Rising rates of hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia in NHS acute trusts in England: a review of national surveillance data, August 2020-February 2021.

Increases in hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia rates in England were observed between August 2020 and February 2021 to the highest levels recorded since the start of mandatory surveillance in April 2017. Cases were extracted from England's mandatory surveillance database for key Gram-negative bloodstream infections. Incidence rates for hospital-onset bacteraemia cases increased from 8.9 (N=255) to 14.9 (N=394) per 100,000 bed-days for Klebsiella spp. [incidence rate ratio (IRR) 1.7, P<0.001], and from 4.9 (N=139) to 6.2 (N=164) per 100,000 bed-days for P. aeruginosa (IRR 1.3, P<0.001) (August 2020-February 2021). These incidence rates were higher than the average rates observed during the same period in the previous 3 years. These trends coincided with an increase in the percentage of hospital-onset bacteraemia cases that were also positive for severe acute respiratory syndrome coronavirus-2.

Improving retention of community-recruited participants in HIV prevention research through Saturday household visits; findings from the HPTN 071 (PopART) study in South Africa.

BACKGROUND: Identifying successful strategies to improve participant retention in longitudinal studies remains a challenge. In this study we evaluated whether non-traditional fieldworker shifts (after hours during the week and weekends) enhanced participant retention when compared to retention during traditional weekday shifts in the HPTN 071 (PopART) population cohort (PC). METHODS: HPTN 071 (PopART) PC participants were recruited and followed up in their homes on an annual basis by research fieldworkers over a 3-4 year period. The average number of successful follow-up visits, where a PC participant was found and retained in the study, was calculated for each of 3 visit schedules (early weekday shift, late weekday shift, and Saturday shift), and standardized to account for variation in fieldwork shift duration. We used one-way univariate analysis of variance (ANOVA) to describe differences in mean-successful visits and 95% confidence intervals between the shift types. RESULTS: Data on 16 651 successful visits were included. Successful visit rates were higher when conducting Saturday visits (14.0; 95% CI: 11.3-16.6) compared to both regular (4.5; 95% CI: 3.7-5.3) and late weekday shifts (5.3; 95% CI: 4.7-5.8) overall and in all subgroup analyses (P<0.001). The successful visit rate was higher amongst women than men were during all shift types (3.2 vs. 1.3, p<0.001). Successful visit rates by shift type did not differ significantly by age, over time, by PC round or by community triplet. CONCLUSION: The number of people living with HIV continues to increase annually. High quality evidence from longitudinal studies remains critical for evaluating HIV prevention and treatment strategies. This study showed a significant benefit on participant retention through introduction of Saturday shifts for home visits and these data can make an important contribution to the emerging body of evidence for improving retention in longitudinal research. TRIAL REGISTRATION: PopART was approved by the Stellenbosch University Health Research Ethics Committees (N12/11/074), London School of Hygiene and Tropical Medicine (6326) ethics committee and the Division of AIDS (DAIDS) (Protocol ID 11865). PopART was registered with ClinicalTrials.gov (registration number NCT01900977 ).

Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa.

OBJECTIVES: Renal dysfunction is a significant cause of morbidity and mortality among HIV-positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. METHODS: A retrospective cohort analysis of routine data for HIV-positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) < 60 mL/min after ART initiation among individuals with a baseline (pre-ART) eGFR ≥ 60 mL/min. RESULTS: Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/µL [interquartile range (IQR) 195-468 cells/µL], were included in the analysis. Forty-seven individuals had a baseline eGFR < 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir-containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR < 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR < 60 mL/min at baseline CD4 counts of > 500 cells/µL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11-0.80], 351-500 cells/µL (aOR 0.22; 95% CI 0.08-0.59) and 201-350 (aOR 0.48; 95% CI: 0.24-0.97) compared with baseline CD4 counts < 200 cells/µL. CONCLUSIONS: This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts > 200 cells/µL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.

Access to human immunodeficiency virus testing services in Cape Town, South Africa: a user perspective.

Objective: To compare the availability, affordability and acceptability of two non-governmental organisation (NGO) led human immunodeficiency virus (HIV) testing service (HTS) modalities (mobile and stand-alone) with HTS at a public primary health care facility. Methods: Adult participants who self-referred for HIV testing were enrolled as they exited the HTS modalities. Data collection using an electronic questionnaire took place between November 2014 and February 2015. Logistic regression analysis was used to assess differences in the participants' demographic characteristics and the availability, affordability and acceptability of HTS between modalities. Results: There were 130 participants included in the study. Irrespective of modality, most participants walked to the service provider, had a travel time of <30 min and reported no costs. Participants were less likely to report waiting times of ⩾30 min compared to <15 min at the mobile modality compared to the public facility (aOR < 0.001, 95%CI < 0.001-0.03). Conclusion: Irrespective of modality, HIV testing services were available and affordable in our study. Waiting times were significantly higher at the public facility compared to the NGO modalities. As South Africa moves toward achieving the first UNAIDS target, it is essential not only to make HTS available and affordable, but also to ensure that these services are acceptable, especially to those who have never been tested before.

Objectif : Comparer la disponibilité, l'accessibilité et l'acceptabilité de deux modalités de services de test du virus de l'immunodéficience humaine (VIH) (HTS) : modalité mobile réalisée par des organisations non gouvernementales (ONG) et modalité autonome réalisée par une structure de soins de santé primaires.Méthodes : Les participants adultes qui se sont présentés pour un test VIH ont été enrôlés lors de leur sortie des modalités de HTS. Le recueil de données, basé sur un questionnaire électronique, a eu lieu entre novembre 2014 et février 2015. Une analyse de régression logistique a été utilisée afin d'évaluer les différences des caractéristiques démographiques des participants et de la disponibilité, de l'accessibilité et de l'acceptabilité du HTS selon les modalités.Résultats : Des 130 participants qui ont été inclus dans l'étude, quelle que soit la modalité, la majorité s'est rendue à pied chez le prestataire de soins, marchant pendant <30 min, et n'a subi aucun coût. Les participants des structures mobiles ont été moins susceptibles que ceux de la structure publique de rapporter un temps de trajet ⩾ 30 min comparés à <15 min (ORa < 0,001 ; IC95% < 0,001­0,03).Conclusion : Les services de test VIH, quelle que soit la modalité, ont été disponibles et abordables dans notre étude. Les durées d'attente ont été significativement plus élevées dans la structure publique comparée aux modalités des ONG. Comme l'Afrique du Sud évolue vers l'atteinte de la première cible de l'ONUSIDA, il est essential non seulement de rendre le HST disponible et abordable, mais également de s'assurer que ces services sont acceptables, surtout à ceux qui n'ont jamais eu de test auparavant.

Objetivo: Comparar la disponibilidad, la asequibilidad y la aceptabilidad de dos modalidades de servicios de pruebas diagnósticas del virus de inmunodeficiencia humana (VIH) (HTS móvil y fijo independiente) propuestas por organizaciones no gubernamentales (ONG) y los servicios diagnósticos propuestos en un establecimiento público de atención primaria de salud.Métodos: Los adultos que acudían de manera espontánea en busca de pruebas diagnósticas se incluyeron en el estudio a la salida de los HTS. Se recogieron datos por conducto de un cuestionario electrónico de noviembre 2014 hasta febrero 2015. Mediante análisis de regresión logística se evaluaron las diferencias en las características demográficas de los participantes y la disponibilidad, la asequibilidad y la aceptabilidad de los HTS según las diferentes modalidades.Resultados: Participaron en el estudio 130 personas. Con independencia de la modalidad, la mayoría de los participantes caminó hasta el punto de prestación de servicios, su tiempo de desplazamiento fue <30 min y refirió no haber incurrido en ningún gasto. Fue menos probable que los usuarios de los servicios móviles refiriesen un tiempo de espera ⩾ 30 min en lugar de <15 min, al compararlos con los usuarios del establecimiento público (P < 0,001; IC95% < 0,001­0,03).Conclusión: El presente estudio reveló que los servicios de pruebas diagnósticas del VIH, sea cual fuere su modalidad, estaban disponibles y eran asequibles. Los tiempos de espera fueron significativamente más prolongados en el establecimiento público, en comparación con la espera en las modalidades de las ONG. A medida que Suráfrica progresa hacia el cumplimiento de la primera meta del Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA, es primordial, no solo que los HTS estén disponibles y sean asequibles, sino que se garantice su aceptabilidad, sobre todo por parte las personas que nunca han recibido la prueba.