Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Bhakti Hansoti; George Mwinnyaa; Elizabeth Hahn; Aditi Rao; John Black; Victoria Chen; Kathryn Clark; William Clarke; Anna L. Eisenberg; Reinaldo Fernandez; Joshua Iruedo; Oliver Laeyendecker; Roshen Maharaj; Pamela Mda; Jernelle Miller; Nomzamo Mvandaba; Yandisa Nyanisa; Steven J. Reynolds; Andrew D. Redd; Sofia Ryan; David F. Stead; Lee A. Wallis; Thomas C. Quinn

doi:10.1016/j.eclinm.2019.08.007

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Bhakti Hansoti, George Mwinnyaa, Elizabeth Hahn, Aditi Rao, John Black, Victoria Chen, Kathryn Clark, William Clarke, Anna L. Eisenberg, Reinaldo Fernandez, Joshua Iruedo, Oliver Laeyendecker, Roshen Maharaj, Pamela Mda, Jernelle Miller, Nomzamo Mvandaba, Yandisa Nyanisa, Steven J. Reynolds, Andrew D. Redd, Sofia RyanDavid F. Stead, Lee A. Wallis, Thomas C. Quinn

School of Medicine

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. Methods: We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. Findings: Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. Interpretation: Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.

Original language	English (US)
Pages (from-to)	14-22
Number of pages	9
Journal	EClinicalMedicine
Volume	15
DOIs	https://doi.org/10.1016/j.eclinm.2019.08.007
State	Published - Oct 2019

Keywords

Emergency medicine
HIV and trauma
HIV in men
HIV testing
South Africa

ASJC Scopus subject areas

General Medicine

Access to Document

10.1016/j.eclinm.2019.08.007

Cite this

Hansoti, B., Mwinnyaa, G., Hahn, E., Rao, A., Black, J., Chen, V., Clark, K., Clarke, W., Eisenberg, A. L., Fernandez, R., Iruedo, J., Laeyendecker, O., Maharaj, R., Mda, P., Miller, J., Mvandaba, N., Nyanisa, Y., Reynolds, S. J., Redd, A. D., ... Quinn, T. C. (2019). Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments. EClinicalMedicine, 15, 14-22. https://doi.org/10.1016/j.eclinm.2019.08.007

Hansoti, B, Mwinnyaa, G, Hahn, E, Rao, A, Black, J, Chen, V, Clark, K, Clarke, W, Eisenberg, AL, Fernandez, R, Iruedo, J, Laeyendecker, O, Maharaj, R, Mda, P, Miller, J, Mvandaba, N, Nyanisa, Y, Reynolds, SJ, Redd, AD, Ryan, S, Stead, DF, Wallis, LA & Quinn, TC 2019, 'Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments', EClinicalMedicine, vol. 15, pp. 14-22. https://doi.org/10.1016/j.eclinm.2019.08.007

@article{3ae3009942db4a2b8b1086b2dc6a5840,

title = "Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments",

abstract = "Background: The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. Methods: We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. Findings: Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. Interpretation: Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.",

keywords = "Emergency medicine, HIV and trauma, HIV in men, HIV testing, South Africa",

author = "Bhakti Hansoti and George Mwinnyaa and Elizabeth Hahn and Aditi Rao and John Black and Victoria Chen and Kathryn Clark and William Clarke and Eisenberg, {Anna L.} and Reinaldo Fernandez and Joshua Iruedo and Oliver Laeyendecker and Roshen Maharaj and Pamela Mda and Jernelle Miller and Nomzamo Mvandaba and Yandisa Nyanisa and Reynolds, {Steven J.} and Redd, {Andrew D.} and Sofia Ryan and Stead, {David F.} and Wallis, {Lee A.} and Quinn, {Thomas C.}",

note = "Funding Information: Research reported in this publication was supported by the South African Medical Research Council and in part by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases , NIH . Funding agencies had no role in study design, data collection, data analysis, interpretation, or the writing of the report. Publisher Copyright: {\textcopyright} 2019 Acta Materialia Inc.",

year = "2019",

month = oct,

doi = "10.1016/j.eclinm.2019.08.007",

language = "English (US)",

volume = "15",

pages = "14--22",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Lancet Publishing Group",

}

TY - JOUR

T1 - Targeting the HIV Epidemic in South Africa

T2 - The Need for Testing and Linkage to Care in Emergency Departments

AU - Hansoti, Bhakti

AU - Mwinnyaa, George

AU - Hahn, Elizabeth

AU - Rao, Aditi

AU - Black, John

AU - Chen, Victoria

AU - Clark, Kathryn

AU - Clarke, William

AU - Eisenberg, Anna L.

AU - Fernandez, Reinaldo

AU - Iruedo, Joshua

AU - Laeyendecker, Oliver

AU - Maharaj, Roshen

AU - Mda, Pamela

AU - Miller, Jernelle

AU - Mvandaba, Nomzamo

AU - Nyanisa, Yandisa

AU - Reynolds, Steven J.

AU - Redd, Andrew D.

AU - Ryan, Sofia

AU - Stead, David F.

AU - Wallis, Lee A.

AU - Quinn, Thomas C.

N1 - Funding Information: Research reported in this publication was supported by the South African Medical Research Council and in part by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases , NIH . Funding agencies had no role in study design, data collection, data analysis, interpretation, or the writing of the report. Publisher Copyright: © 2019 Acta Materialia Inc.

PY - 2019/10

Y1 - 2019/10

N2 - Background: The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. Methods: We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. Findings: Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. Interpretation: Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.

AB - Background: The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. Methods: We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. Findings: Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. Interpretation: Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.

KW - Emergency medicine

KW - HIV and trauma

KW - HIV in men

KW - HIV testing

KW - South Africa

UR - http://www.scopus.com/inward/record.url?scp=85070663516&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070663516&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2019.08.007

DO - 10.1016/j.eclinm.2019.08.007

M3 - Article

C2 - 31709410

AN - SCOPUS:85070663516

SN - 2589-5370

VL - 15

SP - 14

EP - 22

JO - EClinicalMedicine

JF - EClinicalMedicine

ER -

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this