Browsing by Author "Euvrard, Jonathan"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Open Access
    Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality
    (2022) Fieggen, Joshua; Euvrard, Jonathan
    Background: Advanced HIV disease is the major contributor to the recent plateau in HIV related deaths globally. However, limited data exists on which patients with advanced HIV are at highest risk of death. Methods: A retrospective cohort study was nested within a larger cohort of 13 HIV treatment facilities in Khayelitsha, South Africa. All adults who had a CD4 count less than 200 cells/mm3 between 1 January 2017 and 31 March 2021 were enrolled. Descriptive statistics were calculated, and the cohort was then restricted to those who had linked vital status information. We evaluated risk factors for mortality using risk ratios, Cox proportional hazards models and Kaplan-Meier curves. Results: Between 19% and 28% of the larger cohort (n=72,102) were estimated to have advanced HIV disease at any point during the study period. Of these patients 20% were on treatment, 40% were disengaged from care and 40% were treatment naïve at enumeration. Overall mortality was 12% with mortality highest in the first year (6,8%) following enumeration. Mortality was highest among patients on ART (17%) with viraemia an important risk factor for death in this group (aHR 1.42 [95% CI: 1.11 | 1.81]). Age >40 years, enumeration CD4 count, and tuberculosis were all predictors of death. 28% of patients off ART were found to have current tuberculosis at enumeration. Conclusion: There was a high prevalence of advanced HIV disease with significant associated mortality within this contemporary South African HIV cohort. Major modifiable contributors to mortality were disengagement from care and tuberculosis.
  • Thumbnail Image
    Item
    Open Access
    Cohort Profile: The Western Cape Pregnancy Exposure Registry (WCPER)
    (2022-06) Kalk, Emma; Heekes, Alexa; Slogrove, Amy; Phelanyane, Florence; Davies, Mary-Ann; Myer, Landon; Euvrard, Jonathan; Kroon, Max; Petro, Greg; Fieggen, Karen; Stewart, Chantal; Rhoda, Natasha; Gebhardt, Stefan; Osman, Ayesha; Anderson, Kim; Boulle, Andrew; Mehta, Ushma
    Purpose: The Western Cape Pregnancy Exposure Registry (PER) was established at two public sector healthcare sentinel sites in the Western Cape province, South Africa, to provide ongoing surveillance of drug exposures in pregnancy and associations with pregnancy outcomes. Participants: Established in 2016, all women attending their first antenatal visit at primary care obstetric facilities were enrolled and followed to pregnancy outcome regardless of the site (ie, primary, secondary, tertiary facility). Routine operational obstetric and medical data are digitised from the clinical stationery at the healthcare facilities. Data collection has been integrated into existing services and information platforms and supports routine operations. The PER is situated within the Provincial Health Data Centre, an information exchange that harmonises and consolidates all health-related electronic data in the province. Data are contributed via linkage across a unique identifier. This relationship limits the missing data in the PER, allows validation and avoids misclassification in the population-level data set. Findings to date: Approximately 5000 and 3500 pregnant women enter the data set annually at the urban and rural sites, respectively. As of August 2021, >30 000 pregnancies have been recorded and outcomes have been determined for 93%. Analysis of key obstetric and neonatal health indicators derived from the PER are consistent with the aggregate data in the District Health Information System. Future plans: This represents significant infrastructure, able to address clinical and epidemiological concerns in a low/middle-income setting.
  • Thumbnail Image
    Item
    Open Access
    Where do HIV-infected adolescents go after transfer? – Tracking transition/transfer of HIV-infected adolescents using linkage of cohort data to a health information system platform
    (2017) Davies, Mary-Ann; Tsondai, Priscilla; Tiffin, Nicki; Eley, Brian; Rabie, Helena; Euvrard, Jonathan; Orrell, Catherine; Prozesky, Hans; Wood, Robin; Cogill, Dolphina; Haas, Andreas D; Sohn, Annette H; Boulle, Andrew
    Introduction: To evaluate long-term outcomes in HIV-infected adolescents, it is important to identify ways of tracking outcomes after transfer to a different health facility. The Department of Health (DoH) in the Western Cape Province (WCP) of South Africa uses a single unique identifier for all patients across the health service platform. We examined adolescent outcomes after transfer by linking data from four International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) cohorts in the WCP with DoH data.