Browsing by Author "Osler, Meg"

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    Open Access
    A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa
    (2014-08-18) Leon, Natalie; Mathews, Catherine; Lewin, Simon; Osler, Meg; Boulle, Andrew; Lombard, Carl
    Abstract Background We examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care. Methods In a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms. Results There was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007). Conclusion The PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies. Trial registration Current Controlled Trials ISRCTN93692532
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    Associations of severe hyperlactataemia and lactic acidosis in HIV-infected patients receiving antiretroviral theraphy
    (2007) Osler, Meg; Boulle, Andrew
    Severe symptomatic hyperlactataemia and lactic acidosis (SHLA) are life-threatening events that are occurring at increasing incidence levels in South Africa. Globally, the rise in SHLA cases is closely correlated to the increased accessibility of anti retroviral (ARV) medication for human immunodeficiency virus (HIV). Although hyperlactataemia and lactic acidosis were once thought of as rare conditions, they are now being recognized as important concerns when administering antiretroviral therapy. A better understanding of the risk factors for SHLA is important in combating the morbidity and mortality associated with such an adverse event.
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    Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study
    (BioMed Central Ltd, 2010) Schutz, Charlotte; Boulle, Andrew; Stead, Dave; Rebe, Kevin; Osler, Meg; Meintjes, Graeme
    BACKGROUND: Interventions to promote prevention and earlier diagnosis of severe symptomatic hyperlactataemia (SHL) were implemented in the Western Cape provincial antiretroviral programme (South Africa) from 2004. Interventions included clinician education, point-of-care lactate meters, switch from stavudine to zidovudine in high risk patients and stavudine dose reduction. This study assessed trends in referral rate, severity at presentation and case fatality rate for severe SHL. METHODS: Retrospective study of severe SHL cases diagnosed at a referral facility from 1 January 2003 to 31 December 2008. Severe SHL was defined as patients with compatible symptoms and serum lactate [greater than or equal to] 5 mmol/l attributable to antiretroviral therapy (ART). Cumulative ART exposure at referring ART clinics was used to calculate referral rates. RESULTS: There were 254 severe SHL cases. The referral rate (per thousand patient years [py] ART exposure) peaked in 2005 (20.4/1000py), but fell to 1.3/1000py by 2008 (incidence rate ratio [IRR] = 0.07, 95%CI 0.04-0.11). In 2003, 66.7% of cases presented with a standard bicarbonate (SHCO3) level <15 mmol/l, but this fell to 12.5% by 2008 (p for trend < 0.001). Case fatality rate fell from a peak of 33.3% in 2004 to 0% in 2008 (p for trend = 0.002). CONCLUSIONS: These trends suggest the interventions were associated with reduced referral, less severe metabolic acidosis at presentation and improved survival.