Maternal mortality associated with tuberculosis–HIV-1 co-infection in Durban, South Africa

Khan, Munira; Pillay, Thillagavathie; Moodley, J; Connolly, Catherine

doi:10.1097/00002030-200109280-00016

Cited by 122 publications

(88 citation statements)

References 21 publications

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“…11,12 Between 2011 and 2013, there was no change in the antenatal HIV-prevalence. 13 Substandard diagnostic care and delayed and missed diagnoses have been reported as some of the contributing factors to maternal mortality in rural communities in South Africa.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Mashamba-Thompson

Moodley

Sartorius

et al. 2018

South. Afr. j. HIV med.

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Introduction: South African guidelines recommend two rapid tests for diagnosing human immunodeficiency virus (HIV) using the serial HIV testing algorithm, but the accuracy and compliance to this algorithm is unknown in rural clinics. We evaluated the accuracy of HIV rapid testing and the time to receiving test results among pregnant women in rural KwaZulu-Natal (KZN).Method: We observed the accuracy of rapid HIV testing algorithms for 208 consenting antenatal patients accessing voluntary HIV testing services in nine rural primary healthcare (PHC) clinics in KZN. A PHC-based HIV counsellor obtained finger-prick whole blood from each participant to perform rapid testing using the Advanced Quality™ One Step anti-HIV (1&2) and/or ABON™ HIV 1/2/O Tri-Line HIV test. A research nurse obtained venous blood for an enzyme-linked immunosorbent assay (ELISA) HIV test, which is the gold standard diagnostic test. We recorded the time of receipt of HIV test results for each test.Results: Among 208 pregnant women with a mean age of 26 years, 72 women from nine rural PHC clinics were identified as HIV-positive by two rapid tests with an HIV-prevalence of 35% (95% Bayesian credibility intervals [BCI]: 28% – 41%). Of the 208 patients, 135 patients from six clinics were tested with the serial HIV testing algorithm. The estimated sensitivity and specificity for the 135 participants were 100% (95% confidence interval [CI]: 93% – 100%) and 99% (CI: 95% – 100%), respectively. The positive predictive value and negative predictive value were estimated at 98% (CI: 94% – 100%) and 95% (CI: 88% – 99%), respectively. All women received their HIV rapid test results within 20 min of testing. Test stock-out resulted in poor test availability at point-of-care, preventing performance of a second HIV test in three out of nine PHC clinics in rural KZN.Conclusion: Despite the poor compliance with national guidelines for HIV rapid testing services, HIV rapid test results provided to pregnant women in rural PHC clinics in KZN were generally accurate and timely. Test stock-out was shown to be one of the barriers to test availability in rural PHC clinics, resulting in poor compliance with guidelines. We recommend a compulsory confirmation HIV rapid test for all HIV-negative test results obtained from pregnant patients in rural and resource-limited settings.

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Section: Introductionmentioning

confidence: 99%

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Mashamba-Thompson

Moodley

Sartorius

et al. 2018

South. Afr. j. HIV med.

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“…2 The findings of a study in Durban revealed a 3-fold higher maternal mortality ratio (MMR) among HIV-infected women with TB (12 170/100 000 live births) compared with TB-infected HIVuninfected women (3 850/100 000 live births) in the absence of antiretroviral therapy (ART). 11 Of the women diagnosed with TB, 79% were co-infected with HIV. 11 Similarly high MMRs in TB/HIV-co-infected women have been observed in a number of studies in sub-Saharan Africa.…”

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confidence: 99%

Tuberculosis prevention in HIV-infected pregnant women in South Africa

Martin

Black

2012

South. Afr. j. HIV med.

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The high burden of HIV and tuberculosis (TB) among pregnant women in South Africa contributes to a high maternal mortality rate. Isoniazid preventive therapy (IPT) is recommended for the prevention of active TB in HIV-infected individuals, including pregnant women. However, there are few data regarding IPT use in the latter, with concern regarding the concurrent use of IPT with nevirapine in pregnancy, as both treatments are hepatotoxic. The benefit and safety of IPT in HIV-infected pregnant women has not been established. We recommend a simplification of HIV and TB interventions by providing triple antiretroviral therapy to all HIV-infected pregnant women.

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“…Observed indirect causes of maternal death in our study (anemia, HIV, malaria) are diseases closely associated with poverty [18]- [20].…”

Section: Discussionmentioning

confidence: 66%

Maternal Mortality Risk Factors in Regional Hospital of Burkina Faso

Savadogo¹,

Zombra²,

Tamini³

et al. 2014

OJEpi

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Maternal mortality associated with tuberculosis–HIV-1 co-infection in Durban, South Africa

Abstract: Tuberculosis and HIV-1 are emerging as significant contributors to maternal mortality in KwaZulu Natal. Any attempt to improve maternal health must also include careful screening and investigation for tuberculosis in high-risk pregnant women.

Cited by 122 publications

References 21 publications

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Tuberculosis prevention in HIV-infected pregnant women in South Africa

Maternal Mortality Risk Factors in Regional Hospital of Burkina Faso

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