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45 Evaluation of Drug-Resistant Tuberculosis Guidelines and Outcomes by Treatment Site in South Africa
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- Charles H. Rhea, Violet Chihota, Matthew Oladimeji, Africa Peter F. Rebeiro, Gustavo Amorim, Nina von Knorring, Shaheed V. Omar, Farzana Ismail, Gavin Churchyard, Yuri van der Heijden
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue s1 / April 2024
- Published online by Cambridge University Press:
- 03 April 2024, p. 12
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OBJECTIVES/GOALS: DR-TB care in South Africa includes decentralized treatment with shorter, all-oral regimens. Treatment guidelines direct regular clinical and laboratory evaluation to assess patient improvement. We therefore measured sputum collection frequency and follow-up time to assess fidelity to these guidelines in Gauteng Province, South Africa. METHODS/STUDY POPULATION: We included Rifampicin-resistant (RR) sputum specimens from the South African National Health Laboratory Service, which provides pathology services to 80% of the population, submitted between August 2022-September 2023. Patient data were obtained from a DR-TB registry and additional sputum specimen data were collected from follow-up laboratory worksheets. Follow-up spanned from first sputum collection date (baseline) to patient outcome date (e.g., completion, lost) or study closure date (if still on treatment). Monthly sputum submission rate was measured for those with ≥1 additional sputum submitted. We compared patient data by treatment site: at the specialized hospital vs. any other site, using Wilcoxon ranksum and χ2 tests. RESULTS/ANTICIPATED RESULTS: Baseline RR-TB specimens were available for 142 patients, of whom 28 (20%) had specimens submitted from the specialized hospital. Patients at the specialized hospital were older (median age 41 vs. 35.5 years, p=0.03), had higher baseline fluoroquinolone resistance (10% vs. 1%, p=0.01), and longer follow-up (median 5.2 vs. 3.5 months, p=0.01) compared to patients elsewhere. Further, 43 (30%) patients had ≥1 additional sputum submitted during follow-up. Among these, monthly sputum collection rates did not differ by site (0.3 vs. 0.3 sputum per month, p=0.89). We anticipate that increased sputum frequency will be associated with successful TB treatment outcomes based on preliminary findings. DISCUSSION/SIGNIFICANCE: These findings highlight ongoing challenges with routine laboratory follow-up according to DR-TB guidelines across treatment sites in South Africa. Future research is needed to determine reasons for low sputum collection rates, such as low patient adherence, variation in practice of healthcare workers, loss to follow-up, and clinical challenges.
Population status of four endemic land bird species after an unsuccessful rodent eradication on Henderson Island
- ALEXANDER L. BOND, M. DE L. BROOKE, RICHARD J. CUTHBERT, JENNIFER L. LAVERS, GREGORY T.W. MCCLELLAND, THOMAS CHURCHYARD, ANGUS DONALDSON, NEIL DUFFIELD, ALICE FORREST, GAVIN HARRISON, LORNA MACKINNON, TARA PROUD, ANDREW SKINNER, NICK TORR, JULIET A. VICKERY, STEFFEN OPPEL
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- Journal:
- Bird Conservation International / Volume 29 / Issue 1 / March 2019
- Published online by Cambridge University Press:
- 10 April 2018, pp. 124-135
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Invasive rodents detrimentally affect native bird species on many islands worldwide, and rodent eradication is a useful tool to safeguard endemic and threatened species. However, especially on tropical islands, rodent eradications can fail for various reasons, and it is unclear whether the temporary reduction of a rodent population during an unsuccessful eradication operation has beneficial effects on native birds. Here we examine the response of four endemic land bird species on subtropical Henderson Island in the Pitcairn Island Group, South Pacific Ocean, following an unsuccessful rodent eradication in 2011. We conducted point counts at 25 sampling locations in 14 survey periods between 2011 and 2015, and modelled the abundance trends of all species using binomial mixture models accounting for observer and environmental variation in detection probability. Henderson Reed Warbler Acrocephalus taiti more than doubled in abundance (2015 population estimate: 7,194-28,776), and Henderson Fruit Dove Ptilinopus insularis increased slightly between 2011 and 2015 (2015 population estimate: 4,476–10,072), while we detected no change in abundance of the Henderson Lorikeet Vini stepheni (2015 population estimate: 554–3014). Henderson Crake Zapornia atra increased to pre-eradication levels following anticipated mortality during the operation (2015 population estimate: 4,960–20,783). A temporary reduction of rat predation pressure and rat competition for fruit may have benefitted the reed warbler and the fruit dove, respectively. However, a long drought may have naturally suppressed bird populations prior to the rat eradication operation in 2011, potentially confounding the effects of temporary rat reduction and natural recovery. We therefore cannot unequivocally ascribe the population recovery to the temporary reduction of the rat population. We encourage robust monitoring of island biodiversity both before and after any management operation to better understand responses of endemic species to failed or successful operations.
27 - Tuberculosis and HIV
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- By Gavin Churchyard, University of Cape Town, Elizabeth Corbett
- Edited by S. S. Abdool Karim, University of KwaZulu-Natal, South Africa, Q. Abdool Karim, University of KwaZulu-Natal, South Africa
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- Book:
- HIV/AIDS in South Africa
- Published online:
- 07 September 2011
- Print publication:
- 17 June 2010, pp 457-478
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Summary
TUBERCULOSIS IS AN IMPORTANT GLOBAL public health threat and the burden of tuberculosis is increasing because of HIV infection. Tuberculosis is the leading cause of death among HIV-infected Africans. South Africa not only has the highest number of HIV-infected individuals in the world, but has the 4th highest burden of tuberculosis worldwide.
In individuals with early hiv infection, the presentation of tuberculosis is similar to that in hiv-uninfected individuals and is usually pulmonary. But in those with severe immunosupression, presentation may be atypical. Tuberculosis is treated in the same way in hiv-infected and hiv-unifected individuals, but care must be taken when treating hiv and tuberculosis concomitantly because of interactions between antituberculosis and antiretroviral drugs. Treatment with antiretrovirals can lead to immune reconstitution inflammatory syndrome in those coinfected with tuberculosis and hiv. dots is reducing tuberculosis transmission in many countries, but is not enough to prevent the incidence of tuberculosis rising in areas of high hiv prevalence. What is needed are efforts to reduce tuberculosis transmission through active case finding and by preventing reactivation of latent tuberculosis through preventive therapy.
Tuberculosis (tb), a curable and preventable disease, remains an important public health threat globally. Approximately one third of the world's population is infected with Mycobacterium tuberculosis. In sub-Saharan Africa and globally the burden of tuberculosis has peaked and is starting to decline. An estimated 68% of all individuals who are co-infected with hiv and M tuberculosis (mtb/hiv co-infection) live in sub-Saharan Africa.