Although infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) have been reported from a number of countries, including Australia, the optimal therapy is unknown. We reviewed the clinical features, therapy, and outcome of 25 patients with serious infections due to SA-RVS in Australia and New Zealand. Eight patients had endocarditis, 9 had bacteremia associated with deep-seated infection, 6 had osteomyelitis or septic arthritis, and 2 had empyema. All patients had received vancomycin before the isolation of SA-RVS, and glycopeptide treatment had failed for 19 patients (76%). Twenty-one patients subsequently received active treatment, which was effective for 16 patients (76%). Eighteen patients received linezolid, which was effective in 14 (78%), including 4 patients with endocarditis. Twelve patients received a combination of rifampicin and fusidic acid. Surgical intervention was required for 15 patients (60%). Antibiotic therapy, especially linezolid with or without rifampicin and fusidic acid, in conjunction with surgical debulking is effective therapy for the majority of patients with serious infections (including endocarditis) caused by SA-RVS.

B A C K G R O U N D :Scaling up treatment for multidrugr esistant tuberculosis is a global health priority. However, current treatment regimens are long and associated with side effects, and default rates are consequently high. This systematic review aimed to identify strategies for reducing treatment default. M E T H O D S :We conducted a systematic search up to May 2012 to identify studies describing interventions to support patients receiving treatment for multidrugr esistant tuberculosis (MDR-TB). The potential influence of study interventions were explored through subgroup analyses. R E S U LT S : A total of 75 studies provided outcomes for 18 294 patients across 31 countries. Default rates ranged from 0.5% to 56%, with a pooled proportion of 14.8% (95%CI 12.4-17.4). Strategies identified to be associated with lower default rates included the engagement of community health workers as directly observed treatment (DOT) providers, the provision of DOT throughout treatment, smaller cohort sizes and the provision of patient education. C O N C L U S I O N : Current interventions to support adherence and retention are poorly described and based on weak evidence. This review was able to identify a number of promising, inexpensive interventions feasible for implementation and scale-up in MDR-TB programmes. The high default rates reported from many programmes underscore the pressing need to further refine and evaluate simple intervention packages to support patients. K E Y W O R D S : default; retention; MDR-TB THE MULTIDRUG-RESISTANT tuberculosis (MDR-TB) pandemic is rising in prevalence and global importance. There were an estimated 650 000 cases of MDR-TB cases worldwide in 2010, with <5% of all TB patients tested for multidrug resistance. 1 Historically, proportions of MDR-TB among TB cases have been highest in Eastern European countries, although in absolute numbers China and India now contribute 50% of all new MDR-TB cases. 2 Furthermore, in sub-Saharan Africa, the human immunodefi ciency virus (HIV) epidemic and limited resources for comprehensive MDR-TB programmes have aided the spread of MDR-TB and the emergence of extensively drugresistant TB (XDR-TB). 3 MDR-TB, defi ned as Mycobacterium tuberculosis resistant to isoniazid and rifampicin, is more costly and complex to treat than fully susceptible disease, with treatment typically lasting at least 18 months. XDR-TB is defi ned as MDR-TB with additional resistance to a fl uoroquinolone and a second-line injectable agent. 2 Current approaches to treating MDR-TB rely on lengthy treatment durations (typically a minimum of 20 months) using drugs associated with substantial toxicities, often resulting in high default rates. Other reported factors infl uencing treatment default include high costs of treatment for patients in settings where patients must pay, 4 indirect costs such as loss of wages, 5 increased poverty and sex discrimination, 6 dissatisfaction with health care worker attitudes, 7 limited knowledge and negative beliefs and attitudes to treatment, 8 ch...

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CitationHepatitis C seroprevalence and HIV co-infection in subSaharan Africa: a systematic review and meta-analysis. SummaryBackground An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa.

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