How times have changed: HIV and AIDS in South Africa in 2011

Pillay, Yogan; White, Cheri; McCormick, Nora

doi:10.7196/samj.5284

Cited by 18 publications

(17 citation statements)

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“…The widespread use of rapid diagnostic tests (RDTs) in high HIV prevalence settings has resulted in the increase in the number of people tested for HIV and the decentralization of HIV testing from health facilities into communities, reaching more young people, males, first-time testers and those at higher CD4 cell counts, and HIV-related less morbidity [2,3]. For example, 13.3 million people were tested for HIV in a national HIV testing campaign conducted in South Africa in the period 2011 to 2012 [4,5], and it is estimated that 9.9 million individuals were tested in 2015 [6]. With the introduction of the universal test and treat strategy and antiretroviral (ARV)-based HIV prevention strategies such as pre-exposure prophylaxis (PrEP), more and more people will be expected to test for HIV on a regular basis in order to initiate ART immediately or continue taking PrEP [7].…”

Section: Introductionmentioning

confidence: 99%

Misdiagnosis of HIV infection during a South African community‐based survey: implications for rapid HIV testing

Kufa

Kharsany

Cawood

et al. 2017

Journal of the International AIDS Society

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Introduction: We describe the overall accuracy and performance of a serial rapid HIV testing algorithm used in community-based HIV testing in the context of a population-based household survey conducted in two sub-districts of uMgungundlovu district, KwaZulu-Natal, South Africa, against reference fourth-generation HIV-1/2 antibody and p24 antigen combination immunoassays. We discuss implications of the findings on rapid HIV testing programmes. Methods: Cross-sectional design: Following enrolment into the survey, questionnaires were administered to eligible and consenting participants in order to obtain demographic and HIV-related data. Peripheral blood samples were collected for HIV-related testing. Participants were offered community-based HIV testing in the home by trained field workers using a serial algorithm with two rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using two fourth-generation immunoassays with all positives in the confirmatory test considered true positives. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and false-positive and false-negative rates were determined. Results: Of 10,236 individuals enrolled in the survey, 3740 were tested in the home (median age 24 years (interquartile range 19–31 years), 42.1% males and HIV positivity on RDT algorithm 8.0%). From those tested, 3729 (99.7%) had a definitive RDT result as well as a laboratory immunoassay result. The overall accuracy of the RDT when compared to the fourth-generation immunoassays was 98.8% (95% confidence interval (CI) 98.5–99.2). The sensitivity, specificity, positive predictive value and negative predictive value were 91.1% (95% CI 87.5–93.7), 99.9% (95% CI 99.8–100), 99.3% (95% CI 97.4–99.8) and 99.1% (95% CI 98.8–99.4) respectively. The false-positive and false-negative rates were 0.06% (95% CI 0.01–0.24) and 8.9% (95% CI 6.3–12.53). Compared to true positives, false negatives were more likely to be recently infected on limited antigen avidity assay and to report antiretroviral therapy (ART) use. Conclusions: The overall accuracy of the RDT algorithm was high. However, there were few false positives, and the sensitivity was lower than expected with high false negatives, despite implementation of quality assurance measures. False negatives were associated with recent (early) infection and ART exposure. The RDT algorithm was able to correctly identify the majority of HIV infections in community-based HIV testing. Messaging on the potential for false positives and false negatives should be included in these programmes.

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Section: Introductionmentioning

confidence: 99%

Misdiagnosis of HIV infection during a South African community‐based survey: implications for rapid HIV testing

Kufa

Kharsany

Cawood

et al. 2017

Journal of the International AIDS Society

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“…The South African HIV treatment programme is largely funded by the national fiscus, making it one of the few African programmes not wholly reliant on donor support [12,14]. Despite expanded treatment, challenges remain, not least that prevention efforts have remained ineffective despite a relatively large amount of investment in public messaging and condom distribution [4,15,16]. Continued new infections mean that people requiring treatment will continue to enter the ART programme for decades to come [5,7].…”

Section: Introductionmentioning

confidence: 99%

“…It has taken South Africa 10 years to commence 2.5 million people on treatment and in 2012 a total of almost 376,000 patients started ART -almost 100,000 more than in the previous year [3]. Seven years ago, only 7% of South Africans in need -based on 2010 World Health Organization (WHO) guidelines -were on ART but by the end of 2010, this figure had jumped to 84% [4]. By March 2011, 1.46 million people were on antiretroviral drugs (ARVs).…”

mentioning

confidence: 99%

Provision of Antiretroviral Therapy in South Africa: The Nuts and Bolts

et al. 2013

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Public sector antiretroviral provision had a slow start in South Africa despite a raging epidemic and a World AIDS conference that shed significant public light on the disparities of therapy access globally. This was largely due to political prevarication in the midst of AIDS denialism. There has been an unprecedented expansion in the HIV treatment programme since 2008. As a result, South Africa now has the largest number of patients on antiretroviral drugs in the world, and South African life expectancy has increased by more than a decade. However, this has led to a number of fiscal, logistic and operational challenges that the country must face as the treatment programme continues to expand. Challenges include increasing detection within communities, linkage and retention in care, while strengthening operational support functions such as consistent drug supply, health staffing and infrastructure, diagnostic services, programme monitoring and sustainable financing. As a middle-income country, albeit with marked income inequality, and the heaviest HIV burden in the world, South Africa is a test case of whether a large-scale public health programme can boast of success in the face of numerous other health-system challenges.

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“…In their editorial 2 Pillay and colleagues reflect on the dark days of the South African government AIDS denialism and its negative international reception by medical scientists. Despite scepticism about South Africa being able to recover from the consequences of this major blunder, they paint a picture of a remarkable turnaround.…”

Section: Aids Turnaroundmentioning

confidence: 99%

“…Three papers [2][3][4] provide messages of hope for the massive task of managing South Africa's huge HIV/AIDS pandemic.…”

Section: Aids Turnaroundmentioning

confidence: 99%