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Mofokeng N, Maponga TG, van Schalkwyk M, Hugo S, Morobadi MD, Vawda S, Badenhorst L, van Vuuren C, van Rensburg C, Preiser W, Taljaard J, Wang S, Miller V, Wu D, Tucker JD, Seeley J, Goedhals D, Matthews PC. Barriers that prevent adults living with HBV infection from participating in clinical research: experience from South Africa. J Virus Erad 2023; 9:100317. [PMID: 36911657 PMCID: PMC9995934 DOI: 10.1016/j.jve.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
High profile international goals have been set for the elimination of hepatitis B virus (HBV) infection as a public health threat by the year 2030. Developing and expanding equitable, accessible translational HBV research programmes that represent real-world populations are therefore an urgent priority for clinical and academic communities. We present experiences and insights by an expert interdisciplinary group focusing on barriers that impede adults living with HBV infection from participating in clinical studies. Our viewpoint describes barriers we have identified through working in a variety of settings across South Africa, including lack of education and awareness, experiences of stigma and discrimination, challenges for governance and data management, and a burden of complex morbidity. Through identifying these challenges, we propose solutions and interventions, highlight new approaches, and provide a framework for future research.
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Affiliation(s)
- Nombuyiselo Mofokeng
- University of the Free State, Nelson Mandela Drive, Bloemfontein, 9300, South Africa
| | - Tongai G Maponga
- Division of Medical Virology, University of Stellenbosch, Tygerberg Hospital, Francie Van Zijl Drive, Cape Town, 7505, South Africa
| | - Marije van Schalkwyk
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University / Tygerberg Academic Hospital, Cape Town, South Africa
| | - Susan Hugo
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University / Tygerberg Academic Hospital, Cape Town, South Africa
| | - Molefi Daniel Morobadi
- University of the Free State, Nelson Mandela Drive, Bloemfontein, 9300, South Africa.,Ampath Laboratories, Pretoria, South Africa
| | - Sabeehah Vawda
- University of the Free State, Nelson Mandela Drive, Bloemfontein, 9300, South Africa
| | - Leane Badenhorst
- University of the Free State, Nelson Mandela Drive, Bloemfontein, 9300, South Africa
| | - Cloete van Vuuren
- University of the Free State, Nelson Mandela Drive, Bloemfontein, 9300, South Africa
| | - Christo van Rensburg
- Division of Gastroenterology, Department of Medicine, Stellenbosch University / Tygerberg Academic Hospital, Cape Town, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, University of Stellenbosch, Tygerberg Hospital, Francie Van Zijl Drive, Cape Town, 7505, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University / Tygerberg Academic Hospital, Cape Town, South Africa
| | - Su Wang
- Cooperman Barnabas Medical Center, Florham Park, NJ, USA.,World Hepatitis Alliance, London, UK
| | - Veronica Miller
- University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94704, USA
| | - Dan Wu
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Joseph D Tucker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Africa Health Research Institute (AHRI), 719 Umbilo Rd, Umbilo, Durban, 4001, South Africa
| | - Dominique Goedhals
- University of the Free State, Nelson Mandela Drive, Bloemfontein, 9300, South Africa.,PathCare Vermaak, Pretoria, South Africa
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, OX1 3SY, UK.,The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK.,University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals, 235 Euston Rd, London, NW1 2BU, UK
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Hardie DR, Korsman SN, Hsiao NY, Morobadi MD, Vawda S, Goedhals D. Contamination with HIV antibody may be responsible for false positive results in specimens tested on automated platforms running HIV 4th generation assays in a region of high HIV prevalence. PLoS One 2017; 12:e0182167. [PMID: 28759622 PMCID: PMC5536287 DOI: 10.1371/journal.pone.0182167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/13/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION In South Africa where the prevalence of HIV infection is very high, 4th generation HIV antibody/p24 antigen combo immunoassays are the tests of choice for laboratory based screening. Testing is usually performed in clinical pathology laboratories on automated analysers. To investigate the cause of false positive results on 4th generation HIV testing platforms in public sector laboratories, the performance of two automated platforms was compared in a clinical pathology setting, firstly on routine diagnostic specimens and secondly on known sero-negative samples. METHODS Firstly, 1181 routine diagnostic specimens were sequentially tested on Siemens and Roche automated 4th generation platforms. HIV viral load, western blot and follow up testing were used to determine the true status of inconclusive specimens. Subsequently, known HIV seronegative samples from a single donor were repeatedly tested on both platforms and an analyser was tested for surface contamination with HIV positive serum to identify how suspected specimen contamination could be occurring. RESULTS Serial testing of diagnostic specimens yielded 163 weakly positive or discordant results. Only 3 of 163 were conclusively shown to indicate true HIV infection. Specimen contamination with HIV antibody was suspected, based on the following evidence: the proportion of positive specimens increased on repeated passage through the analysers; viral loads were low or undetectable and western blots negative or indeterminate on problem specimens; screen negative, 2nd test positive specimens tested positive when reanalysed on the screening assay; follow up specimens (where available) were negative. Similarly, an increasing number of known negative specimens became (repeatedly) sero-positive on serial passage through one of the analysers. Internal and external analyser surfaces were contaminated with HIV serum, evidence that sample splashes occur during testing. CONCLUSIONS Due to the extreme sensitivity of these assays, contamination with minute amounts of HIV antibody can cause a negative sample to test positive. Better contamination control measures are needed on analysers used in clinical pathology environments, especially in regions where HIV sero-prevalence is high.
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Affiliation(s)
- Diana Ruth Hardie
- Division of Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, South Africa
| | - Stephen N. Korsman
- Division of Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, South Africa
| | - Nei-Yuan Hsiao
- Division of Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, South Africa
| | - Molefi Daniel Morobadi
- National Health Laboratory Service, South Africa
- Department of Medical Microbiology and Virology, University of the Free State, Bloemfontein, South Africa
| | - Sabeehah Vawda
- National Health Laboratory Service, South Africa
- Department of Medical Microbiology and Virology, University of the Free State, Bloemfontein, South Africa
| | - Dominique Goedhals
- National Health Laboratory Service, South Africa
- Department of Medical Microbiology and Virology, University of the Free State, Bloemfontein, South Africa
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