An analysis of the HIV testing cascade of a group of HIV-exposed infants from birth to 18 months in peri-urban Khayelitsha, South Africa

BACKGROUND: Despite the reduction of HIV mother-to-child transmission, there are concerns regarding transmission rate in the breastfeeding period. We describe the routine uptake of 6 or 10 (6/10) weeks, 9 months and 18 months testing, with and without tracing, in a cohort of infants who received HIV PCR testing at birth (birth PCR) (with and without point of care (POC) testing) in a peri-urban primary health care setting in Khayelitsha, South Africa. METHODS: In this cohort study conducted between November 2014 and February 2018, HIV-positive mothers and their HIV-exposed babies were recruited at birth and all babies were tested with birth PCR. Results of routine 6/10 weeks PCR, 9 months and 18 months testing were followed up by a patient tracer. We compared testing at 6/10 weeks with a subgroup from historical cohort who was not tested with birth PCR. RESULTS: We found that the uptake of 6/10 weeks testing was 77%, compared to 82% with tracing. When including all infants in the cascade and comparing to a historical cohort without birth testing, we found that infants who tested a birth were 22% more likely to have a 6/10 weeks test compared to those not tested at birth. There was no significant difference between the uptake of 6/10 weeks testing after birth PCR POC versus birth PCR testing without POC. Uptake of 9 months and 18 months testing was 39% and 24% respectively. With intense tracing efforts, uptake increased to 45% and 34% respectively. CONCLUSION: Uptake of HIV testing for HIV-exposed uninfected infants in the first 18 months of life shows good completion of the 6/10 weeks PCR but suboptimal uptake of HIV testing at 9 months and 18 months, despite tracing efforts. Birth PCR testing did not negatively affect uptake of the 6/10 weeks HIV test compared to no birth PCR testing

"Life continues": Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa.

BACKGROUND:Self-administered treatment (SAT), a differentiated model of care for rifampicin-resistant tuberculosis (RR-TB), might address adherence challenges faced by patients and health care systems. This study explored patient, health-care worker (HCW) and community care worker (CCW) perspectives on a SAT pilot programme in South Africa, in which patients were given medication to take at home with the optional support of a CCW. METHODS:We conducted a mixed-methods study from July 2016-June 2017. The quantitative component included semi-structured questionnaires with patients, HCWs and CCWs; the qualitative component involved in-depth interviews with patients enrolled in the pilot programme. Interviews were conducted in isiXhosa, translated, transcribed and manually coded. RESULTS:Overall, 27 patients, 12 HCWs and 44 CCWs were enrolled in the quantitative component; nine patients were also interviewed. Of the 27 patients who completed semi-structured questionnaires, 22 were HIV-infected and 17 received a monthly supply of RR TB treatment. Most HCWs and CCWs (10 and 32, respectively) understood the pilot programme; approximately half (n = 14) of the patients could not correctly describe the pilot programme. Overall, 11 and 41 HCWs and CCWs reported that the pilot programme promoted treatment adherence. Additionally, 11 HCWs reported that the pilot programme relieved pressure on the clinic. Key qualitative findings highlighted the importance of a support person and how the flexibility of SAT enabled integration of treatment into their daily routines and reduced time spent in clinics. The pilot programme was also perceived to allow patients more autonomy and made it easier for them to manage side-effects. CONCLUSION:The SAT pilot programme was acceptable from the perspective of patients, HCWs and CCWs and should be considered as a differentiated model of care for RR-TB, particularly in settings with high burdens of HIV, in order to ease management of treatment for patients and health-care providers

Kaplan Meier survival curves for probability of retention on ART among patients in DMOC, 2012–2018, KwaZulu Natal, South Africa.

The long dash black line = facility AC, facility adherence club; the short dash blue line = community AC, community adherence club; the long dash-dot blue line = CAG, community ART group; the solid black line = SFLA, spaced and fast lane appointment model; the dash-dot black line, PuP = decentralized medication delivery at community pick up points.</p

Kaplan Meier curves for retention in DMOC, by type of model, KwaZulu-Natal, South Africa.

Thelong dash black line = facility AC, facility adherence club; the short dash blue line = community AC, community adherence club; the long dash-dot blue line = CAG, community ART group; the solid black line = SFLA, spaced and fast lane appointment model; the dash-dot black line, PuP = decentralized medication delivery at community pick up points.</p

Weibull parametric survival model¹ for factors associated with all cause attrition from DMOC (death, LTFU or return to clinic care).

Weibull parametric survival model1 for factors associated with all cause attrition from DMOC (death, LTFU or return to clinic care).</p

Baseline characteristics and outcomes of patients enrolled in DMOC in 2012–2018, by initial DMOC type.

Baseline characteristics and outcomes of patients enrolled in DMOC in 2012–2018, by initial DMOC type.</p

Weibull parametric survival model¹ for factors associated with viral load rebound (> = 1000 copies/mL) among DMOC patients.

Weibull parametric survival model1 for factors associated with viral load rebound (> = 1000 copies/mL) among DMOC patients.</p

Adaptation of TIER.net for capture of DMOC visits at MSF-supported ART clinics.

(DOCX)</p

Weibull parametric survival model¹ factors associated with all cause attrition from ART (death or LTFU) among DMOC patients.

Weibull parametric survival model1 factors associated with all cause attrition from ART (death or LTFU) among DMOC patients.</p