Early infant diagnosis of HIV and fast initiation of anti-retroviral therapy in a rural African setting: how well are we doing?

BACKGROUND: In South Africa, current estimates indicate that 1% of infants will be HIV PCR-positive by 2 months of age. WHO recommends early infant diagnosis (EID) and immediate initiation of antiretroviral therapy (ART) in infants who are diagnosed with HIV infection within the first year of life. AIMS: To investigate rates of EID and subsequent ART initiation in infants attending the Primary Health Care (PHC) clinics which fed Mseleni Hospital during 2012. OBJECTIVES: To measure the number of infants (<1 year of age) testing HIV PCR-positive who are currently collecting ART and those lost to follow-up. METHODS: HIV PCR test results from Mseleni Hospital in 2012 were cross-referenced with the national database (TIER.net) for ART initiation and follow-up from the National Health Laboratory Service (NHLS) database. RESULTS: 455 of 843 (54%) HIV-exposed infants (<2 months) were tested by HIV PCR, 11 of whom (2·4%) tested positive, reflecting the national prevalence. Of 897 HIV PCR tests undertaken in infants <1 year, 51 (5·7%) were positive, and 36 were included for analysis. Only 13 (36·1%) of these infants are currently collecting ART; seven (19·4%) commenced ART but were lost to follow-up, and 16 (44·5%) never started ART. CONCLUSION: 16 (44·5%) HIV PCR-positive infants in Mseleni Hospital and its feeder PHCs were not commenced on ART. This may reflect a similar problem in other rural hospitals in South Africa. Specific interventions are required to rapidly up-scale early initiation of ART in this vulnerable group of infants.

Mseleni joint disease: a potential model of epigenetic chondrodysplasia.

OBJECTIVE: In this paper past research on the natural history of Mseleni joint disease, a crippling endemic osteoarthritis, its socio-economic impacts, the demographics, diet, geology and the genetic background of affected people are reviewed. In addition, some new research ideas are suggested to continue the search for etiological avenues for this disease such as stable isotope analysis and epigenetic mechanisms. RESULTS: Mseleni joint disease is a chondrodysplasia first described in 1970. It is geographically confined to a remote area in the Maputaland region in northern Kwazulu Natal, South Africa. This disease affects most joints but primarily those of the hip; it is a progressive condition beginning with pain and stiffness until the patient's ability to walk becomes compromised. Mseleni joint disease is characterized by two distinct abnormalities, protrusio acetabuli that mainly affects females and increases in frequency with age, and hip dysplasia that is more frequent with age. Much research has been conducted on the people with the disease and their surrounding environment. CONCLUSION: Despite intensive investigations into the etiology of Mseleni joint disease, it remains unknown. As a result the examination of epigenetic mechanisms and stable isotope analysis of teeth are suggested as a means of providing information on the etiology of the disease. These methods can also be applied to other chondroplasias of unknown etiology.

How far should they walk? Increasing antiretroviral therapy access in a rural community in northern KwaZulu-Natal, South Africa.

Mseleni is a rural community located in northern KwaZulu-Natal, South Africa. As in most rural regions in sub-Saharan Africa, Mseleni's health care facilities are short staffed and suffer from significant resource constraints. Although these barriers exist, Mseleni's clinic-based antiretroviral therapy (ART) program is currently estimated to be meeting the needs of 60% of individuals who require therapy within its catchment area. To increase ART coverage, close attention must be paid to staffing levels and to collection of the appropriate data to inform improvements in clinical care. A number of reviews and interventions have been undertaken to fine-tune the system. The integrated team approach is key to programmatic development and should lead to strengthening of both primary health care and the ART program. Furthermore, to meet a greater percentage of treatment needs, full use of community networks is needed to draw asymptomatic patients into voluntary counseling and testing.