Search

The limited capabilities in most low-middle income countries to study the benefit of pneumococcal conjugate vaccine (PCV) against invasive pneumococcal disease (IPD), calls for alternate strategies to assess this. We used a mathematical model, to predict the direct and indirect effectiveness of PCV by analyzing serotype specific colonization prevalence and IPD incidence prior to and following childhood PCV immunization in South Africa. We analyzed IPD incidence from 2005-2012 and colonization studies undertaken in HIV-uninfected and HIV-infected child-mother dyads from 2007-2009 (pre-PCV era), in 2010 (7-valent PCV era) and 2012 (13-valent PCV era). We compared the model-predicted to observed changes in IPD incidence, stratified by HIV-status in children >3 months to 5 years and also in women aged >18-45 years. We observed reductions in vaccine-serotype colonization and IPD due to vaccine serotypes among children and women after PCV introduction. Using the changes in vaccine-serotype colonization data, the model-predicted changes in vaccine-serotype IPD incidence rates were similar to the observed changes in PCV-unvaccinated children and adults, but not among children

Part I. Clinical management and costs of outpatient careObjective. To provide a detailed breakdown of clinical presentations and management of outpatients with HIV. and associated costs, in order to inform clinical practice, health service planning and projections of the costs of HIV care in South AfricaSetting. The outpatient department of a public sector, academic hospital in Soweto, South AfricaDesign. A retrospective, descriptive study using a record review and a combination of direct and step-down costing of health service costs (1992 prices).Patients. All 179 patients with HIV seen at the outpatient department between 1989 and 1992.Results. The average age at presentation was 30 years for men and 29 years for women. The most common clinical presentations at first viSIT were lymphadenopathy, weight loss, peripheraJ neuropathy and tuberculosis. Many patients, however, were asymptomatic. Analysis of clinical presentations, investigations and drugs used indicated that at least 80% of patients could have been managed at primary care leveL The average cost per consultation was R112.03. Costs per patient and per visit increased with stage of disease. Most of the costs arose from variable costs, which are influenced by clinical management decisions. Laboratory investigations (30%), staff (21 %) and drugs (22%), especially for fungal, viral and tuberculosis infection, were the major contributors to costs.Conclusions. Given projected HIV infection rates and the associated, potentially enormous costs of care revealed by this study, clinicians and health service planners must identify and implement cost-effective approaches to investigating, treating and meeting other health care needs of HIV-infected people. Treatment of people with HIV at primary care outpatient services seems both possible and potentially more cost-effective than hospital-level care in South Africa Emphasis should be placed on building primary level capacity to take on this role effectively. Further studies are required to identify the costeffectiveness, not only of treating HIV-related conditions, but also of treating other diseases if just and adequately infonned decisions about rationing of care are required in view of resource constraints.

Post-print copy of: Pillay P, Wadley AL, Cherry CL, Karstaedt AS, Kamerman PR. Psychological factors associated with painful versus non-painful HIV-associated sensory neuropathy. AIDS and Behavior (in press). DOI: 10.1007/s10461-017-1856-9, PMID: 28710709 Data and analysis scripts: 10.6084/m9.figshare.4555474.v2Abstract: HIV-associated sensory neuropathy (HIV-SN) is a common, and frequently painful complication of HIV, but factors that determine the presence of pain are unresolved. We investigated: (i) if psychological factors associated with painful (n = 125) versus non-painful HIV-SN (n = 72), and (ii) if pain and psychological factors affected quality of life (QoL). We assessed anxiety and depression using the Hopkins Symptoms Checklist-25. Pain catastrophizing and QoL were assessed using the Pain Catastrophizing Scale and Euroqol-5D, respectively. Presence of neuropathy was detected using the Brief Neuropathy Screening Tool, and pain was characterised using the Wisconsin Brief Pain Questionnaire. Overall, there was a high burden of pain, depression and anxiety in the cohort. None of the psychological variables associated with having painful HIV-SN. Greater depressive symptoms and presence of pain were independently associated with lower QoL. In those participants with painful HIV-SN, greater depressive symptom scores were associated with increased pain intensity. In conclusion, in a cohort with high background levels of psychological dysfunction, psychological factors do not predict the presence of pain, but both depression and presence of pain are associated with poor quality of life.