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Hoffmann CJ, Shearer K, Kekana B, Kerrigan D, Moloantoa T, Golub JE, Variava E, Martinson NA. Reducing HIV-associated post-hospital mortality through home-based care in South Africa: a randomized controlled trial. Clin Infect Dis 2023:ciad727. [PMID: 38051643 DOI: 10.1093/cid/ciad727] [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: 08/15/2023] [Revised: 10/24/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Twenty-three percent of people with HIV (PWH) die within 6-months of hospital discharge. We tested the hypothesis whether a series of structured home visits could reduce mortality. METHODS We designed a disease neutral home visit package with up to 6 home visits starting 1-week post-hospitalization and every 2 weeks thereafter. The home visit team used a structured assessment algorithm to evaluate and triage social and medical needs of the participant and provide nutritional support. We compared all-cause mortality 6-months following discharge for the intervention compared to usual care in a pilot randomized trial conducted in South Africa. To inform potential scale-up we also included and separately analyzed a group of people without HIV (PWOH). RESULTS We enrolled 125 people with HIV and randomized them 1:1 to the home visit intervention or usual care. Fourteen were late exclusions because of death prior to discharge or delayed discharge leaving 111 for analysis. The median age was 39 years, 31% were men; and 70% had advanced HIV disease. At six months among PWH 4 (7.3%) in the home visit arm and 10 (17.9%) in the usual care arm (p = 0.09) had died. Among the 70 PWOH enrolled overall 6-month mortality was 10.1%. Of those in the home visit arm, 91% received at least one home visit. CONCLUSIONS We demonstrated feasibility of delivering post-hospital home visits and demonstrated preliminary efficacy among PWH with a substantial, but not statistically significant, effect size (59% reduction in mortality). COVID-19 related challenges resulted in under-enrollment.
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Affiliation(s)
- Christopher J Hoffmann
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Shearer
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Boitumelo Kekana
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Deanna Kerrigan
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Tumelo Moloantoa
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan E Golub
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, North West Department of Health, Klerksdorp, South Africa
| | - Neil A Martinson
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Turkova A, White E, Kekitiinwa AR, Mumbiro V, Kaudha E, Liberty A, Ahimbisibwe GM, Moloantoa T, Srirompotong U, Mosia NR, Puthanakit T, Kobbe R, Fortuny C, Kataike H, Bbuye D, Na-Rajsima S, Coelho A, Lugemwa A, Bwakura-Dangarembizi MF, Klein N, Mujuru HA, Kityo C, Cotton MF, Ferrand RA, Giaquinto C, Rojo P, Violari A, Gibb DM, Ford D. Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial. Lancet Child Adolesc Health 2023; 7:718-727. [PMID: 37562418 DOI: 10.1016/s2352-4642(23)00164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124-159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir. FUNDING Penta Foundation, ViiV Healthcare, and UK Medical Research Council.
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Affiliation(s)
- Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
| | - Ellen White
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | - Vivian Mumbiro
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | - Afaaf Liberty
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | | | - Tumelo Moloantoa
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | | | - Nozibusiso Rejoice Mosia
- Department of Paediatrics and Children Health, King Edward VIII Hospital, Enhancing Care Foundation, University of KwaZulu-Natal, Durban, South Africa
| | - Thanyawee Puthanakit
- HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand; Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Clàudia Fortuny
- Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Department of Surgery and Medico-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Hajira Kataike
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Alexandra Coelho
- INSERM/ANRS SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | | | | | - Nigel Klein
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, UK; Africa Health Research Institute, Kwazulu-Natal, South Africa
| | - Hilda A Mujuru
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Mark F Cotton
- Children's Infectious Diseases Clinical Research Unit, Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
| | - Rashida A Ferrand
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Carlo Giaquinto
- Department of Women and Child Health, Padova, University of Padova, Italy
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, London, UK
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Nabeemeeah F, Sabet R, Moloantoa T, Waja Z, Pretorius Z, Majoro K, Letutu-Xaba M, Vilaplana C, Nigou J, Martinson N. Exhaled breath specimens subjected to point-of-care lipoarabinomannan testing. Int J Tuberc Lung Dis 2023; 27:703-705. [PMID: 37608487 PMCID: PMC10443782 DOI: 10.5588/ijtld.23.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/10/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- F Nabeemeeah
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - R Sabet
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - T Moloantoa
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Z Waja
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Z Pretorius
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - K Majoro
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - M Letutu-Xaba
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - C Vilaplana
- Experimental Tuberculosis Unit, Microbiology Department, Institut i Hospital d'Investigació en Ciències de la Salut i Hospital Germans Trias i Pujol, Dirección Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Badalona, Catalonia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - J Nigou
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, Centre national de la recherche scientifique, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - N Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University Centre for TB Research, Baltimore, MD, USA
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Sabet N, Omar T, Milovanovic M, Magajane T, Mosala M, Moloantoa T, Kato-Kalule N, Semedo LV, Swanepoel F, Wallis C, Abraham P, Lebina L, Variava E, Martinson N. Undiagnosed Pulmonary Tuberculosis (TB) and Coronavirus Disease 2019 (COVID-19) in Adults Dying at Home in a High-TB-Burden Setting, Before and During Pandemic COVID-19: An Autopsy Study. Clin Infect Dis 2023; 77:453-459. [PMID: 37041678 DOI: 10.1093/cid/ciad212] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Missing or undiagnosed patients with tuberculosis (TB) or coronavirus disease 2019 (COVID-19) are of concern. Identifying both infections in patients with no diagnosis prior to death contributes to understanding the burden of disease. To confirm reports of global reduction in TB incidence, a 2012 autopsy study of adults dying at home of natural causes in a high-TB-burden setting was repeated, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assessments after the first COVID-19 surge in South Africa. METHODS Adult decedents who died at home with insufficient information to determine cause of death, no recent hospitalization, and no current antemortem TB or COVID-19 diagnosis were identified between March 2019 and October 2020 with a 4-month halt during lockdown. A standardized verbal autopsy followed by minimally invasive needle autopsy (MIA) was performed. Biopsies were taken for histopathology from liver, bilateral brain and lung; bronchoalveolar lavage fluid was collected for Xpert (MTB/RIF) and mycobacterial culture, and blood for human immunodeficiency virus (HIV) polymerase chain reaction (PCR) testing. After the start of the COVID-19 pandemic, a nasopharyngeal swab and lung tissue were subjected to SARS-CoV-2 PCR testing. RESULTS Sixty-six MIAs were completed in 25 men and 41 women (median age, 60 years); 68.2% had antemortem respiratory symptoms and 30.3% were people with HIV. Overall, TB was diagnosed in 11 of 66 (16.7%) decedents, and 14 of 41 (34.1%) in the COVID-19 pandemic were SARS-CoV-2 positive. CONCLUSIONS Undiagnosed TB in adults dying at home has decreased but remains unacceptably high. Forty percent of decedents had undiagnosed COVID-19, suggesting that estimates of excess deaths may underestimate the impact of SARS-CoV-2 on mortality.
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Affiliation(s)
- Nadia Sabet
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa
| | - Tanvier Omar
- Department of Anatomical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Tebogo Magajane
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Modiehi Mosala
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Tumelo Moloantoa
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nalukenge Kato-Kalule
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - Lenise Varela Semedo
- Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa
| | - Floris Swanepoel
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Carole Wallis
- Bio Analytical Research Corporation, Johannesburg, South Africa
| | - Pattamukkil Abraham
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, Durban, South Africa
| | - Ebrahim Variava
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA
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Loh SM, Moloantoa T, Yende N, Variava E, Niaura R, Golub JE, Martinson N, Elf JL. A cross-sectional study of attitudes and behaviors of snuff use and cessation among people with and without HIV in South Africa. Tob Use Insights 2023; 16:1179173X231193890. [PMID: 37577008 PMCID: PMC10422901 DOI: 10.1177/1179173x231193890] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Background Despite a high (48%) prevalence of snuff use among women with HIV in South Africa, little is known of the attitudes and behaviors of use, strategies for cessation, and potential health risks. Methods In a cross-sectional study, a questionnaire was administered to adults (≥18 years) with (HIV+) and without HIV (HIV-) who self-reported current snuff use to collect information on demographics, snuff use and cessation attempts, preferred strategies for cessation, other substance use, history of respiratory illness, and mental health. Results 150 (74 HIV+, 76 HIV-) participants were enrolled; 115 (77%) were daily snuff users, 6 (4%) were current smokers, and 17 (11%) former smokers. Top reasons for current snuff use included improving health (n = 48, 32%), reducing stress (n = 26, 16%), and "being a habit" (n = 38, 25%). Participants believed snuff use to have mostly positive (n = 68, 46%) or no (n = 54, 36%) health impacts, and 57 (38%) participants believed snuff cures headaches. 103 (69%) participants reported a previous quit attempt, and 110 (73%) indicated high interest in quitting snuff. Although 105 (70%) participants indicated that advice from a healthcare provider would aid them in quitting snuff, only 30 (20%) reported ever receiving that advice. A majority of participants (n = 141, 94%) suffer from moderate to high levels of perceived stress, and overall few differences were seen by HIV status. Conclusions Education on negative impacts of snuff, advice to quit from healthcare providers, and nicotine replacement therapy should be considered in the development of a snuff cessation program.
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Affiliation(s)
- Samantha M. Loh
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | | | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa
| | - Raymond Niaura
- Department of Epidemiology; Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Jonathan E. Golub
- Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Jessica L. Elf
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Arias L, Otwombe K, Waja Z, Tukvadze N, Korinteli T, Moloantoa T, Fonseca KL, Pillay N, Seiphetlo T, Ouchi-Vernet D, Siles A, Carabias L, Quiñones C, Vashakidze S, Martinson N, Vilaplana C. SMA-TB: study protocol for the phase 2b randomized double-blind, placebo-controlled trial to estimate the potential efficacy and safety of two repurposed drugs, acetylsalicylic acid and ibuprofen, for use as adjunct therapy added to, and compared with, the standard WHO recommended TB regimen. Trials 2023; 24:435. [PMID: 37370174 PMCID: PMC10304643 DOI: 10.1186/s13063-023-07448-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The duration and regimen of tuberculosis (TB) treatment is currently based predominantly on whether the M. tuberculosis (Mtb) strain is drug-sensitive (DS) or multidrug-resistant (MDR) with doses adjusted by patients' weight only. The systematic stratification of patients for personalized treatment does not exist for TB. As each TB case is different, individualized treatment regimens should be applied to obtain better outcomes. In this scenario, novel therapeutic approaches are urgently needed to (1) improve outcomes and (2) shorten treatment duration, and host-directed therapies (HDT) might be the best solution. Within HDT, repurposed drugs represent a shortcut in drug development and can be implemented at the short term. As hyperinflammation is associated with worse outcomes, HDT with an anti-inflammatory effect might improve outcomes by reducing tissue damage and thus the risk of permanent sequelae. METHODS SMA-TB is a multicentre randomized, phase IIB, placebo-controlled, three-arm, double-blinded clinical trial (CT) that has been designed in the context of the EC-funded SMA-TB Project ( www.smatb.eu ) in which we propose to use 2 common non-steroidal anti-inflammatory drugs (NSAID), acetylsalicylic acid (ASA) and ibuprofen (Ibu), as an HDT for use as adjunct therapy added to, and compared with, the standard of care (SoC) World Health Organization (WHO)-recommended TB regimen in TB patients. A total of 354 South African and Georgian adults diagnosed with confirmed pulmonary TB will be randomized into SoC TB treatment + placebo, SoC + acetylsalicylic acid or SoC + ibuprofen. DISCUSSION SMA-TB will provide proof of concept of the HDT as a co-adjuvant treatment and identify the suitability of the intervention for different population groups (different epidemiological settings and drug susceptibility) in the reduction of tissue damage and risk of bad outcomes for TB patients. This regimen potentially will be more effective and targeted: organ saving, reducing tissue damage and thereby decreasing the length of treatment and sequelae, increasing cure rates and pathogen clearance and decreasing transmission rates. It will result in better clinical practice, care management and increased well-being of TB patients. TRIAL REGISTRATION Clinicaltrials.gov NCT04575519. Registered on October 5, 2020.
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Affiliation(s)
- Lilibeth Arias
- Unitat de Tuberculosi Experimental, Germans Trias I Pujol Research Institute (IGTP), Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Waja
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases (NCTLD), Tbilisi, Georgia
| | - Tamta Korinteli
- National Center for Tuberculosis and Lung Diseases (NCTLD), Tbilisi, Georgia
| | - Tumelo Moloantoa
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Kaori L Fonseca
- Unitat de Tuberculosi Experimental, Germans Trias I Pujol Research Institute (IGTP), Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Natasha Pillay
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Thabiso Seiphetlo
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Dan Ouchi-Vernet
- Institut d'Investigació en Atenció Primària de Salut Jordi Gol (IDIAPJgol), Barcelona, Spain
| | - Adrian Siles
- Pharmacy department, Germans Trias I Pujol Hospital and Research Institute (HUGTIP-IGTP), Badalona, Catalonia, Spain
| | - Lidia Carabias
- Pharmacy department, Germans Trias I Pujol Hospital and Research Institute (HUGTIP-IGTP), Badalona, Catalonia, Spain
| | - Carles Quiñones
- Pharmacy department, Germans Trias I Pujol Hospital and Research Institute (HUGTIP-IGTP), Badalona, Catalonia, Spain
| | - Sergo Vashakidze
- National Center for Tuberculosis and Lung Diseases (NCTLD), Tbilisi, Georgia
- The University of Georgia, Tbilisi, Georgia
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Centre for TB Research, Johns Hopkins University, Baltimore, USA
| | - Cristina Vilaplana
- Unitat de Tuberculosi Experimental, Germans Trias I Pujol Research Institute (IGTP), Badalona, Catalonia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain.
- Direcció Clínica Territorial de Malalties Infeccioses, Salut Internacional de Gerència Territorial Metropolitana Nord, Badalona, Catalonia, Spain.
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Motlhaoleng K, Moropeng L, Abraham P, Moloantoa T. Healthcare workers' knowledge and practice of the South African national tuberculosis management guidelines. S Afr Med J 2023; 113:54-58. [PMID: 37170603 DOI: 10.7196/samj.2023.v113i5.16658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a global public health concern. The 2014 South African (SA) national TB management guidelines were developed to decrease the burden of TB, but implementation remains a challenge. OBJECTIVES To estimate healthcare workers' level of knowledge about the national TB management guidelines and to assess the implementation of these guidelines. METHODS A cross-sectional descriptive study was conducted in four randomly selected health facilities in Dr Kenneth Kaunda district, North West Province, SA. We administered a TB knowledge questionnaire and reviewed TB registers and 204 patient files. RESULTS A total of 38 participants completed the TB knowledge questionnaire. The majority were professional nurses (89%). The participants' mean (standard deviation) age was 46 (8) years, and the median (interquartile range) career length was 10 (8 - 17) years. Inadequate knowledge of the national TB management guidelines was revealed in 12 participants (32%). The review of the TB register showed that 163 153 patients were screened for TB. Of these, 9 308 (6%) had presumptive TB, 8 116 (87%) had an Xpert test and 1 292 (16%) had positive Xpert results. Overall, 1 150 (12%) of the patients with presumptive TB were diagnosed with drug-sensitive TB and started treatment based on laboratory results and a clinical diagnosis. Of this sample, 999 patients (87%) were treated successfully. The patient file review showed that a total of 197 patients (97%) received the correct treatment dose according to body weight and treatment phase. Smear microscopy was consistently done throughout the intensive and continuation phases of TB treatment. Body weight was monitored in 199 patients (98%). Contact investigation was conducted for 133 patients (65%), and there was evidence that child contacts aged <5 years were started on isoniazid preventive therapy. Only 110 patients (54%) had documented HIV status. Of these, 66 (60%) were HIV positive, and 39 (59%) of them received antiretroviral therapy. Body mass index was monitored in 55 patients (27%). Eighty (39%) of the patients with TB were women of childbearing potential, and only 8 (10%) of them had their pregnancy test results recorded. Treatment side-effects were reported in 17 patient files (8%); 13 (76%) were managed and 8 (62%) had resolved side-effects. CONCLUSION Most participants had adequate knowledge of the national TB management guidelines. A high TB treatment success rate was noted, along with some good practices. The study also highlights several knowledge and practice gaps that can be overcome by measures such as quality audits to improve record keeping. Adequate training of healthcare workers, sustaining and updating knowledge through continuous training, and strengthened supervision mechanisms to ensure compliance with the guidelines are recommended.
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Affiliation(s)
- K Motlhaoleng
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - L Moropeng
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.
| | - P Abraham
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - T Moloantoa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Mankgele M, Variava E, Moloantoa T, Otwombe K, Hlongwane K, Disenyane D, Bida M, Chikwati R, Snyman T, Martinson N, Mahlangu J. Underdiagnosis of iron deficiency anaemia in HIV-infected individuals: a pilot study using soluble transferrin receptors and intensive bone marrow iron stores to improve the diagnosis. J Clin Pathol 2022:jcp-2022-208172. [PMID: 36137739 DOI: 10.1136/jcp-2022-208172] [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: 01/18/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Abstract
AIM We compared soluble transferrin receptors (sTfR), serum ferritin, mean cell volume (MCV) of red cells and the sTfR-ferritin index with the intensive method bone marrow trephine (BMT) iron stores in the diagnosis of iron deficiency anaemia (IDA) in Human Immunodeficiency Virus (HIV)-positive hospitalised participants. METHODS In this cross-sectional study, we recruited hospitalised HIV-positive and coronavirus of 2019 (COVID-19)-negative adults with anaemia who required a bone marrow examination as part of their diagnostic workup. We measured the full blood count, ferritin, sTfR and assessed iron using the intensive method in Haemotoxylin and Eosin (H&E)-stained BMT core biopsies of consenting participants. RESULTS Of the 60 enrolled participants, 57 were evaluable. Thirteen (22.80%) had IDA on H&E BMT iron stores assessment, and 44 (77.19%) had anaemia of chronic diseases (ACD). The sTfR and the sTfR-ferritin index had sensitivities of 61.54% and 53.85%, respectively, for IDA diagnosis. The sensitivity and specificity of ferritin was 7.69% and 92.31%, respectively. The sTfR and sTfR-ferritin index's diagnostic specificity was relatively low at 46.15% and 38.46%, respectively. CONCLUSION In this pilot study in HIV-positive participants, the prevalence of iron deficiency using the BMT assessment was low. Both the sTfR and the sTfR-ferritin index had a better quantitative correlation to bone marrow iron stores when compared with the MCV and ferritin and, may be more accurate surrogate markers of IDA.
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Affiliation(s)
- Mahlatse Mankgele
- Division of Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Academic Hospital Complex and the University of the Witwatersrand, Johannesburg, South Africa
| | - Tumelo Moloantoa
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.,School of Public health, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Dineo Disenyane
- Anatomical Pathology, University of Pretoria, Pretoria, South Africa
| | - Meshack Bida
- Anatomical Pathology, University of Pretoria, Pretoria, South Africa
| | - Raylton Chikwati
- Division of Chemical Pathology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Tracy Snyman
- Division of Chemical Pathology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Johnny Mahlangu
- Molecular Medicine and Haematology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
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