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1. Impact of prior cryptococcal antigen screening on in-hospital mortality in cryptococcal meningitis or fungaemia among HIV-seropositive individuals in South Africa: a cross-sectional observational study

Author

Abrahams, Shareef, Ahmed, Khatija, Avenant, Theunis, Bamford, Colleen, Bhola, Prathna, Bishop, Kate, Black, John, Blumberg, Lucille, Bosman, Norma, Botha, Maria, Brink, Adrian, Budavari, Suzy, Burra, Asmeeta, Chibabhai, Vindana, Chomba, Rispah, Cohen, Cheryl, Coovadia, Yacoob, Crowther-Gibson, Penny, Dawood, Halima, de Gouveia, Linda, Dlamini, Nomonde, Dlamini, Siyanda, Dreyer, Andries, du Plessis, Nicolette, du Plessis, Erna, du Plessis, Mignon, Erasmus, Linda, Feldman, Charles, Govender, Nelesh, Govind, Chetna, Groome, Michelle, Haffejee, Sumayya, Hamese, Ken, Haumann, Carel, Hoho, Nombulelo, Hoosen, Anwar, Hoosien, Ebrahim, Howell, Victoria, Hoyland, Greta, Ismail, Farzana, Ismail, Husna, Ismail, Nazir, Ive, Prudence, Jooste, Pieter, Karstaedt, Alan, Khantsi, Ignatius, Kleinhans, Vicky, Kleynhans, Jackie, Kolojane, Molebogeng, Kufa-Chakezha, Tendesayi, Lebaka, Tiisetso, Lebudi, Jacob, Legare, Neo, Lekalakala, Ruth, Lindeque, Kathy, Lowman, Warren, Madhi, Shabir, Magobo, Rindidzani, Mahabeer, Prasha, Maharaj, Adhil, Makgoba, Martha, Maloba, Molatji, Maluleka, Caroline, Manaka, Mokupi, Mangena, Phetho, Maningi, Nontuthuko, Marcus, Louis, Marshall, Terry, Mathebula, Rudzani, Mathunjwa, Azwifarwi, Mbelle, Nontombi, Mbuthu, Bongani, McCarthy, Kerrigan, Meiring, Susan, Mekgoe, Omphile, Menezes, Colin, Miller, Cecilia, Mlisana, Koleka, Moncho, Masego, Moore, David, Moremi, Myra, Morris, Lynn, Moshe, Moamokgethi, Mothibi, Lesego, Moultrie, Harry, Mpembe, Ruth, Mutevedzi, Portia, Mwansa-Kambafwile, Judith, Naby, Fathima, Naicker, Preneshni, Naidoo, Romola, Nana, Trusha, Nchabeleng, Maphoshane, Ndlovu, Phathutshedzo, Nel, Jeremy, Ngomane, Mimmy, Ngubane, Wendy, Nicol, Mark, Njikho, Sunnieboy, Ntlemo, Grace, Ntuli, Sindi, Page, Nicola, Paulse, Nuraan, Pearce, Vanessa, Perovic, Olga, Pillay, Keshree, Pombo, Dina, Poswa, Xoliswa, Prentice, Elizabeth, Puren, Adrian, Quan, Vanessa, Ramjathan, Praksha, Ramkillawan, Yeishna, Reddy, Kessendri, Reubenson, Gary, Richards, Lauren, Said, Mohammed, Samodien, Nazlee, Samuel, Catherine, Seetharam, Sharona, Sekwadi, Phuti, Selekisho, Mirriam, Senekal, Marthinus, Shuping, Liliwe, Sibiya, Ngoaka, Sirkar, Surendra, Smit, Juanita, Smith, Anthony, Smith, Marshagne, Sookan, Lisha, Sriruttan, Charlotte, Stacey, Sarah, Swe Han, Khine Swe, Thomas, Teena, Thomas, Juno, Tsisti, Merika, van Schalkwyk, Erika, Variava, Ebrahim, Vazi, Phumeza, Verwey, Charl, von Gottberg, Anne, Wadula, Jeanntte, Walaza, Sibongile, Wende, Linda, Whitelaw, Andrew, Wilson, Douglas, Zietsman, Inge, Paccoud, Olivier, Mashau, Rudzani, Greene, Greg, and Govender, Nelesh P.

Published
2023
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2. HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012-2017

Author

Govender, Nelesh P., Todd, Jim, Nel, Jeremy, Mer, Mervyn, Karstaedt, Alan, and Cohen, Cheryl

Subjects
Sepsis -- Patient outcomes, Hospital patients -- Statistics, HIV infection -- Complications and side effects -- Patient outcomes, Candidiasis -- Patient outcomes, Health
Abstract

Candida is a common cause of healthcare-associated bloodstream infections in South Africa; the estimated national incidence risk in 2016-2017 was 84 (95% CI 81-86) cases per 100,000 hospital admissions (2). [...]

Published
2021
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6. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016-2017

Author

van Schalkwyk, Erika, Mpembe, Ruth S., Thomas, Juno, Shuping, Liliwe, Ismail, Husna, Lowman, Warren, Karstaedt, Alan S., Chibabhai, Vindana, Wadula, Jeannette, Avenant, Theunis, Messina, Angeliki, Govind, Chetna N., Moodley, Krishnee, Dawood, Halima, Ramjathan, Praksha, and Govender, Nelesh P.

Subjects
Mycoses -- Health aspects -- Comparative analysis, Antifungal agents -- Health aspects -- Comparative analysis, Mass spectrometry -- Health aspects -- Comparative analysis, Infection -- Health aspects -- Comparative analysis, Intelligence gathering, Spectroscopy, Health
Abstract

Since 2009, when the first case of Candida auris infection was identified in South Africa, the number of laboratory-confirmed cases has increased exponentially (1). This multidrug-resistant fungal pathogen emerged worldwide, [...]

Published
2019
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8. Contributors

Author

Andersson, Monique, primary, Devar, J.W.S., additional, Fedail, Suliman Salih, additional, Karstaedt, Alan, additional, Kgomo, M.K., additional, Madiba, T.E., additional, Makumbi, F., additional, Mitchell, Hazel M., additional, Mwantembe, O., additional, Rutherford Thomson, S.R., additional, Segal, Isidor, additional, Setshedi, Mashiko, additional, Smith, M.D., additional, Sonderup, Mark W., additional, Tovey, Frank, additional, Vorster, Hester H., additional, and Spearman, C. Wendy, additional

Published
2019
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10. Impact of prior cryptococcal antigen screening on in-hospital mortality in cryptococcal meningitis or fungemia among HIV-seropositive individuals in South Africa: a cross-sectional observational study

Author

Paccoud, Olivier, primary, Shuping, Liliwe, additional, Mashau, Rudzani, additional, Greene, Greg, additional, Quan, Vanessa, additional, Meiring, Susan, additional, Govender, Nelesh P., additional, Abrahams, Shareef, additional, Ahmed, Khatija, additional, Avenant, Theunis, additional, Bamford, Colleen, additional, Bhola, Prathna, additional, Bishop, Kate, additional, Black, John, additional, Blumberg, Lucille, additional, Bosman, Norma, additional, Botha, Maria, additional, Brink, Adrian, additional, Budavari, Suzy, additional, Burra, Asmeeta, additional, Chibabhai, Vindana, additional, Chomba, Rispah, additional, Cohen, Cheryl, additional, Coovadia, Yacoob, additional, Crowther-Gibson, Penny, additional, Dawood, Halima, additional, de Gouveia, Linda, additional, Dlamini, Nomonde, additional, Dlamini, Siyanda, additional, Dreyer, Andries, additional, du Plessis, Nicolette, additional, du Plessis, Erna, additional, du Plessis, Mignon, additional, Erasmus, Linda, additional, Feldman, Charles, additional, Govender, Nelesh, additional, Govind, Chetna, additional, Groome, Michelle, additional, Haffejee, Sumayya, additional, Hamese, Ken, additional, Haumann, Carel, additional, Hoho, Nombulelo, additional, Hoosen, Anwar, additional, Hoosien, Ebrahim, additional, Howell, Victoria, additional, Hoyland, Greta, additional, Ismail, Farzana, additional, Ismail, Husna, additional, Ismail, Nazir, additional, Ive, Prudence, additional, Jooste, Pieter, additional, Karstaedt, Alan, additional, Khantsi, Ignatius, additional, Kleinhans, Vicky, additional, Kleynhans, Jackie, additional, Kolojane, Molebogeng, additional, Kufa-Chakezha, Tendesayi, additional, Lebaka, Tiisetso, additional, Lebudi, Jacob, additional, Legare, Neo, additional, Lekalakala, Ruth, additional, Lindeque, Kathy, additional, Lowman, Warren, additional, Madhi, Shabir, additional, Magobo, Rindidzani, additional, Mahabeer, Prasha, additional, Maharaj, Adhil, additional, Makgoba, Martha, additional, Maloba, Molatji, additional, Maluleka, Caroline, additional, Manaka, Mokupi, additional, Mangena, Phetho, additional, Maningi, Nontuthuko, additional, Marcus, Louis, additional, Marshall, Terry, additional, Mathebula, Rudzani, additional, Mathunjwa, Azwifarwi, additional, Mbelle, Nontombi, additional, Mbuthu, Bongani, additional, McCarthy, Kerrigan, additional, Mekgoe, Omphile, additional, Menezes, Colin, additional, Miller, Cecilia, additional, Mlisana, Koleka, additional, Moncho, Masego, additional, Moore, David, additional, Moremi, Myra, additional, Morris, Lynn, additional, Moshe, Moamokgethi, additional, Mothibi, Lesego, additional, Moultrie, Harry, additional, Mpembe, Ruth, additional, Mutevedzi, Portia, additional, Mwansa-Kambafwile, Judith, additional, Naby, Fathima, additional, Naicker, Preneshni, additional, Naidoo, Romola, additional, Nana, Trusha, additional, Nchabeleng, Maphoshane, additional, Ndlovu, Phathutshedzo, additional, Nel, Jeremy, additional, Ngomane, Mimmy, additional, Ngubane, Wendy, additional, Nicol, Mark, additional, Njikho, Sunnieboy, additional, Ntlemo, Grace, additional, Ntuli, Sindi, additional, Page, Nicola, additional, Paulse, Nuraan, additional, Pearce, Vanessa, additional, Perovic, Olga, additional, Pillay, Keshree, additional, Pombo, Dina, additional, Poswa, Xoliswa, additional, Prentice, Elizabeth, additional, Puren, Adrian, additional, Ramjathan, Praksha, additional, Ramkillawan, Yeishna, additional, Reddy, Kessendri, additional, Reubenson, Gary, additional, Richards, Lauren, additional, Said, Mohammed, additional, Samodien, Nazlee, additional, Samuel, Catherine, additional, Seetharam, Sharona, additional, Sekwadi, Phuti, additional, Selekisho, Mirriam, additional, Senekal, Marthinus, additional, Sibiya, Ngoaka, additional, Sirkar, Surendra, additional, Smit, Juanita, additional, Smith, Anthony, additional, Smith, Marshagne, additional, Sookan, Lisha, additional, Sriruttan, Charlotte, additional, Stacey, Sarah, additional, Swe Han, Khine Swe, additional, Thomas, Teena, additional, Thomas, Juno, additional, Tsisti, Merika, additional, van Schalkwyk, Erika, additional, Variava, Ebrahim, additional, Vazi, Phumeza, additional, Verwey, Charl, additional, von Gottberg, Anne, additional, Wadula, Jeanntte, additional, Walaza, Sibongile, additional, Wende, Linda, additional, Whitelaw, Andrew, additional, Wilson, Douglas, additional, and Zietsman, Inge, additional

Published
2023
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11. Epidemiology of serotype 1 invasive pneumococcal disease, South Africa, 2003-2013

Author

von Mollendorf, Claire, Cohen, Cheryl, Tempia, Stefano, Meiring, Susan, de Gouveia, Linda, Quan, Vanessa, Lengana, Sarona, Karstaedt, Alan, Dawood, Halima, Seetharam, Sharona, Lekalakala, Ruth, Madhi, Shabir A., Klugman, Keith P., and von Gottberg, Anne

Subjects
Pneumococcal infections -- Distribution, Public health administration -- Methods, Company distribution practices, Health
Abstract

Streptococcus pneumoniae serotype 1 is highly invasive Oand rarely carried asymptomatically (1). The incidence of serotype 1 invasive pneumococcal disease (IPD) fluctuates year to year; disease is associated with outbreaks [...]

Published
2016
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12. HIV in the ICU

Author

Karstaedt, Alan S., Rhudo Mathivha, L., Banage, Christine L. N., Rello, Jordi, editor, Feldman, Charles, editor, and Sarosi, George A., editor

Published
2005
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16. The utility of repeat Xpert MTB/RIF testing to diagnose tuberculosis in HIV-positive adults with initial negative result

Author

Hanifa, Yasmeen, primary, Fielding, Katherine L., additional, Chihota, Violet N., additional, Adonis, Lungiswa, additional, Charalambous, Salome, additional, Foster, Nicola, additional, Karstaedt, Alan, additional, McCarthy, Kerrigan, additional, Nicol, Mark P., additional, Ndlovu, Nontobeko T., additional, Sinanovic, Edina, additional, Sahid, Faieza, additional, Stevens, Wendy, additional, Vassall, Anna, additional, Churchyard, Gavin J., additional, and Grant, Alison D., additional

Published
2022
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20. HIV/AIDS and antiretroviral treatment knowledge, attitudes, beliefs, and practices in HIV-infected adults in Soweto, South Africa

Author

Nachega, Jean B., Lehman, Dara A., Hlatshwayo, Dorothy, Mothopeng, Rachel, Chaisson, Richard E., and Karstaedt, Alan S.

Subjects
HIV patients -- Surveys, AIDS treatment -- Surveys, Antiviral agents -- Usage, Health
Abstract

A cross-sectional study of knowledge, attitudes, beliefs and practices toward HIV and antiretroviral therapy (ART) was conducted in Soweta, South Africa using a standardized validated questionnaire. One hundred and five HIV clinic patients were evaluated, of which 70% were not on ART, 89% had good knowledge about the cause of HIV infection and 83% knew about modes of transmission.

Published
2005

25. Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

Author

van Schalkwyk, Erika, primary, Mhlanga, Mabatho, additional, Maphanga, Tsidiso G., additional, Mpembe, Ruth S., additional, Shillubane, Amanda, additional, Iyaloo, Samantha, additional, Tsotetsi, Ernest, additional, Pieton, Kim, additional, Karstaedt, Alan S., additional, Sahid, Faieza, additional, Menezes, Colin N., additional, Tsitsi, Merika, additional, Motau, Ayanda, additional, Wadula, Jeannette, additional, Seetharam, Sharona, additional, van den Berg, Eunice, additional, Sriruttan, Charlotte, additional, and Govender, Nelesh P., additional

Published
2020
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29. Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update

Author

Govender, Nelesh P., primary, Meintjes, Graeme, additional, Mangena, Phetho, additional, Nel, Jeremy, additional, Potgieter, Samantha, additional, Reddy, Denasha, additional, Rabie, Helena, additional, Wilson, Douglas, additional, Black, John, additional, Boulware, David, additional, Boyles, Tom, additional, Chiller, Tom, additional, Dawood, Halima, additional, Dlamini, Sipho, additional, Harrison, Thomas S., additional, Ive, Prudence, additional, Jarvis, Joseph, additional, Karstaedt, Alan, additional, Madua, Matamela C., additional, Menezes, Colin, additional, Moosa, Mahomed-Yunus S., additional, Motlekar, Zaaheera, additional, Shroufi, Amir, additional, Stacey, Sarah Lynn, additional, Tsitsi, Merika, additional, van Cutsem, Gilles, additional, Variava, Ebrahim, additional, Venter, Michelle, additional, and Wake, Rachel, additional

Published
2019
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32. A study of patient attitudes towards decentralisation of HIV care in an urban clinic in South Africa

Author

Mukora Rachel, Charalambous Salome, Dahab Maysoon, Hamilton Robin, and Karstaedt Alan

Subjects
decentralization, down-referral, South Africa, ART, level of care, Public aspects of medicine, RA1-1270
Abstract

Abstract Background In South Africa, limited human resources are a major constraint to achieving universal antiretroviral therapy (ART) coverage. Many of the public-sector HIV clinics operating within tertiary facilities, that were the first to provide ART in the country, have reached maximum patient capacity. Decentralization or "down-referral" (wherein ART patients deemed stable on therapy are referred to their closest Primary Health Clinics (PHCs) for treatment follow-up) is being used as a possible alternative of ART delivery care. This cross-sectional qualitative study investigates attitudes towards down-referral of ART delivery care among patients currently receiving care in a centralized tertiary HIV clinic. Methods Ten focus group discussions (FGDs) with 76 participants were conducted in early 2008 amongst ART patients initiated and receiving care for more than 3 months in the tertiary HIV clinic study site. Eligible individuals were invited to participate in FGDs involving 6-9 participants, and lasting approximately 1-2 hours. A trained moderator used a discussion topic guide to investigate the main issues of interest including: advantages and disadvantages of down-referral, potential motivating factors and challenges of down-referral, assistance needs from the transferring clinic as well as from PHCs. Results Advantages include closeness to patients' homes, transport and time savings. However, patients favour a centralized service for the following reasons: less stigma, patients established relationship with the centralized clinic, and availability of ancillary services. Most FGDs felt that for down-referral to occur there needed to be training of nurses in patient-provider communication. Conclusion Despite acknowledging the down-referral advantages of close proximity and lower transport costs, many participants expressed concerns about lack of trained HIV clinical staff, negative patient interactions with nurses, limited confidentiality and stigma. There was consensus that training of nurses and improved health systems at the local clinics were needed if successful down-referral was to take place.

Published
2011
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33. Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study

Author

Hamilton Robin, Fielding Katherine L, Karstaedt Alan S, Charalambous Salome, Dahab Mison, La Grange Lettie, Churchyard Gavin J, and Grant Alison D

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Many national antiretroviral therapy (ART) programmes encourage providers to identify and address baseline factors associated with poor treatment outcomes, including modifiable adherence-related behaviours, before initiating ART. However, evidence on such predictors is scarce, and providers judgement may often be inaccurate. To help address this evidence gap, this observational cohort study examined baseline factors potentially predictive of poor treatment outcomes in two ART programmes in South Africa, with a particular focus on determinants of adherence. Methods Treatment-naïve patients starting ART were enrolled from a community and a workplace ART programme. Potential baseline predictors associated with poor treatment outcomes (defined as viral load > 400 copies/ml or having discontinued treatment by six months) were assessed using logistic regression. Exposure variables were organised for regression analysis using a hierarchical framework. Results 38/227 (17%) of participants in the community had poor treatment outcomes compared to 47/117 (40%) in the workplace. In the community, predictors of worse outcomes included: drinking more than 20 units of alcohol per week, having no prior experience of chronic medications, and consulting a traditional healer in the past year (adjusted odds ratio [aOR] 15.36, 95% CI 3.22-73.27; aOR 2.30, 95%CI 1.00-5.30; aOR 2.27, 95% CI 1.00-5.19 respectively). Being male and knowing someone on ART were associated with better outcomes (aOR 0.25, 95%CI 0.09-0.74; aOR 0.44, 95%CI 0.19-1.01 respectively). In the workplace, predictors of poor treatment outcomes included being uncertain about the health effects of ART and a traditional healer's ability to treat HIV (aOR 7.53, 95%CI 2.02-27.98; aOR 4.40, 95%CI 1.41-13.75 respectively). Longer pre-ART waiting time (2-12 weeks compared to Conclusion Baseline predictors of poor treatment outcomes were largely unique to each programme, likely reflecting different populations and pathways to HIV care. In the workplace, active promotion of HIV testing may have extended ART to individuals who, without provider initiation, would not have spontaneously sought care. As provider-initiated testing makes ART available to individuals less motivated to seek care, patients may need additional adherence support, especially addressing uncertainty about the health benefits of ART.

Published
2010
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34. The utility of repeat Xpert MTB/RIF testing to diagnose tuberculosis in HIV-positive adults with initial negative result

Author

Hanifa, Yasmeen, Fielding, Katherine L, Chihota, Violet N, Adonis, Lungiswa, Charalambous, Salome, Foster, Nicola, Karstaedt, Alan, McCarthy, Kerrigan, Nicol, Mark P, Ndlovu, Nontobeko T, Hanifa, Yasmeen, Fielding, Katherine L, Chihota, Violet N, Adonis, Lungiswa, Charalambous, Salome, Foster, Nicola, Karstaedt, Alan, McCarthy, Kerrigan, Nicol, Mark P, and Ndlovu, Nontobeko T

Abstract

Background: Amongst HIV-positive adults in South Africa with initial negative Xpert results, we compared the yield from repeating Xpert MTB/RIF (“Xpert”) on sputum to guideline-recommended investigation for tuberculosis (TB). Methods: A systematic sample of adults attending for HIV care were enrolled in a cohort exploring TB investigation pathways. This substudy was restricted to those at highest risk of TB (CD4<200 cells/mm3 or unknown) who had a negative initial Xpert result. At attendance for the Xpert result, a repeat sputum sample was stored, and further investigations facilitated per national guidelines. Participants were reviewed monthly, with reinvestigation if indicated, for at least three months, when sputum and blood were cultured for mycobacteria, and the stored sputum tested using Xpert. We defined TB as “confirmed” if Xpert, line probe assay or Mycobacterium tuberculosis culture within six months of enrolment were positive, and “clinical” if TB treatment was started without microbiological confirmation. Results: Amongst 227 participants with an initial negative Xpert result (63% female, median age 37 years, median CD4 count 100 cells/mm3), 28 (12%) participants had TB diagnosed during study follow-up (16 confirmed, 12 clinical); stored sputum tested positive on Xpert in 5/227 (2%). Amongst 27 participants who started TB treatment, the basis was bacteriological confirmation 11/27 (41%); compatible imaging 11/27 (41%); compatible symptoms 2/27 (7%); and unknown 3/27 (11%). Conclusions: Amongst HIV-positive individuals at high risk of active TB with a negative Xpert result, further investigation using appropriate diagnostic modalities is more likely to lead to TB treatment than immediately repeating sputum for Xpert. TB diagnostic tests with improved sensitivity are needed.

Published
2018

35. Imputing direct and indirect vaccine effectiveness of childhood pneumococcal conjugate vaccine against invasive disease by surveying temporal changes in nasopharyngeal pneumococcal colonization

Author

Nzenze, Susan A., Madhi, Shabir A., Shiri, Tinevimbo, Klugman, Keith P., de Gouveia, Linda, Moore, David P., Karstaedt, Alan S., Tempia, Stefano, Nunes, Marta C., and von Gottberg, Anne

Subjects
bacterial infections and mycoses, complex mixtures, RC
Abstract

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

Published
2017

36. Care of HIV-infected adults at Baragwanath Hospital, Soweto

Author

Kinghom, Anthony W. A., Lee, Tennyson C. M., Karstaedt, Alan S., Khuonane, Brenda, and Schneider, Helen

Abstract

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.

Published
2017

37. Post-print: Psychological factors associated with painful versus non-painful HIV-associated sensory neuropathy. DOI: 10.1007/s10461-017-1856-9

Author

Prinisha Pillay, Wadley, Antonia, Cherry, Catherine, Karstaedt, Alan, and Kamerman, Peter

Abstract

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.

Published
2017
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38. The utility of repeat Xpert MTB/RIF testing to diagnose tuberculosis in HIV-positive adults with initial negative result

Author

Hanifa, Yasmeen, primary, Fielding, Katherine L., additional, Chihota, Violet N., additional, Adonis, Lungiswa, additional, Charalambous, Salome, additional, Foster, Nicola, additional, Karstaedt, Alan, additional, McCarthy, Kerrigan, additional, Nicol, Mark P., additional, Ndlovu, Nontobeko T., additional, Sinanovic, Edina, additional, Sahid, Faieza, additional, Stevens, Wendy, additional, Vassall, Anna, additional, Churchyard, Gavin J., additional, and Grant, Alison D., additional

Published
2018
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39. A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa

Author

Hanifa, Yasmeen, Fielding, Katherine L, Chihota, Violet N, Adonis, Lungiswa, Charalambous, Salome, Foster, Nicola, Karstaedt, Alan, McCarthy, Kerrigan, Nicol, Mark P, Ndlovu, Nontobeko T, Hanifa, Yasmeen, Fielding, Katherine L, Chihota, Violet N, Adonis, Lungiswa, Charalambous, Salome, Foster, Nicola, Karstaedt, Alan, McCarthy, Kerrigan, Nicol, Mark P, and Ndlovu, Nontobeko T

Abstract

BackgroundThe World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.ObjectiveTo develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.DesignCohort study exploring a TB testing algorithm.SettingHIV clinics, South Africa.ParticipantsRepresentative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model.OutcomeTB, defined as “confirmed” if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and “clinical” if TB treatment started without microbiological confirmation, within six months of enrolment.ResultsOverall, 79/2602 (3.0%) participants on ART fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508 (32.3%) participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%) in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART < 3 months); body mass index (continuous); CD4 (continuous); number of WHO symptoms (1 vs. >1 symptom). We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested.ConclusionOur clinical score may help prioritise TB investigation among symptomatic individuals.

Published
2017

40. A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa

Author

Hanifa, Yasmeen, primary, Fielding, Katherine L., additional, Chihota, Violet N., additional, Adonis, Lungiswa, additional, Charalambous, Salome, additional, Foster, Nicola, additional, Karstaedt, Alan, additional, McCarthy, Kerrigan, additional, Nicol, Mark P., additional, Ndlovu, Nontobeko T., additional, Sinanovic, Edina, additional, Sahid, Faieza, additional, Stevens, Wendy, additional, Vassall, Anna, additional, Churchyard, Gavin J., additional, and Grant, Alison D., additional

Published
2017
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42. Imputing the Direct and Indirect Effectiveness of Childhood Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease by Surveying Temporal Changes in Nasopharyngeal Pneumococcal Colonization

Author

Nzenze, Susan A., primary, Madhi, Shabir A., additional, Shiri, Tinevimbo, additional, Klugman, Keith P., additional, de Gouveia, Linda, additional, Moore, David P., additional, Karstaedt, Alan S., additional, Tempia, Stefano, additional, Nunes, Marta C., additional, and von Gottberg, Anne, additional

Published
2017
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44. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016-20171.

Author

van Schalkwyk, Erika, Mpembe, Ruth S., Thomas, Juno, Shuping, Liliwe, Ismail, Husna, Lowman, Warren, Karstaedt, Alan S., Chibabhai, Vindana, Wadula, Jeannette, Avenant, Theunis, Messina, Angeliki, Govind, Chetna N., Moodley, Krishnee, Dawood, Halima, Ramjathan, Praksha, Govender, Nelesh P., for GERMS-SA, and GERMS-SA

Subjects
CANDIDEMIA, CANDIDA, FUNGEMIA, MASS spectrometry, ODDS ratio, DRUG therapy
Abstract

Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016-2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2-86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8-2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non-C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa. [ABSTRACT FROM AUTHOR]

Published
2019
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47. Diagnostic Accuracy of Lateral Flow Urine LAM Assay for TB Screening of Adults with Advanced Immunosuppression Attending Routine HIV Care in South Africa

Author

Hanifa, Yasmeen, primary, Fielding, Katherine L., additional, Chihota, Violet N., additional, Adonis, Lungiswa, additional, Charalambous, Salome, additional, Karstaedt, Alan, additional, McCarthy, Kerrigan, additional, Nicol, Mark P., additional, Ndlovu, Nontobeko T., additional, Sahid, Faieza, additional, Churchyard, Gavin J., additional, and Grant, Alison D., additional

Published
2016
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