BACKGROUND: KwaZulu-Natal ranked second highest among South African provinces for the number of laboratory-confirmed cases during the second wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The seroprevalence of SARS-CoV-2 among certain vulnerable groups, such as people living with HIV in KwaZulu-Natal, is unknown. OBJECTIVE: The study aimed to determine the prevalence of SARS-CoV-2 immunoglobulin G (IgG) in HIV-positive versus HIV-negative patients. METHODS: This was a retrospective analysis of residual clinical blood specimens unrelated to coronavirus disease 2019 (COVID-19) submitted for diagnostic testing at Inkosi Albert Luthuli Central Hospital, Durban, from 10 November 2020 to 09 February 2021. Specimens were tested for SARS-CoV-2 immunoglobulin G on the Abbott Architect analyser. RESULTS: A total of 1977/8829 (22.4%) specimens were positive for SARS-CoV-2 antibodies. Seroprevalence varied between health districts from 16.4% to 37.3%, and was 19% in HIV-positive and 35.3% in HIV-negative specimens. Seroprevalence was higher among female patients (23.6% vs 19.8%; p < 0.0001) and increased with increasing age, with a statistically significant difference between the farthest age groups (< 10 years and > 79 years; p < 0.0001). The seroprevalence increased from 17% on 10 November 2020 to 43% on 09 February 2021 during the second wave. CONCLUSION: Our results highlight that during the second COVID-19 wave in KwaZulu-Natal a large proportion of people living with HIV were still immunologically susceptible. The reduced seropositivity in people with virological failure further emphasises the importance of targeted vaccination and vaccine response monitoring in these individuals. WHAT THE STUDY ADDS: This study contributes to data on SARS-CoV-2 seroprevalence before and during the second wave in KwaZulu-Natal, South Africa, which has the highest HIV prevalence globally. Reduced seropositivity was found among people living with HIV with virological failure, highlighting the importance of targeted booster vaccination and vaccine response monitoring.

INTRODUCTION: South African guidelines recommend two rapid tests for diagnosing human immunodeficiency virus (HIV) using the serial HIV testing algorithm, but the accuracy and compliance to this algorithm is unknown in rural clinics. We evaluated the accuracy of HIV rapid testing and the time to receiving test results among pregnant women in rural KwaZulu-Natal (KZN). METHOD: We observed the accuracy of rapid HIV testing algorithms for 208 consenting antenatal patients accessing voluntary HIV testing services in nine rural primary healthcare (PHC) clinics in KZN. A PHC-based HIV counsellor obtained finger-prick whole blood from each participant to perform rapid testing using the Advanced Quality™ One Step anti-HIV (1&2) and/or ABON™ HIV 1/2/O Tri-Line HIV test. A research nurse obtained venous blood for an enzyme-linked immunosorbent assay (ELISA) HIV test, which is the gold standard diagnostic test. We recorded the time of receipt of HIV test results for each test. RESULTS: Among 208 pregnant women with a mean age of 26 years, 72 women from nine rural PHC clinics were identified as HIV-positive by two rapid tests with an HIV-prevalence of 35% (95% Bayesian credibility intervals [BCI]: 28% - 41%). Of the 208 patients, 135 patients from six clinics were tested with the serial HIV testing algorithm. The estimated sensitivity and specificity for the 135 participants were 100% (95% confidence interval [CI]: 93% - 100%) and 99% (CI: 95% - 100%), respectively. The positive predictive value and negative predictive value were estimated at 98% (CI: 94% - 100%) and 95% (CI: 88% - 99%), respectively. All women received their HIV rapid test results within 20 min of testing. Test stock-out resulted in poor test availability at point-of-care, preventing performance of a second HIV test in three out of nine PHC clinics in rural KZN. CONCLUSION: Despite the poor compliance with national guidelines for HIV rapid testing services, HIV rapid test results provided to pregnant women in rural PHC clinics in KZN were generally accurate and timely. Test stock-out was shown to be one of the barriers to test availability in rural PHC clinics, resulting in poor compliance with guidelines. We recommend a compulsory confirmation HIV rapid test for all HIV-negative test results obtained from pregnant patients in rural and resource-limited settings.

BACKGROUND: The prevalence of hepatitis B virus (HBV) amongst South African infants and children has been reported in the pre-HIV era. Despite the reported high prevalence of HIV in the general population of South Africa, the rate of HIV/HBV co-infection amongst infants and children remains poorly reported. OBJECTIVES: We describe the prevalence of HBV infection amongst HIV-positive and HIV-negative infants by molecular methods of diagnosis using dried blood spot samples. METHODS: This retrospective cross-sectional study was conducted between July 2011 and December 2011 in an academic referral laboratory offering viral diagnostic services to the entire KwaZulu-Natal province of South Africa. A total of 322 study samples were collected from discarded residual dried blood spot samples following routine infant diagnosis of HIV. Equal proportions of HIV-positive and HIV-negative infant specimens were studied. Statistical differences in the prevalence of HBV between the HIV-positive and HIV-negative samples were calculated using the Pearson chi-square test, and a p-value < 0.05 was considered statistically significant. Further testing for HBV DNA using a nested polymerase chain reaction method was performed. RESULTS: The overall prevalence of HBV was 10%. In the HIV-positive group, 21 of 161 infants tested positive for HBV compared with 12 of 161 HIV-negative infants who tested positive for HBV. The proportion of infants infected with HBV was marginally higher amongst HIV-positive infants (13.0%; 95% CI 6.8-19.9) compared with HIV-negative infants (7.5%; 95% CI 2.5-13.7; P = 0.098), though not statistically significant. CONCLUSION: The finding of a 10% HBV prevalence in this infant cohort is clinically significant. The non-statistically significant difference in HBV prevalence between the HIV-positive and HIV-negative infants suggests that high prevalence of HBV infection in children may be a problem independent of HIV.

BACKGROUND: There is a paucity of data on the prevalence of hepatitis C virus (HCV) in children, particularly in sub-Saharan Africa. A major obstacle in resource-limited settings for polymerase chain reaction (PCR) testing is the necessity for specimen transportation and storage at low temperatures. There are numerous recent studies of using real-time HCV PCR for diagnosis and screening of plasma and serum, but few have looked at using dried blood spot (DBS) specimens. OBJECTIVES: The aim of this study was to optimise a real-time HCV PCR method to detect HCV RNA from infant DBS specimens for use as a tool for HCV surveillance in KwaZulu-Natal, South Africa. METHOD: The LightCycler® 2.0 instrument was used for the HCV PCR using the LightCycler® RNA Master SYBR Green I kit. Template volume, primer concentration and primer annealing temperatures were optimised and the method was used on 179 DBS specimens from HIV-exposed infants in KwaZulu-Natal. RESULTS: Primer concentrations adjusted to 0.25 µM and a template volume of 10 µL improved the PCR amplification. Primer annealing temperatures lowered from 65 °C to 58 °C resulted in higher quantities of amplified PCR product. The limit of detection of the optimised HCV PCR assay was between 1200 IU/mL and 3580 IU/mL of HCV RNA. HCV was not detected in any of the 179 DBS specimens. CONCLUSION: The optimised real-time HCV PCR on infant DBS specimens performed well, but HCV was not found in this surveillance study. HIV infection may have little impact on the vertical transmission of HCV in this region.

OBJECTIVE: To determine the operational effectiveness of the South African programme for preventing mother-to-child transmission (PMTCT) of HIV in reducing rates of early transmission of infection. METHODS: Participants were mother-infant pairs who participated in the South African PMTCT programme between October 2002 and November 2004. This was a prospective cohort study. Three sites in different provinces were selected to represent differences in socioeconomic status and HIV prevalence. Data on antenatal care and labour ward care were obtained from maternal interviews and from reviews of medical records. A total of 665 mother-infant pairs in which the mother was HIV-positive were recruited and 588 (88.4%) were followed up at 3 or 4 weeks postpartum to determine the HIV status and vital status of the infant. FINDINGS: Rural participants were significantly poorer and their health care was significantly worse. Women of higher socioeconomic status and those who received better counselling were more likely to be treated with nevirapine. Rates of early HIV transmission ranged from 8.6% to 13.7%. Maternal viral load was the only statistically significant risk factor for transmission. After adjusting for maternal viral load and prevalence of low birth weight, the odds of transmission were 1.8 times higher at the rural site. Controlling for having had > 4 antenatal visits and any delivery complication reduced the odds of transmission to 1.5 higher at the rural site. CONCLUSION: Rates of early transmission of HIV in an operational setting using single-dose nevirapine administered both to mother and child are similar to those obtained in clinical trials. Scaling up access to antiretroviral regimens for women will further reduce transmission to infants.

OBJETIVO: Determinar la eficacia operacional del programa sudafricano de prevención de la transmisión de la madre al niño (PTMN) del VIH en lo que respecta a la reducción de las tasas de transmisión temprana de la infección. MÉTODOS: Se analizó la evolución de pares de madre y lactante que participaron en el programa de PTMN de Sudáfrica entre octubre de 2002 y noviembre de 2004. En este estudio prospectivo de cohortes se seleccionaron tres sitios de diferentes provincias para que estuvieran representados los distintos estatus socioeconómicos y prevalencias de la infección por VIH. Los datos sobre la atención prenatal y en las salas de parto proceden de entrevistas maternas e historias clínicas. Se reclutó a un total de 665 pares de madre y lactante en que la madre era VIH-positiva, lográndose someter a seguimiento a 588 (88,4%) de ellas a las 3 o 4 semanas tras el parto para determinar su serología VIH y el estado del lactante. RESULTADOS: Las participantes rurales eran significativamente más pobres y la atención sanitaria que recibieron fue significativamente peor. Las mujeres de estatus socioeconómico más alto y las que recibieron mejor asesoramiento presentaron una mayor probabilidad de ser tratadas con nevirapina. Las tasas de transmisión temprana del VIH se situaron entre el 8,6% y el 13,7%. La carga viral materna fue el único factor de riesgo de transmisión estadísticamente significativo. Después de ajustar los datos en función de la carga viral materna y de la prevalencia de peso bajo al nacer, la probabilidad de transmisión resultó ser 1,8 veces mayor en el sitio rural. Controlando el número de visitas prenatales (> 4) y las posibles complicaciones del parto, el factor de aumento de la probabilidad de transmisión en el sitio rural se reducía a 1,5. CONCLUSIÓN: Las tasas de transmisión temprana de la infección por VIH en un entorno operacional de administración de una sola dosis de nevirapina a ambos, madre y niño, son similares a las observadas en ensayos clínicos. La expansión del acceso a los regímenes antirretrovirales para las mujeres reducirá aún más la transmisión a los lactantes.

OBJETIF: Déterminer l’efficacité opérationnelle du programme de prévention de la transmission de la mère à l’enfant du VIH (PTME) mené en Afrique du Sud dans la réduction des taux de transmission précoce de l’infection. MÉTHODES: On a choisi comme sujets de l’étude des couples mères-enfants ayant bénéficié du programme PTME pour l’Afrique du Sud entre octobre 2002 et novembre 2004. Ces couples ont fait l’objet d’une étude prospective de cohorte. On a sélectionné trois sites dans des provinces différentes afin de prendre en compte les écarts de statut socioéconomique et de prévalence du VIH. Des entretiens avec les mères et une analyse des dossiers médicaux ont permis d’obtenir des données sur les soins anténatals et ceux dispensés en salle de travail. On a recruté au total 665 couples mères-enfants comprenant une mère séropositive, parmi lesquels 588 (88,4 %) ont été suivis 3 à 4 semaines après l’accouchement pour déterminer le statut vital et le statut à l’égard du VIH du nourrisson. RÉSULTATS: Les sujets de l’étude vivant en milieu rural étaient nettement plus pauvres et leur état de santé sensiblement plus dégradé par rapport aux sujets de milieux urbains. La probabilité de recevoir un traitement par la névirapine était plus forte chez les femmes de statut socioéconomique élevé et chez celles ayant été bien conseillées. Les taux de transmission précoce du VIH se situaient entre 8,6 et 13,7 %. La charge virale maternelle s’est révélée le seul facteur de risque ayant une influence statistiquement significative. Après ajustement pour la charge virale et la prévalence des faibles poids à la naissance, la probabilité de transmission du virus pour le site rural était 1,8 fois supérieure à celle en milieu urbain. En contrôlant pour les femmes du site rural ayant bénéficié de 4 visites anténatales au moins et dont l’accouchement s’était opéré sans aucune complication, la probabilité de transmission pour ce site est passée à 1,5 fois celle du site urbain. CONCLUSION: Les taux de transmission précoce du VIH obtenus dans un contexte opérationnel en administrant une dose unique de névirapine à la mère et à l’enfant sont similaires à ceux enregistrés dans des essais cliniques. L’élargissement de l’accès pour les femmes au traitement antirétroviral permettra de réduire davantage la transmission du VIH aux nourrissons.