Maternal HIV viral load testing during pregnancy and postpartum care in Gauteng Province, South Africa

Background. Pregnant and breastfeeding women living with HIV (WLHIV) are a target population for elimination of mother-to-child transmission of HIV (eMTCT). However, there are limited data on maternal virological responses during pregnancy and the postpartum period in South Africa (SA).Objectives. To review compliance of viral load (VL) testing with national guidelines and suppression rates during pregnancy and up to 9  months postpartum among WLHIV delivering in four tertiary hospitals in Gauteng Province, SA.Methods. All women who had a point-of-care HIV VL test using Xpert HIV-1 VL (Cepheid, USA) at delivery in four tertiary obstetric units in Gauteng between June 2018 and February 2020 were included. HIV VL tests of eligible women performed up to 9 months before and after delivery were extracted from the National Health Laboratory Service’s Corporate Data Warehouse. Proportions of women delivering who had antenatal and postpartum VL tests performed and their suppression rates were determined and expressed as percentages.Results. Of 4 989 eligible WLHIV (median age 31.1 years), 917 (18.4%) had a VL performed during the antenatal period; of these, 335 (36.5%) had a VL ≥50 copies/mL and 165 (18.0%) a VL ≥1 000 copies/mL. At delivery, 1 911 women (38.3%) had a VL ≥50 copies/mL and 1 028 (20.6%) a VL ≥1 000 copies/mL. Among 627 women (12.6%) with a VL test postpartum, 234 (37.3%) had a VL ≥50 copies/mL and 93 (14.8%) a VL ≥1 000 copies/mL. Overall, having a VL test performed during the antenatal period was associated with viral suppression at delivery and receiving a VL test postpartum (p<0.001). Women with a VL ≥50 copies/mL at delivery were more likely to be younger and to remain virally unsuppressed postpartum (p<0.001) compared with women with a VL <50 copies/mL.Conclusions. Fewer than 5% of WLHIV with a VL at the time of delivery received VL monitoring during the antenatal and postpartum periods in accordance with national guidelines. More than 80% of WLHIV delivering had no evidence of VL monitoring during the antenatal period, and they were more likely than women who received monitoring during the antenatal period to be virally unsuppressed at delivery and to receive no VL monitoring postpartum. Women with a high VL at delivery were likely to remain virally unsuppressed postpartum. These results emphasise the need for closer monitoring of and rapid reaction to high maternal VLs during pregnancy, at delivery and postpartum for attainment of eMTCT

Effluent quality of wet process coffee processing factories in coffee growing ecological zones in Burundi

Open Access Article; Published online: 30 Nov 2020Arabica coffee is cultivated by smallholders for commercial purposes, and it is commonly processed using wet Coffee Processing Technology. Burundi has more than 250 Coffee Processing factories which discharge their effluents to water bodies. The goal of this study was to determine the levels of physicochemical parameters in wastewater from Coffee Processing Technology factories in major coffee growing ecological zones in Burundi. Wastewater samples were collected from 19 sites representing private, public and cooperative owned coffee processing stations. Physicochemical analyses were determined in-situ field and laboratory conditions using standard procedures. Results indicate that the wastewater does not meet Burundi Effluent Discharge standards for Total Suspended solids, Chemical Oxygen Demand, Biochemical Oxygen Demand, pH. The data revealed that the wet coffee processing pollutes the environment in terms of pH, Total Suspended solids, Chemical Oxygen Demand, Biochemical Oxygen Demand. There is need to install quality polishing technologies to treat the water before disposal

Effects of lime and phosphorus rates on growth of hybrid Arabica coffee seedlings at Jimma, southwest Ethiopia

Open Access ArticleCoffee growing soil of southwestern region parts of Ethiopia are classified as Nitisols with having a low pH and highly deficient in phosphorus. A nursery experiment was conducted at Jimma Agricultural Research Center, southwestern Ethiopia to evaluate the effects of lime and phosphorus rates on coffee seedling growth under nursery conditions. The experiment was laid out in a randomized complete block design with 3 replications. The treatments were arranged in factorial combinations of five levels of lime (0, 5, 10, 15 and 20 g) and four levels of phosphorus (0, 400, 600 and 800 mg) 2.5 kg-1top soil. The statical data was analyzed through SAS software and treatment means were compared at 5% probability using Duncan Multiple Range Test. The results revealed that the interactions of lime and P rates significantly increased the growth of both non-destructive parameters (plant height, girth, number of nods, interned length, leaf number and leaf area) and Root growth parameters (taproot length, lateral root length, lateral root number, root volume, leaf stem and root fresh weight, of coffee seedlings. The maximum shoot and root extensions were obtained from the interaction of 10 g lime and 800 mg P rates 2.5 kg-1top soil. On the other hand, applications of P significantly (P≤ 0.01) affected soil and plant growth parameters. As P rate increased availability P boosted and plant growth were enhanced. Similarly, an application of lime significantly affected (P≤ 0.01) plant growth and enhance nutrient availability up to 10 g, though further applications adversely affect seedling growth and nutrient availability. Hence, combined application of 10 g lime and 800 mg P rate 2.5 kg-1top enhances the optimum growth of coffee seedlings under nursery conditions

Evaluating the performance of the GeneXpert HIV‑1 qualitative assay as a consecutive test for a new early infant diagnosis algorithm in South Africa

Background. The proportion of HIV-exposed infants and young children infected with HIV in South Africa (SA) has declined markedly over the past decade as a result of the country’s comprehensive prevention of mother-to-child transmission programme. This decrease has in turn reduced the positive predictive value (PPV) of diagnostic assays, necessitating review of early infant diagnosis (EID) algorithms to ensure improved accuracy. Objectives. To evaluate the performance of the GeneXpert HIV-1 qualitative assay (Xpert EID) as a consecutive test for infants with an ‘HIV-detected’ polymerase chain reaction screening test at birth. Methods. We retrospectively analysed a longitudinal cohort of HIV-exposed infants on whom birth testing was performed, using whole-blood ethylenediaminetetra-acetic acid samples, from four tertiary sites in Gauteng Province between June 2014 and December 2019. Birth samples from all infants with a Cobas AmpliPrep/Cobas TaqMan HIV-1 Qualitative Test v2.0 (CAP/CTM v2.0) HIV-detected screening test, a concurrent Xpert EID test and a subsequent confirmatory CAP/CTM v2.0 test on a separate specimen were included. Performance of the Xpert EID in predicting final HIV status was determined as proportions with 95% confidence intervals (CIs). A comparison of indeterminate CAP/CTM v2.0 results, as per National Health Laboratory Service resulting practice, with discordant CAP/CTM v2.0 v. Xpert EID results was performed. Results. Of 150 infants who met the inclusion criteria, 6 (3.9%) had an Xpert EID result discordant with final HIV status: 5 (3.3%) were false negatives and 1 (0.7%) was false positive. As a consecutive test, the Xpert EID yielded a sensitivity of 96.5% (95% CI 92 - 98.9), specificity of 85.7% (95% CI 42.1 - 99.6), PPV of 99.3% (95% CI 95.7 - 99.9), negative predictive value of 54.5% (95% CI 32.5 - 74.9) and overall accuracy of 96.1% (95% CI 91.5 - 98.5). Using discordant CAP/CTM v2.0/Xpert EID results as criteria to verify indeterminate results instead of current practice would have reduced the number of indeterminate screening results by 42.1%, from 18 (12.6%) to 11 (7.2%), without increasing the false-positive rate. Conclusions. Addition of the Xpert EID as a consecutive test for specimens with an HIV-detected PCR screening result has the potential to improve the PPV and reduce the indeterminate rate, thereby reducing diagnostic challenges and time to final status, in SA’s EID programme

Influence of location, elevation gradients, processing methods, and soil quality on the physical and cup quality of coffee in the Kafa Biosphere Reserve of SW Ethiopia

Open Access Journal; Published online: 13 Aug 2021In-depth forest coffee cup quality assessments have not been conducted yet on Kafa Biosphere Reserve coffees. Hence, the influence of location, elevation gradient, and processing methods on coffee bean physical and sensorial qualities, and the relationship between soil and coffee quality variables were studied in 2017. Districts (Gimbo, Gawata, and Decha), elevation gradient ranges (low-1800 m a.s.l), and processing methods (wet, semi-wet, and dry) were taken as factors. Preliminary coffee quality assessment data was collected from cup quality analysis of coffee beans obtained from the combination of the three factors where four replicate samples were taken for each of the combinations. The effect of location was only significant for bean moisture content and there was no significant (P > 0.05) difference among locations for above 14 screen retention and preliminary cup quality variables (odor, raw, acidity, body, flavor, cup, total, and grade). The elevation gradient had a significant (P 0.05) on most of the preliminary cup quality variables, but it was significant for moisture content (P < 0.001), odor (P < 0.05), and overall raw (P < 0.01) scores. Screen retention was decreased with increasing elevation gradient but with better quality. High elevation coffees processed with the dry method gave better raw (38.5–40 ​%) and cup (48.00–51.75 ​%) quality scores. Except for high soil molybdenum and clay percentage, reduced amounts of most of the soil nutrients, pH, and silt percentage were important for better forest coffee quality. Since each sampled forest had diverse shade types and densities, a further investigation that includes the component of shade is strongly recommended in future studies

The demographic and clinical profiles of women presenting with vaginal discharge syndrome at primary care facilities in South Africa: Associations with age and implications for management

Background. Current South African guidelines for the management of vaginal discharge syndrome (VDS) do not recommend treatment for sexually transmitted infection (STI) pathogens for women aged ≥35 years whose partners do not have male urethritis syndrome. The guideline assumes that older women are unlikely to have an STI and that their partners do not have asymptomatic infections.Objectives. To describe the demographic, behavioural and clinical characteristics of women with VDS, comparing older women (≥35 years) with younger women, and to determine the performance of age alone as a criterion for predicting the presence of STI.Methods. This was a cross-sectional study at seven primary healthcare centres taking part in the aetiological surveillance of STIs between January 2015 and December 2016. Eligible women presenting with VDS were enrolled and completed a nurse-administered questionnaire. Genital swabs and blood specimens were collected for laboratory testing. Data were entered into surveillance-specific databases and exported into Stata 14 for analysis. Descriptive statistics were used to compare demographic and clinical profiles of older with younger women. A receiver operator curve (ROC) was used to determine the age cut-off that would best differentiate between women who had infection with STI pathogens and those without.Results. Of 757 women enrolled, 157 (20.7%) were aged ≥35 years. HIV positivity was 46.6%, and higher in older than younger women (54.9% v. 44.5%; p=0.02). Of those enrolled, 283 (37.4%) had bacterial vaginosis (BV) and/or Candida infection only, 232 (30.7%) had BV or Candida with STI pathogens detected, 98 (13%) were infected with STI pathogens only, and 144 (19.0%) did not have any detectable STI or non-STI causes. Although older women were less likely than younger women to have Neisseria gonorrhoeae, Chlamydia trachomatis or Mycoplasma genitalium infection (23.6% v. 38.2%; p&lt;0.01), the burden in older women was not negligible. The area under the ROC for age was 57.5% (95% confidence interval 53.2 - 61.8%), which implies suboptimal performance.Conclusions. Although older women with VDS were less likely than younger women to have STIs, a significant proportion of them did have an infection with STI pathogens. Age alone was not a good criterion for discriminating between women with and without infection with STI pathogens. Other ways of improving the VDS algorithm performance are needed, as is better integration of HIV and STI prevention and treatment.Â

Evaluation of the national clinical sentinel surveillance system for sexually transmitted infections in South Africa: Analysis of provincial and district-level data

Background. Globally, >1 million new cases of curable sexually transmitted infections (STIs) are estimated to occur daily, an alarming rate that has prevailed for over a decade. Modelled STI prevalence estimates for South Africa (SA) are among the highest globally. Robust STI surveillance systems have implications for policy and planning, antimicrobial stewardship and prevention strategies, and are critical in stemming the tide of STIs. Objectives. To evaluate the STI clinical sentinel surveillance system (STI CSSS) in SA, to describe the population incidence of four designated STI syndromes in males and females ≥15 years, and to provide recommendations for strengthening the STI CSSS. Methods. This was a retrospective analysis of the STI CSSS in SA. Distribution of the primary healthcare facilities designated as STI CSSS sites was described, taking into account provincial population distribution and headcount coverage of STI CSSS facilities. Reporting compliance was evaluated to determine completion of data reporting. Further analysis was undertaken for those provinces that had good reporting compliance over a 12-month period. Population-level and demographic STI syndrome incidence were estimated from CSSS data using case reports of male urethritis syndrome (MUS) as a proxy for data extrapolation. Results. Reporting compliance exceeded 70% for seven of the nine provinces. STI syndromes with the highest incidence were MUS and vaginal discharge syndrome (VDS). The 20 - 24 years age group had the highest STI incidence, at least double the incidence estimated in the other two age groups. Overall STI incidence in females was higher than among males in all provinces, except Limpopo and Western Cape. The 15 - 19 years age group had the most prominent gender disparity, with the national STI incidence in females 70% higher than in males. District-level analysis revealed high regional STI incidence even in provinces with lower overall incidence. Conclusion. The STI CSSS is pivotal to epidemiological monitoring and proactive management of STIs, especially in view of the high HIV prevalence in SA. CSSS processes and facility selection should be reviewed and revised to be representative and responsive to the current STI needs of the country, with biennial analysis and reporting to support evidence-based policy development and targeted implementation

An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: Results of the MERGE cluster randomised trial

Kielmann, Karina - ORCID 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658Objectives: To evaluate the effect of an intervention to optimize TB/HIV integration on patient outcomes.Methods: Cluster randomised control trial at 18 primary care clinics in South Africa. The intervention was placement of a nurse (TB/HIV integration officer) to facilitate provision of integrated TB/HIV services, and a lay health worker (TB screening officer) to facilitate TB screening for 24 months. Primary outcomes were i) incidence of hospitalisation/death among individuals newly diagnosed with HIV, ii) incidence of hospitalisation/ death among individuals newly diagnosed with TB and iii) proportion of HIV-positive individuals newly diagnosed with TB who were retained in HIV care 12 months after enrolment.Results: Of 3328 individuals enrolled, 3024 were in the HIV cohort, 731 in TB cohort and 427 in TB-HIV cohort. For the HIV cohort, the hospitalisation/death rate was 12.5 per 100 person-years (py) (182/1459py) in the intervention arm vs. 10.4/100py (147/1408 py) in the control arms respectively (Relative Risk (RR) 1.17 [95% CI 0.92–1.49]).For the TB cohort, hospitalisation/ death rate was 17.1/100 py (67/ 392py) vs. 11.1 /100py (32/ 289py) in intervention and control arms respectively (RR 1.37 [95% CI 0.78–2.43]). For the TB-HIV cohort, retention in care at 12 months was 63.0% (213/338) and 55.9% (143/256) in intervention and control arms (RR 1.11 [95% 0.89–1.38]).Conclusions: The intervention as implemented failed to improve patient outcomes beyond levels at control clinics. Effective strategies are needed to achieve better TB/HIV service integration and improve TB and HIV outcomes in primary care clinics.Trial registration: South African Register of Clinical Trials (registration number DOH-27-1011-3846).This study was supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of [Cooperative agreement 5U2GPS000811]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.https://doi.org/10.1016/j.cct.2018.07.01372pubpu