Factors associated with loss to follow-up after occupational HIV exposure among health care workers attending the Groote Schuur Hospital Occupational Health Clinic

Background There is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals (ART) like zidovudine were used. Methods A retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic (OHC) in Cape Town, South Africa, for post-exposure prophylaxis (PEP) during a period when tenofovir (TDF) was available. Data was obtained from an existing database maintained by the OHC. Our primary outcome was to identify factors associated with LTFU at the 3-month visit, with secondary outcomes evaluating factors associated with LTFU at the 6-week and 6-months visits. We selected 7 variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias. Results Two hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5 to 0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3 to 5.5]), and time from exposure to receiving PEP of more than 24 hours (aOR 5.9 [95% CI, 1.3 to 26.9]). Discussion Our finding that LTFU increases with successive visits is consistent with other studies. It is believed higher LTFU in younger HCWs may be related to the greater change and instability they experience in their younger years. Doctors are more likely to be LTFU than other HCWs which could be related to concerns of confidentiality in performing HIV testing at their facility. Additionally, doctors may be making their own assessments of the risk of exposure. Lastly, doctors may be submitting their own blood samples for HIV testing instead of attending the OHC. One study showed longer time from exposure to receiving PEP was not associated with attendance of visits, but we showed this did influence LTFU at the 3-month visit. This could be explained by HCWs who present after 24 hours having a perceived lower benefit from PEP. Newer studies have shown that completion of PEP is based on the tolerability of ART and not on whether dual or triple therapy are used. This could explain why in our cohort there was no correlation between type of ART and LTFU. There is literature to support increased attendance of follow-up visits by contacting HCWs by telephone or mail. Furthermore, the WHO has recently advised the final follow-up visit to be at 3 months rather than 6 months. We suspect with fewer visits, there may be less LTFU. Conclusion We identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up

Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

Background: There is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals like zidovudine were used. Methods: A retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic in Cape Town, South Africa for post-exposure prophylaxis (PEP) during a period when tenofovir was available. Our primary outcome was LTFU at the 3-month visit. We selected seven variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias. Results: Two hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5–0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3–5.5]), and time from exposure to receiving PEP of more than 24 h (aOR 5.9 [95% CI, 1.3–26.9]). Conclusion: We identifed factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up

A case of pericardial schistosomiasis and non-Hodgkin high grade B-cell lymphoma

Chronic schistosomiasis affects either the genitourinary or gastrointestinal tract. Rarely, schistosomes cause ectopic disease, such as in the case of a South African woman from a non-endemic province, who presented with suspected pericardial tamponade because of tuberculosis. However, histology and polymerase chain reaction from pericardial biopsy confirmed Schistosoma haematobium. A finding of mediastinal non-Hodgkin lymphoma came to light when our patient’s clinical condition unexpectedly deteriorated. Contribution: This case highlights an unusual manifestation of schistosomiasis

Southern African HIV Clinicians Society 2023 Guideline for post-exposure prophylaxis: Updated recommendations

No abstract available

Clinical features and outcomes of COVID-19 admissions in a population with a high prevalence of HIV and tuberculosis: a multicentre cohort study

Background There is still a paucity of evidence on the outcomes of coronavirus disease 2019 (COVID-19) among people living with human immunodeficiency virus (PWH) and those co-infected with tuberculosis (TB), particularly in areas where these conditions are common. We describe the clinical features, laboratory findings and outcome of hospitalised PWH and human immunodeficiency virus (HIV)-uninfected COVID-19 patients as well as those co-infected with tuberculosis (TB). Methods We conducted a multicentre cohort study across three hospitals in Cape Town, South Africa. All adults requiring hospitalisation with confirmed COVID-19 pneumonia from March to July 2020 were analysed. Results PWH comprised 270 (19%) of 1434 admissions. There were 47 patients with active tuberculosis (3.3%), of whom 29 (62%) were PWH. Three-hundred and seventy-three patients (26%) died. The mortality in PWH (n = 71, 26%) and HIV-uninfected patients (n = 296, 25%) was comparable. In patients with TB, PWH had a higher mortality than HIV-uninfected patients (n = 11, 38% vs n = 3, 20%; p = 0.001). In multivariable survival analysis a higher risk of death was associated with older age (Adjusted Hazard Ratio (AHR) 1.03 95%CI 1.02–1.03, p < 0.001), male sex (AHR1.38 (95%CI 1.12–1.72, p = 0.003) and being “overweight or obese” (AHR 1.30 95%CI 1.03–1.61 p = 0.024). HIV (AHR 1.28 95%CI 0.95–1.72, p 0.11) and active TB (AHR 1.50 95%CI 0.84–2.67, p = 0.17) were not independently associated with increased risk of COVID-19 death. Risk factors for inpatient mortality in PWH included CD4 cell count < 200 cells/mm3, higher admission oxygen requirements, absolute white cell counts, neutrophil/lymphocyte ratios, C-reactive protein, and creatinine levels. Conclusion In a population with high prevalence of HIV and TB, being overweight/obese was associated with increased risk of mortality in COVID-19 hospital admissions, emphasising the need for public health interventions in this patient population

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)