The Diagnostic Accuracy of Urine Lipoarabinomannan Test for Tuberculosis Screening in a South African Correctional Facility.

CAPRISA, 2015.Abstract available in pdf

Outcomes of on-site antiretroviral therapy provision in a South African correctional facility.

We evaluated a novel on-site antiretroviral therapy (ART) programme in a South African correctional facility using routinely collected programme data, from a retrospective cohort of adult inmates starting ART between 03/2007 and 03/2009 followed-up to 09/2009. We report (1) mortality (using survival analysis); (2) retention in the programme (to 09/2009); and (3) virological suppression at six and 12 months (6 months (95% confidence interval 1.1-7.5)/100 person-years; p < 0.001. At 09/2009, 35.6% (144/404) remained in the correctional facility, with 94.4% (136/144) retained in the programme; 38.4% (155/404) were released; and 20.0% (81/404) transferred to another facility. ART-naïve patients in care six and 12 months after ART initiation, 94.7% (124/131) and 92.5% (74/80) were virologically suppressed, respectively. High early mortality warrants the early identification and management of HIV-positive inmates. The high mobility of inmates necessitates systems for facilitating continuity of care. Good virological responses and retention supports decentralising HIV care to correctional facilities

Common inherited mitochondrial DNA mutations and nucleoside reverse transcriptase inhibitor-induced severe hyperlactataemia in HIV-infected adults: an exploratory study

BACKGROUND: Genetic predisposition to dideoxynucleoside-induced mitochondrial dysfunction might be related to mitochondrial DNA (mtDNA) polymorphisms. Severe hyperlactataemia is probably the best model to assess such a predisposition. METHODS: For this exploratory study in White European and Black African HIV-infected adults, hypervariable region 1 of mtDNA samples from peripheral blood mononuclear cells or buccal smears of patients who have developed confirmed severe hyperlactataemia was sequenced. Additionally, 21 single nucleotide polymorphisms and a 9 bp deletion were genotyped to assign mtDNA haplogroups. Finally, entire mtDNA sequencing was performed in a subset of European samples. Samples were obtained from Black African cases and controls recruited from a single centre in Johannesburg, South Africa and from white European cases from Amsterdam, London and Zurich. RESULTS: A total of 40 cases and 38 controls from Johannesburg were included. All of the cases and 33 controls were receiving stavudine-based therapy at the time of the index date (P=0.024). The distribution of mtDNA haplotypes was not different between cases and controls (P=0.137), and neither were the predicted haplogroups (P=0.751). In total, 11 of the 12 European cases were on stavudine and/or didanosine at the time of the event. No hypervariable region 1 haplotype was consistently found in the European cases. Sequencing of the entire mtDNA from three of these cases supported the absence of any shared mutations other than major alleles frequently seen in the mtDNA database. CONCLUSIONS: We did not find an association between homoplasmic inherited mtDNA polymorphisms and severe hyperlactataemia. Our data do not support the existence of non-synonymous mtDNA mutations that explain an increased predisposition to dideoxynucleoside-induced mitochondrial dysfunction

Performance of urine LAM test overall and stratified by HIV status compared with gold standard of bacteriologically-confirmed TB.

<p>NPV = negative predictive value; PPV = positive predictive value; CI confidence interval</p><p>27 participants with possible TB have been excluded from this analysis</p><p>Performance of urine LAM test overall and stratified by HIV status compared with gold standard of bacteriologically-confirmed TB.</p

Risk factors for undiagnosed tuberculosis^*.

*<p>Undiagnosed tuberculosis defined as participants fulfilling the case definition of definite or probable tuberculosis. †Numerator (undiagnosed tuberculosis cases) = 34 unless otherwise indicated. ‡Denominator = 929 unless otherwise indicated (10 participants on tuberculosis treatment at enrolment, 39 “possible” tuberculosis cases and 3 participants without sputum cultures at enrolment were excluded). §Adjusted for number of prisoners per cell, smoking history and HIV status; n = 878 for adjusted model; numerator (undiagnosed tuberculosis) = 33 for adjusted model. **Fisher’s exact test. ∫3 participants reporting previous IVDU use excluded from the analysis (1 without sputum culture at enrolment; 2 with possible tuberculosis).</p><p>TB = Tuberculosis; OR = Odds ratio; CI = Confidence interval.</p

Study inclusions, losses to follow-up and tuberculosis outcomes.

<p>TB = Tuberculosis.</p

Characteristics of participants.

*<p>Data are number of participants (percent) unless otherwise indicated;</p>†<p>denominator = 981unless otherwise indicated;</p>‡<p>denominator = 526 unless otherwise indicated;</p>§<p>denominator = 455 unless otherwise indicated;</p><p>Duration awaiting trial.</p><p>IQR = Interquartile range; IVDU = Intravenous drug use; ART = Antiretroviral therapy; TB = Tuberculosis; No = Number.</p

HIV and tuberculosis in prisons in sub-Saharan Africa

: Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculsosis prevention, treatment, and care of a standard that meets international goals and human rights obligations