HIV and hepatitis B/C co-infection in KwaZulu-Natal from 2002 to 2010 : a retrospective database analysis.

Master of Medical Science in Public Health Medicine. University of KwaZulu-Natal, Howard College 2015.Introduction Sub-Saharan Africa has the highest Human Immunodeficiency Virus (HIV) prevalence and the second highest Hepatitis B virus (HBV) and Hepatitis C virus (HCV) prevalence in the world. Co-infection of HIV, HBV and HCV occurs due to shared transmission routes and common risk factors. Existing studies from sub-Saharan Africa show wide variations in the prevalence of co-infections, depending on age, gender, race and geographical area. Aim The aim of this study was to describe HIV and HBV/HCV co-infections in KwaZulu-Natal from 2002 to 2010 using a laboratory database. Methods An observational, analytical, retrospective study design was used. The study setting was the National Health Laboratory Service Department of Virology, in Durban. The study population consisted of 507 834 individuals (all those with HIV, HBV or HCV test results from 2002 to 2010 recorded in the database). Results The overall sero-prevalence of HIV was 47%, HBV:12.05% and HCV:4.13%. The highest sero-prevalence of HIV and HCV was in the 30-35 year age group; for HBV it was in the 20-25 year age group. HIV sero-prevalence was higher in females, while HBV and HCV sero-prevalence was higher in males. The uThukela, Amajuba and Zululand health districts had the highest HIV, HBV and HCV sero-prevalence respectively. The sero-prevalence of HIV and HBV has decreased significantly over time, while there was no significant change in the sero-prevalence of HCV. Compared to those without HIV, individuals with HIV had increased odds of being positive for hepatitis markers: 3.19 for Hepatitis B surface antigen, 2.06 for Hepatitis B e antigen and 2.91 for HCV. Those with HIV were less likely to be positive for Hepatitis B surface antibodies. Those with Hepatitis B had a 1.38 times the odds of being co-infected with HCV compared to those without HBV. Discussion This study documented the high sero-prevalence of HIV, HBV and HCV over 9 years for KwaZulu-Natal. A significant number of HIV positive individuals are co-infected with either HBV or HCV. Recommendations The results of this study may guide public health decisions on the approach to diagnosis, treatment and prevention of HBV and HCV among those with HIV

The costs of delivering human papillomavirus vaccination to Grade 4 learners in KwaZulu-Natal, South Africa

Background. The national human papillomavirus (HPV) vaccination roll-out in South Africa provides two doses of Cervarix to all female Grade 4 learners in state schools. This study estimated the costs of vaccinating all learners in KwaZulu-Natal Province (females or males and females) using either the two- or three-dose strategies for both the bivalent and quadrivalent vaccines.Objective. To determine costs of the HPV vaccination programme in KwaZulu-Natal. Methods. Costs were determined adapting World Health Organization vaccination costing guidelines.Results. The 2014 current cost of delivering three doses of Gardasil was ZAR510 per learner. The projected cost of delivering Cervarix to female learners at two or three doses over the period 2014 - 2018, adjusted for inflation, was ZAR172 717 342 and ZAR250 048 426, respectively. Similarly, the cost for Gardasil at these doses was ZAR197 482 200 and ZAR287 194 361, respectively. For male and female learners the cost for Cervarix over this period at two or three doses was ZAR337 101 132 and ZAR540 150 713, respectively. Similarly, the cost for Gardasil at these doses was ZAR426 597 971 and ZAR620 392 784, respectively. Accounting for population variation for females over 5 years, the cost of two doses of Cervarix ranged from ZAR168 888 677 to ZAR 176 545 977 at the lower and upper 95% confidence intervals (CIs), respectively. For three doses the cost ranged from ZAR244 505 544 to ZAR255 591 263 at the lower and upper 95% CIs, respectively. Similarly, the cost for two doses of Gardasil ranged from ZAR193 104 566 to ZAR201 859 798. For three doses the cost ranged from ZAR280 828 057 to ZAR293 560 614. Conclusion. This study gives decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the HPV vaccination programme.