Identifying missed opportunities for early intervention among HIV-infected paediatric admissions at Chris Hani Baragwanath hospital, Soweto, South Africa

Background and design. HIV is a major contributor to childhood morbidity and mortality in South Africa. We describe HIV prevalence, disease profile, outcome and missed opportunities for early intervention in a cohort of HIV-infected children admitted to Chris Hani Baragwanath Hospital’s general paediatric wards between 1 October 2007 and 31 December 2007.Results. Of 1 510 admissions, 446 (29.5%) were HIV infected. Many children (238, 54.1%) were newly diagnosed in hospital and most had advanced HIV disease (405, 92%). The principal admission diagnoses were pneumonia (165, 37.5%), gastro-enteritis (97, 22%), sepsis (86, 19.5%) and tuberculosis (92, 21%). Of children identified as HIV infected before admission, 128/202 (63.4%) were not accessing antiretroviral treatment (ART), although 121/128 (94.5%) met ART eligibility criteria. Of 364 ART-naïve eligible children, only 15 (4.1%) were commenced on ART as inpatients. Problems with PMTCT implementation in infants under 6 months (N=166) included lack of maternal antenatal HIV testing (51, 30.7%); poor uptake of maternal/infant nevirapine prophylaxis (60, 36.2%); limited use of co-trimoxazole (CTX) prophylaxis (44/147, 29.9%); and delayed infant HIV polymerase chain reaction testing (98/147, 87.5%). Of infants known to be HIV infected prior to hospitalisation, 37/51 (73%) had not initiated ART. The in-hospital case fatality rate (CFR) among HIV-infected children was triple that of the combined HIV-uninfected, exposed and unknown group (12% v. 3.6%). Infants <12 months of age accounted for 73.6% of all HIV-related deaths (CFR 17.1%).Conclusions. HIV remains highly prevalent and contributes to significant in-hospital mortality. Missed opportunities for PMTCT, HIV diagnosis and ART initiation are frequent. Interventions to optimise paediatric HIV outcomes should target maternal HIV diagnosis, early infant diagnosis, uptake of CTX prophylaxis and prompt initiation of ART, especially among infants. Hospitalised ART-eligible children should be prioritised for inpatient initiation of ART

Thalassaemia (part 2)

No abstract

SLIM : Scalable Linkage of Mobility Data

We present a scalable solution to link entities across mobility datasets using their spatio-temporal information. This is a fundamental problem in many applications such as linking user identities for security, understanding privacy limitations of location based services, or producing a unified dataset from multiple sources for urban planning. Such integrated datasets are also essential for service providers to optimise their services and improve business intelligence. In this paper, we first propose a mobility based representation and similarity computation for entities. An efficient matching process is then developed to identify the final linked pairs, with an automated mechanism to decide when to stop the linkage. We scale the process with a locality-sensitive hashing (LSH) based approach that significantly reduces candidate pairs for matching. To realize the effectiveness and efficiency of our techniques in practice, we introduce an algorithm called SLIM. In the experimental evaluation, SLIM outperforms the two existing state-of-the-art approaches in terms of precision and recall. Moreover, the LSH-based approach brings two to four orders of magnitude speedup

Is Option B+ the best choice?

The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in middle-income countries, together with clinical trial data on antiretroviral (ARV) treatment as prophylaxis, has emboldened UN agencies to aggressively promote lifelong ARVs for PMTCT (Option B+). Unsubstantiated claims submit that Option B+ is cost-effective at population-level, will protect HIV-negative male partners, improve maternal and infant health, and increase ARV coverage. We provide counterfactual arguments about the ethics, medical safety, programme feasibility and economic benefits of Option B+.Option B+ offers no advantage to PMTCT and there are social hazards associated with privileging pregnant woman for treatment over men and non-pregnant women, especially with the absence of data to suggest that discordant relationships are more frequent among pregnant women or that they contribute disproportionately to the horizontal HIV transmission. The benefits and safety of long-term ARVs – including adherence and resistance – in mothers who do not need treatment for their own health, need to be considered, as well as, crucially, health service costs. The assumption that a decrease in efficiency caused by inappropriate targeting is compensated for by lower recruitment costs, is untested. Lives could be saved instead with appropriately targeted interventions. Countries should make individual decisions based on their HIV epidemiology, resources, priorities and local evidence.S Afr J HIV Med 2013;14(1):8-10. DOI:10.7196/SAJHIVMED.898This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8