Perceptions of Door-to-Door HIV Counselling and Testing in Botswana

Prevalence of HIV infection in Botswana is among the highest in the world; at 23.9 of 15 - 49-year-olds. Most HIV testing is conducted in voluntary counselling and testing centres or medical settings. Improved access to testing is urgently needed. This qualitative study assessed and documented community perceptions about the concept of door-to-door HIV counselling and rapid testing in two of the highest-prevalence districts of Botswana. Community members associated many positive benefits with home-based; door-to-door HIV testing; including convenience; confidentiality; capacity to increase the number of people tested; and opportunities to increase knowledge of HIV transmission; prevention and care through provision of correct information to households. Community members also saw the intervention as increasing opportunities to engage and influence family members and to role model positive behaviours. Participants also perceived social risks and dangers associated with home-based testing including the potential for conflict; coercion; stigma; and psychological distress within households. Community members emphasised the need for individual and community preparation; including procedures to protect confidentiality; provisions for psychological and social support; and links to appropriate services for HIV-positive persons

Brain abscesses - the Groote Schuur experience; 1993 - 2003 : neurosurgery

Objective. To review management and outcome of patients with brain abscess treated at Groote Schuur Hospital (GSH) between 1993 and 2003. Patients and methods. Case notes; radiological results and laboratory records were reviewed retrospectively for 121 patients at GSH who underwent a neurosurgical procedure for treatment of a brain abscess between 1993 and 2003. Patients not treated surgically were excluded. Follow-up with serial computed tomography (CT) scans; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels and the temperature chart were used to determine the duration of parenteral antibiotic treatment and the need for repeat surgical evacuation of pus by either aspiration or excision of the capsule. Results. The mean patient age was 33 years; with a male-to-female ratio of 5:1. Headache; depressed level of consciousness and pyrexia were the commonest presenting symptoms. Other symptoms included seizures and hemiparesis. The frontal lobe was the commonest site (44); the majority of abscesses occurred as a result of infection following trauma. Mastoiditis (21) and sinusitis (8) were the second and third most common causes. Organisms were identified in 81of cases; polymicrobial infections occurred in half of these. Thirty-three different organisms were identified; the majority of which were Gram-positive bacteria. Anaerobes were present in 23; while methicillin-resistant Staphylococcus aureus was identified in 1 patient. Nocardia was seen in 3 patients; 2 of whom were diabetic. The average duration of parenteral antibiotic therapy was 15 and 19 days for excision and aspiration respectively. Accurate ESR records were available in 75of cases; with a positive predictive value in 81; while CRP (in use since 1999) was helpful in 92of cases. Outcome. Sixteen patients (13) died; 12 of whom had been admitted with a Glasgow Coma Score (GCS) of less than 4T/15. Thirteen patients developed epilepsy. On discharge; patients continued to take oral antibiotics for another 4 weeks; at the end of which they were reviewed at the neurosurgery outpatient department. Conclusion. Compared with previous studies from this hospital; mortality and morbidity have been diminishing progressively. GCS at the time of admission remains the most important prognostic factor