Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Bhakti Hansoti; George Mwinnyaa; Elizabeth Hahn; Aditi Rao; John Black; Victoria Chen; Kathryn Clark; William Clarke; Anna L. Eisenberg; Reinaldo Fernandez; Joshua Iruedo; Oliver Laeyendecker; Roshen Maharaj; Pamela Mda; Jernelle Miller; Nomzamo Mvandaba; Yandisa Nyanisa; Steven J. Reynolds; Andrew D. Redd; Sofia Ryan; David F. Stead; Lee A. Wallis; Thomas C. Quinn

EClinicalMedicine (Oct 2019)

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Bhakti Hansoti,
George Mwinnyaa,
Elizabeth Hahn,
Aditi Rao,
John Black,
Victoria Chen,
Kathryn Clark,
William Clarke,
Anna L. Eisenberg,
Reinaldo Fernandez,
Joshua Iruedo,
Oliver Laeyendecker,
Roshen Maharaj,
Pamela Mda,
Jernelle Miller,
Nomzamo Mvandaba,
Yandisa Nyanisa,
Steven J. Reynolds,
Andrew D. Redd,
Sofia Ryan,
David F. Stead,
Lee A. Wallis,
Thomas C. Quinn

Affiliations

Bhakti Hansoti: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA; Corresponding author.
George Mwinnyaa: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
Elizabeth Hahn: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
Aditi Rao: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
John Black: Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa; Department of Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
Victoria Chen: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
Kathryn Clark: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
William Clarke: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
Anna L. Eisenberg: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
Reinaldo Fernandez: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
Joshua Iruedo: Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
Oliver Laeyendecker: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
Roshen Maharaj: Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa; Department of Emergency Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
Pamela Mda: Nelson Mandela Hospital Clinical Research Unit, Sisson St, Fort Gale, Mthatha 5100, South Africa
Jernelle Miller: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
Nomzamo Mvandaba: Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
Yandisa Nyanisa: Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
Steven J. Reynolds: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
Andrew D. Redd: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
Sofia Ryan: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
David F. Stead: Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa; Department of Medicine, Frere Hospital, Amalinda Main Rd, Braelyn, East London 5201, South Africa
Lee A. Wallis: Division of Emergency Medicine, University of Cape Town, Main Rd, Observatory, Cape Town 7925, South Africa
Thomas C. Quinn: The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA

Journal volume & issue: Vol. 15
pp. 14 – 22

Abstract

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Background: The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. Methods: We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. Findings: Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. Interpretation: Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation. Keywords: HIV testing, HIV in men, South Africa, Emergency medicine, HIV and trauma

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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