Browsing by Author "Oosthuizen, Jenna"

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    Correction to: Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis
    (2020-03-02) Antel, Katherine; Oosthuizen, Jenna; Malherbe, Francois; Louw, Vernon J; Nicol, Mark P; Maartens, Gary; Verburgh, Estelle
    After publication of the original article [1], we were notified that there is a mistake in the article note.
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    Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis
    (2020-01-13) Antel, Katherine; Oosthuizen, Jenna; Malherbe, Francois; Louw, Vernon J; Nicol, Mark P; Maartens, Gary; Verburgh, Estelle
    Abstract Background The WHO recently recommended the new Xpert MTB/RIF Ultra assay (Ultra) instead of the Xpert MTB/RIF assay because Ultra has improved sensitivity. We report the diagnostic accuracy of Ultra for tuberculous adenitis in a tuberculosis and HIV endemic setting. Methods We obtained fine-needle aspirates (FNA) and lymph node tissue by core-needle biopsy in adult patients with peripheral lymphadenopathy of >20 mm. Ultra and mycobacterial culture were performed on FNA and tissue specimens, with histological examination of tissue specimens. We assessed the diagnostic accuracy of Ultra against a composite reference standard of ‘definite tuberculosis’ (microbiological criteria) or ‘probable tuberculosis’ (histological and clinical criteria). Results We prospectively evaluated 99 participants of whom 50 were HIV positive: 21 had ‘definite tuberculosis’, 15 ‘probable tuberculosis’ and 63 did not have tuberculosis (of whom 38% had lymphoma and 19% disseminated malignancy). Using the composite reference standard the Ultra sensitivity on FNA was 70% (95% CI 51–85; 21 of 30), and on tissue was 67% (45–84; 16/24) these were far superior to the detection of acid-fast bacilli on an FNA (26%; 7/27); AFB on tissue (33%; 8/24); or tissue culture (39%; 9/23). The detection of granulomas on histology had high senstivity (83%) but the lowest specficity. When compared with culture the Ultra on FNA had a sensitvity of 78% (40-97; 7/9) and tissue 90% (55-100; 9/10). Conclusions Ultra performed on FNA or tissue of a lymph node had good sensitivity and high specificity. Ultra had a higher yield than culture and has the advantage of being a rapid test. Ultra on FNA would be an appropriate initial investigation for lymphadenopathy in tuberculosis endemic areas followed by a core biopsy for histopathology with a repeat Ultra on tissue if granulomas are present.
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    Family planning behaviours among South African HIV-infected and HIV-negative women during the post partum period
    (2018) Oosthuizen, Jenna; Lesosky, Maia
    There has been growing research on the impact of HIV on family planning and fertility behaviours with studies showing conflicting results. However, these relationships have been understudied in sub-Saharan Africa, especially during the postpartum period. Based on the differences reported in different studies as well as the lack of studies performed in South Africa during the postpartum period, further research is required to investigate differences in fertility desire and use and need for family planning among and between HIV-infected and HIV-uninfected women. The aim of this study was to compare family planning use, fertility desires and unmet family planning need at 12 months postpartum in a population of HIV-infected and HIV-uninfected women from Gugulethu, Cape Town. The thesis components include a study protocol, a literature review investigating previous work on family planning uptake, fertility desire and unmet family planning need in sub-Saharan Africa, and an analysis of secondary data from three contributing studies performed in Gugulethu, Cape Town of HIV-infected and HIV-uninfected women who participated at 12 months postpartum. Logistic regression was used to model associations between HIV status and family planning use, fertility desires and unmet family planning need. Of the 854 women included in this analysis, 497 (58.0%) were HIV-infected and 357 (42.0%) were HIV-uninfected. Family planning prevalence was 62.3%, injectable contraceptives were the most common FP methods used among participants (>90.0%) and 37.2% of participants had an unmet family planning need. Only 8 participants (0.9%) had an immediate fertility desire (wanted to have a child within the next 12 months) and 20.9% wanted to have a child sometime in the future. Family planning use and unmet family planning need did not differ by HIV status however, fertility desires significantly differed by HIV status. In multivariable analysis, HIV status was not associated with family planning use or unmet family planning need. HIV status was significantly associated with future fertility desire. HIV-infected women were significantly less likely to have a future fertility desire than HIV-uninfected women (OR=0.3, 95% CI=0.2 to 0.4, p<0.001). Age, parity, intended pregnancy and discussed family planning/ pregnancy with partner were also significantly associated with future fertility desire. HIV status appears to be associated with fertility desires in this population. No significant association was found between family planning use and unmet family planning need in this population by HIV status. Family planning services need to be strengthened for all women in this population and access to a larger variety of family planning methods is needed.
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    The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting
    (2019-04-25) Antel, Katherine; Levetan, Carly; Mohamed, Zainab; Louw, Vernon J; Oosthuizen, Jenna; Maartens, Gary; Verburgh, Estelle
    Background Little is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV. Methods We analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay. Results Patients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1–5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1–8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3–2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival. Conclusions Time-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma.