Outcomes of on-site antiretroviral therapy provision in a South African correctional facility

We evaluated a novel on-site antiretroviral therapy (ART) programme in a South African correctional facility using routinely collected programme data, from a retrospective cohort of adult inmates starting ART between 03/2007 and 03/2009 followed-up to 09/2009. We report (1) mortality (using survival analysis); (2) retention in the programme (to 09/2009); and (3) virological suppression at six and 12 months (<400 copies/ml) following ART initiation. In total, 404 started ART (median age 33 years; 91.3% men; median baseline CD4 cell count 152 cells/µl [interquartile range 85-225]). Among 299 starting ART for the first time (ART-naïve), 23 deaths occurred during 252 person-years (median follow-up nine months). Mortality rates were 17.2 at 0-6 months (95% confidence interval 10.9-26.9) and 2.8 at >6 months (95% confidence interval 1.1-7.5)/100 person-years; p < 0.001. At 09/2009, 35.6% (144/404) remained in the correctional facility, with 94.4% (136/144) retained in the programme; 38.4% (155/404) were released; and 20.0% (81/404) transferred to another facility. ART-naïve patients in care six and 12 months after ART initiation, 94.7% (124/131) and 92.5% (74/80) were virologically suppressed, respectively. High early mortality warrants the early identification and management of HIV-positive inmates. The high mobility of inmates necessitates systems for facilitating continuity of care. Good virological responses and retention supports decentralising HIV care to correctional facilities.

Tuberculosis active case finding: uptake and diagnostic yield among minibus drivers in urban South Africa

Background

Tuberculosis (TB) active case finding is a part of TB control in areas of higher TB prevalence. Congested public transportation settings may be areas of increased TB transmission. We evaluated the uptake and diagnostic yield of an active TB screening program among minibus drivers in a large public transportation facility in Johannesburg, South Africa.

Methods

Over an eight month period, we intensively recruited minibus drivers for TB screening with a goal of 80% uptake among the estimated 2000 drivers. All participants were screened for TB symptoms, offered HIV testing, and had sputum collected for smear microscopy and liquid culture.

Results

686 drivers were screened for TB, representing an uptake of only 34% of all drivers (43% of the target screening). Ten drivers (1.5%) were culture positive for TB, nine of whom were sputum smear microscopy negative. Factors associated with previously undiagnosed TB included a history of incarceration (odds ratio [OR] 5.5, 95% confidence interval: 1.1, 27.3) and HIV positivity (OR 5.3, 95% confidence interval: 1.1, 26.3).

Conclusions

We identified undiagnosed pulmonary TB cases among drivers but at a level that may be insufficient to justify systematic case finding in this population considering the poor uptake.

HIV/AIDS prevalence testing--merits, methodology and outcomes of a survey conducted at a large mining organisation in South Africa

OBJECTIVES

To determine the HIV prevalence rate at Anglo Platinum, a large, multinational organisation operating in South Africa (Gauteng, Limpopo and North-West), and to assess the merits, methodology and outcomes of the survey.

METHODS

A sample of 11,339 individuals, representing 18.4% of the organisation's employees, were tested for HIV. HIV prevalence was determined using the Wellcozyme HIV 1+2 GACELISA test (oral fluid assay), and variables such as age, site, grade and gender were analysed.

RESULTS

The overall prevalence rate was 24.6% (95% confidence interval (CI): 20.4-28.8), translating into approximately 15,167 HIV-infected individuals. Interestingly, there was considerable variation in prevalence between sites within the same geographical regions, highlighting the limitations of using data obtained from antenatal HIV surveillance surveys. As an example, the prevalence at sites in Limpopo province ranged from 9.8% to 19%, with the same basic demographic data in terms of race, age and gender.

CONCLUSION

The survey data enabled the organisation to plan resource allocation appropriately for each business unit following their commitment to the treatment of infected employees with antiretroviral therapy. These baseline prevalence data also provide an opportunity for monitoring of proposed interventions using cross-sectional surveys at designated intervals in the future.