District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa
Background: Cryptococcal 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...
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| Format: | Article |
| Language: | English |
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AOSIS
2018-10-01
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| Series: | African Journal of Laboratory Medicine |
| Subjects: | |
| Online Access: | https://ajlmonline.org/index.php/ajlm/article/view/757 |
| _version_ | 1818246945469104128 |
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| author | Naseem Cassim Lindi M. Coetzee Nelesh P. Govender Deborah K. Glencross |
| author_facet | Naseem Cassim Lindi M. Coetzee Nelesh P. Govender Deborah K. Glencross |
| author_sort | Naseem Cassim |
| collection | DOAJ |
| description | Background: Cryptococcal 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.
Objectives: The aim of this study was to interrogate CrAg positivity by health levels to identify hotspots.
Method: Data 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.
Results: The 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.
Conclusion: Cryptococcal 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. |
| first_indexed | 2024-12-12T14:56:52Z |
| format | Article |
| id | doaj.art-22240ac8109f409f9b730857cf48ee89 |
| institution | Directory Open Access Journal |
| issn | 2225-2002 2225-2010 |
| language | English |
| last_indexed | 2024-12-12T14:56:52Z |
| publishDate | 2018-10-01 |
| publisher | AOSIS |
| record_format | Article |
| series | African Journal of Laboratory Medicine |
| spelling | doaj.art-22240ac8109f409f9b730857cf48ee892022-12-22T00:20:53ZengAOSISAfrican Journal of Laboratory Medicine2225-20022225-20102018-10-0171e1e810.4102/ajlm.v7i1.757192District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South AfricaNaseem Cassim0Lindi M. Coetzee1Nelesh P. Govender2Deborah K. Glencross3Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg,Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg,National Institute for Communicable Diseases, Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa; and, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg,Background: Cryptococcal 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. Objectives: The aim of this study was to interrogate CrAg positivity by health levels to identify hotspots. Method: Data 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. Results: The 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. Conclusion: Cryptococcal 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.https://ajlmonline.org/index.php/ajlm/article/view/757HIVCD4CrAgCryptococcal Disease |
| spellingShingle | Naseem Cassim Lindi M. Coetzee Nelesh P. Govender Deborah K. Glencross District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa African Journal of Laboratory Medicine HIV CD4 CrAg Cryptococcal Disease |
| title | District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa |
| title_full | District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa |
| title_fullStr | District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa |
| title_full_unstemmed | District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa |
| title_short | District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa |
| title_sort | district and sub district analysis of cryptococcal antigenaemia prevalence and specimen positivity in kwazulu natal south africa |
| topic | HIV CD4 CrAg Cryptococcal Disease |
| url | https://ajlmonline.org/index.php/ajlm/article/view/757 |
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