Objective To determine the optimal tuberculosis (TB) management strategy for children living in peri-urban, resource-limited settings. Design We compared TB treatment outcomes among children, aged 0–15 years, receiving doorstep care (n=82) to a historical group (n=97) receiving clinic-based care. Results In comparison, the doorstep care and clinic-based groups had similar age and sex profiles; treatment default rates were 3.7% (3/82) vs 38.1% (37/97), p<0.0001; treatment completion rates were 65.9% (54/82) vs 51.6% (50/97), p=0.01; and cure rates were 13.4% (11/82) vs 2.1% (2/97), p<0.0001 respectively. Conclusion Children living within peri-urban communities experience improved TB outcomes with doorstep care.

Background.Retinal cytomegalovirus (CMV) infection is a common opportunistic infection and remains a significant contributor to visual loss in patients with AIDS. We highlight the poor outcomes of CMV retinitis in three HIV-infected patients who were initiated on antiretroviral therapy (ART). We conducted a retrospective chart review of advanced stage HIV-infected patients with known CMV retinitis. Case 1. A 37-year-old man, with a CD4+ cell count of 35 cells/µL, presented for ART initiation with a 5-month history of visual loss in his left eye. Fundoscopy showed left eye CMV retinitis and right eye HIV retinopathy. ART and 5 months of weekly intravitreal ganciclovir injections (left eye) were commenced. Six-month outcomes included virological suppression, and visual acuity in the right eye of 6/6 and in the left eye of 3/60. Case 2. A 31-year-old woman, with a CD4+ cell count of 39 cells/µL and on tuberculosis therapy, presented for ART initiation. She presented with a 2-month history of decreased visual acuity. Fundoscopy showed bilateral CMV retinitis, which was more pronounced in the left eye. ART and 8 months of intravitreal ganciclovir injections were commenced. Six-month outcomes included virological suppression and visual acuity in the right eye of 6/9, and in the left eye of 6/24. Case 3. A 29-year-old woman, with a CD4+ cell count of 24 cells/µL, who was on tuberculosis therapy and ART, complained of blurred vision at her 2-month ART follow-up visit. Fundoscopy showed bilateral retinal detachment secondary to CMV retinitis. While silicone oil tamponade and subsequent retinectomy successfully repaired the right eye, extensive damage rendered the left eye irreparable. Six-month outcomes included virological suppression, with 6/120 visual acuity in the right eye and complete blindness in the left eye. Conclusion. CMV retinitis causes debilitating, permanent sequelae, which is preventable by ART initiation at higher CD4+ cell counts. Despite achieving virological suppression, vision could not be completely restored in these patients, irrespective of the severity of CMV retinitis. Med J 2017;107(10):843-846. DOI:10.7196/SAMJ.2017.v107i10.12740 S Afr 844October 2017, Vol. 107, No. 10 IN PRACTICEdirect damage to the macula or optic nerve, resulting in permanent blindness.[2] Blindness caused by CMV retinitis is irreversible and can occur prior to complete retinal destruction, which was responsible for >90% of HIV-associated blindness in the pre-ART era. [2] A total of 1 815 patients were enrolled into the PEPFAR-funded CAPRISA AIDS Treatment Programme (CAT) at the eThekwini site in Durban, South Africa (SA) between June 2004 and August 2013. In this report, we highlight the three patients in this cohort who developed CMV retinitis.Approval for data collection and analysis for the CAT programme was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (ref. no. E248/05). Case reports Case 1In June 2011, a 37-year-old man presented for ART initiation with a baseline CD4+ cell co...