Browsing by Author "Feucht, Ute"

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    False-positive HIV DNA PCR testing of infants : implications in a changing epidemic
    (Health and Medical Publishing Group (HMPG), 2012-03) Feucht, Ute; Forsyth, Brian; Kruger, Mariana
    Aim. To examine false-positive HIV DNA polymerase chain reaction (PCR) test results in children, and the potential implications for the paediatric HIV epidemic in sub-Saharan Africa. Methods. A review was done of records over a 6-year period of children less than 18 months old at an HIV treatment site in South Africa, to evaluate those with an initial 'false'-positive HIV DNA PCR result, but later proven to be HIV-uninfected with HIV DNA PCR and/or quantitative HIV RNA PCR tests. We calculated the influence of changing HIV transmission rates on predictive values (PV) of HIV DNA PCR tests in a hypothetical population of all HIV-exposed infants over a 1-year period. (Positive PV: proportion of individuals with a positive test with disease; negative PV: proportion of individuals with negative test and no disease). Results. Of 718 children, 40 with an initial positive HIV DNA PCR test were subsequently proven to be HIV-uninfected, resulting in a positive PV of 94.4%. Most (75%) uninfected children had PMTCT interventions and were asymptomatic or mildly symptomatic (77.5%). Calculations using a test specificity of 99.4%, as reported previously, show a decrease in positive PV using a single-test strategy from 98.6% at 30% HIV transmission rate, to 94.8% at 10% transmission, to 62.5% at 1% transmission. Reduction in test specificity further decreases positive PV at low transmission rates. Conclusion. Decreasing mother-to-child HIV transmission rates reduce the positive predictive value of a single HIV DNA PCR test result, necessitating adaptations to diagnostic algorithms to avoid misdiagnosis and inappropriate treatment, especially with early initiation of antiretroviral therapy in asymptomatic infants.
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    Translating new evidence into clinical practice : a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa
    (BMJ Publishing, 2020-10) Goga, Ameena; Doherty, Tanya; Manda, Samuel; Nkwenika, Tshifhiwa; Haskins, Lyn; John, Vaughn; Engebretsen, Ingunn M. S.; Feucht, Ute; Dhansay, Ali; Rollins, Nigel; Kroon, Max; Sanders, David; Kauchali, Shuaib; Tylleskär, Thorkild; Horwood, Christiane
    Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding. Design Quasi-experimental controlled before–after study. Setting Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa. Participants All HWs providing infant feeding counselling in selected facilities were invited. Interventions Three 1–2 hours, on-site workshops over 3–6 weeks. Primary outcome measures Knowledge (22 binary questions), attitude (21 questions—5-point Likert Scale) and confidence (19 questions—3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level. Results In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August–December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups. Conclusion A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs’ knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale.
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    When to start antiretroviral therapy in infants and children
    (AOSIS OpenJournals, 2009-12) Cotton, Mark; Rabie, Helena; Feucht, Ute; Violari, Avy
    This articles provides a background for antiretroviral therapy in infants and children, incorporating both old and new data. There is increasing data favouring early therapy for all age groups. Below a year of age, all HIV-infected infants should commence therapy and thereafter at higher CD4 thresholds than previous recommendations