Abstract
BackgroundCryptococcal meningitis (CM) is a leading cause of mortality among HIV-positive South Africans. Reflex cryptococcal antigen (CrAg) testing of remnant plasma was offered as a pilot prior to implementation in October 2016 in KwaZulu-Natal province. The national reflex CrAg positivity was 5.4% compared to 7.3% for KwaZulu-Natal.ObjectivesThe aim of this study was to interrogate CrAg positivity by health levels to identify hotspots.MethodData for the period October 2016 to June 2017 were analysed. Health district CrAg positivity and prevalence were calculated, with the latter using de-duplicated patient data. The district CrAg positivity and the number of CrAg-positive specimens per health facility were mapped using ArcGIS. For districts with the highest CrAg positivity, a sub-district CrAg positivity analysis was conducted.ResultsThe provincial CrAg positivity was 7.6%. District CrAg positivity ranged from 5.7% (Ugu) to 9.6% (Umkhanyakude) with prevalence ranging from 5.5% (Ugu) to 9.7% (Umkhanyakude). The highest CrAg positivity was reported for the Umkhanyakude (9.6%) and King Cetswayo (9.5%) districts. In these two districts, CrAg positivity of 10% was noted in the Umhlabuyalingana (10.0%), Jozini (10.2%), uMhlathuze (10.5%) and Nkandla (10.8%) subdistricts. In these subdistricts, 135 CrAg-positive samples were reported for the Ngwelezane hospital followed by 41 and 43 at the Hlabisa and Manguzi hospitals respectively.ConclusionCryptococcal antigen positivity was not uniformly distributed at either the district or sub-district levels, with identified facility hotspots in the Umkhanyakude and King Cetswayo districts. This study demonstrates the value of laboratory data to identify hotspots for planning programmatic interventions.
Highlights
Cryptococcal meningitis (CM) is a leading cause of mortality among HIV-positive persons in South Africa.[1]
Cryptococcal antigen (CrAg) reflex testing of specimens with a CD4 count of ≤ 100 cells/μl was implemented across a network of CD4 testing laboratories in South Africa.[2]
These specimens were tested for CrAg using a lateral flow assay (LFA) (Immuno Mycologics, Norman, Oklahoma, United States)
Summary
Cryptococcal meningitis (CM) is a leading cause of mortality among HIV-positive persons in South Africa.[1]. Since the national implementation of reflex CrAg screening in South Africa in October 2016, data collected by testing laboratories confirmed that nationally, about 10% of all CD4 samples tested had a count ≤ 100 cells/μl. These specimens were tested for CrAg using a lateral flow assay (LFA) (Immuno Mycologics, Norman, Oklahoma, United States). Both the percentage of samples eligible for CrAg testing and the percentage of CrAg-positive results vary considerably across the nine provinces in South Africa. The national reflex CrAg positivity was 5.4% compared to 7.3% for KwaZulu-Natal
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have