Tuberculosis is one of the most common causes of death in the era of HIV/AIDS. According to the World Health Organisation (WHO), South Africa houses third largest global burdens of tuberculosis (TB) after India and China, and 28% of the world’s cases involve HIV-TB co-infection. Recent studies in South Africa indicate that <10% of patients attending clinics for TB-related symptoms were screened for TB and TB screening among people living with HIV is around 80%. Among those tested for TB, the availability of results in patient files is limited. Thus, accurate estimates for rates of TB infection remain unknown, particularly for high-risk populations. Recently, provider-initiated TB case-finding has become an integral part of HIV care in resource-poor settings. However, studies comparing symptom-based screening with sputum tests suggest that current symptom screening has poor sensitivity. This presentation will illustrate the use of latent class analysis to empirically identify distinct patterns of self-reported pulmonary TB symptoms from the second wave of Mzantsi Wakho study – the world’s largest cohort of adolescents living with HIV. In turn, given low rates of TB screening and accurate testing in the South Africa this will help to estimate rates of pulmonary TB infection among this high-risk population as well as explore a simple symptom screening checklist that may be crucial for more effective case finding and follow-up treatment in high-burden, low-resource contexts like South Africa.
The Mzantsi Wakho and HEY BABY teams – based at ASRU – gave 14 presentations at the International AIDS Conference 2018 and associated events, held on July 19-27, 2018 in Amsterdam, the Netherlands. Dr Elona Toska presented early findings on pregnancy among adolescents living with HIV in South Africa from the HEY BABY and Mzantsi Wakho studies, while Lesley Gittings presented research on adolescent and provider views on adherence and defaulting, an initiative led by Dr Rebecca Hodes, ASRU director, in collaboration with the Paediatric Adolescent Treatment for Africa.
South Africa has uniquely high rates of parental absence from children’s lives. Apartheid-era restrictions on population movement and residential arrangements contributed to family fragmentation, particularly when adults – mainly men – migrated to work in cities and on the mines. Despite the removal of legal impediments to permanent urban settlement and family co-residence for Africans, patterns of internal and oscillating labour migration have endured, dual or stretched households continue to link urban and rural nodes, and children have remained less urbanised than adults. Importantly for children, migration rates among prime-age women have increased, alongside falling marriage rates, declining remittances and persistently high unemployment. Households, and women especially, may have to make difficult choices about how to manage the competing demands of child care and income generation.