immunodeficiency Virus ◽

Cell Pellet ◽

Hiv Positive Adults ◽

Advanced Hiv Disease

Abstract Background Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB/RIF Ultra (Ultra) in hospitalized adults. Methods We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018–2020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested with TB-LAM (Alere), and remaining urine was centrifuged with the cell pellet resuspended in 2 mL of urine for Xpert Ultra testing. Results We enrolled 348 HIV-positive inpatients with median CD4 of 37 cells/mcL (interquartile range, 13–102 cells/mcL). Overall, 26% (90 of 348; 95% confidence interval [CI], 21%–30%) had evidence of disseminated TB by either urine assay. Of 243 participants with both urine TB-LAM and Ultra results, 20% (48 of 243) were TB-LAM-positive, 12% (29 of 243) were Ultra-positive, and 6% (14 of 243) were positive by both assays. In definite and probable TB meningitis, 37% (14 of 38) were TB-LAM-positive and 41% (15 of 37) were Ultra-positive. In cryptococcal meningitis, 22% (40 of 183) were TB-LAM-positive and 4.4% (6 of 135) were Ultra-positive. Mortality trended higher in those with evidence of disseminated TB by either assay (odds ratio = 1.44; 95% CI, 0.83–2.49; P = .19) and was 6-fold higher in those with definite TB meningitis who were urine Ultra-positive (odds ratio = 5.67; 95% CI, 1.13–28.5; P = .04). Conclusions In hospitalized Ugandans with advanced HIV disease and suspected meningitis, systematic screening with urine TB-LAM and Ultra found a high prevalence of urine TB test positivity (26%). In those with TB meningitis, urine tests were positive in over one third. There was little concordance between Ultra and TB-LAM, which warrants further investigation.

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Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

10.21203/rs.2.11527/v4 ◽

2019 ◽

Author(s):

Belisty Temesgen ◽

Getiye Dejenu Kibret ◽

Nakachew Mekonnen Alamirew ◽

Animut Alebel

Keyword(s):

Opportunistic Infections ◽

Hemoglobin Level ◽

Disease Stage ◽

Hiv Positive ◽

Retrospective Record Review ◽

Immunodeficiency Virus ◽

Hiv Positive Adults ◽

Debre Markos ◽

Record Review

Abstract Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus (PLHIV) are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among people living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy (ART). Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Model with the least value of Akaike’s information criteria was selected as the best model. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow-up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person-years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: The study found that there was a high rate of TB occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Therefore, early detection and treatment of opportunistic infections like TB should get a special attention. Keywords: Debre Markos, HIV, Incidence, Predictors, TB

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Prevalence of Depression among HIV-Positive Adults on Antiretroviral Therapy in O.R. Tambo, Eastern Cape, South Africa: A cross-sectional descriptive study

10.21203/rs.3.rs-33145/v2 ◽

2020 ◽

Author(s):

Dlulane Yola Zimasa ◽

Apalata Teke ◽

Dominic Targema Abaver

Keyword(s):

South Africa ◽

Logistic Regression ◽

Antiretroviral Therapy ◽

Descriptive Study ◽

Hiv Positive ◽

Eastern Cape ◽

Cross Sectional ◽

Prevalence Of Depression ◽

Hiv Positive Adults ◽

Hiv Aids

Abstract Background Living with HIV/AIDS is associated with negative emotional and bodily symptoms; however, there is paucity of data on the prevalence and associated factors depression among this population. This study investigate the prevalence and factors contributing to depression among HIV-positive adults on antiretroviral therapy (ART) in O.R. Tambo Eastern Cape, South Africa. Method This cross-sectional descriptive study involved 334 adults receiving ART in the two Community Health Centers in OR Tambo District, Eastern Cape, South Africa. The Beck’s Depression Inventory (BDI-II) was used to collect data, in addition to a semi-structured questionnaire on coping mechanism and challenges in seeking help with depressive symptoms. Multiple logistic regression analysis were used to assess the factors associated with depression among the HIV-positive adults. Results The prevalence of depression among the HIV-positive adults receiving ART was 44%, and the majority of the patient’s depression fall within the borderline and moderate threshold. The prevalence of depression was significantly higher among females (71.0%; p < 0.0003) and unemployed (73.0%; p < 0.0014) HIV-positive adults. Participants not benefiting from any form of social grant exhibited higher prevalence of depression (79%). Race (p=0.590), age (p=0.338) and married participants (p=0.511) show no statistical significant association between HIV-positive adults accessing ART and depression. Unadjusted logistic regression model show being female (OR = 1.99, 95% CI: 1.23-3.23; p < 0.003) and unemployed (OR =1.73, 95% CI: 1.08-2.77; p < 0.014) were significantly associated with a likelihood of depression. Majority of the participants who could express their feelings of HIV disease and challenges in accessing ART felt more depressed (85%) compared to those who could not express their feelings.Conclusion The rate of depression among HIV/AIDS patients receiving ART is high. Early detection of depression and the challenges associated with accessing treatment and treating would help in improving the compliance to treatment as well as quality of life.

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Incidence of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

10.21203/rs.2.11527/v2 ◽

2019 ◽

Author(s):

Belisty Temesgen ◽

Getiye Dejenu Kibret ◽

Nakachew Mekonnen Alamirew ◽

Animut Alebel

Keyword(s):

Human Immunodeficiency Virus ◽

Opportunistic Infections ◽

Hemoglobin Level ◽

Disease Stage ◽

Hiv Positive ◽

Retrospective Record Review ◽

Immunodeficiency Virus ◽

Hiv Positive Adults ◽

Record Review

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among peoples living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on ART. Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Data were entered using Epi-Data version 4.2 and analyzed using STATA Version 13. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of the time to develop TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: In this study, a high incidence rate of TB was observed among HIV-positive adults. Advanced WHO clinical disease stage (III and IV), being ambulatory and bedridden, baseline opportunistic infections, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Keywords: HIV, Incidence, Predictors, TB

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