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Biomedical subjects

D Wilkinson

Publications and source records attributed to D Wilkinson.

At least 163 records · Page 9Linked to original sources
PubMed1998

HIV infection among patients with sexually transmitted diseases in rural South Africa.

A cross-sectional study of 360 patients presenting with sexually transmitted diseases (STDs) to a primary care clinic in KwaZulu/Natal, South Africa was done. Prevalence of HIV infection was 42.5%. HIV-infected patients were of similar age to uninfected patients (mean age 25.1 vs 26.1 years), but were less likely to be married (9.2% vs 18.8%; P=0.02). HIV prevalence was highest among young women (47.9% among women aged 15-34 years compared with 33.1% among men of the same age; P=0.03). History of a previous STD in the preceding 3 months was high (40.1% in HIV-infected patients). Similar proportions of the HIV-infected and HIV-uninfected had sought care for the previous illness at private practitioners (16.9%), and primary care clinics (50.0%), and traditional healers (14.6%) or had treated themselves (18.5%). Patients with an STD are at very high risk of HIV infection in this setting. Repeat STDs are frequent and opportunities exist to improve treatment seeking behaviour, to reduce the risk of recurrent STDs, and hence to reduce the incidence of HIV infection.

Adolescent↗
PubMed1998

Pregnant women as a reservoir of undetected sexually transmitted diseases in rural South Africa: implications for disease control.

OBJECTIVES: This study was undertaken to determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in rural South Africa and to determine the value of using abnormal urogenital symptoms to identify infected women. METHODS: This was a cross-sectional study of 327 patients attending prenatal clinics. RESULTS: Of the 271 women with complete data, 141 (52%) had at least 1 STD and 49 (18%) had more than 1. Abnormal symptoms were common (n = 225; 83%), but associations were weak, and the positive predictive value of different symptoms for infection ranged from 2% to 54%. CONCLUSIONS: Most STDs in rural South African women remain undetected and untreated. As the scope for laboratory diagnosis in resource-poor settings is limited, presumptive treatment of pregnant women and their partners may be a cost-effective option to reduce transmission of STDs and HIV infection.

Adult↗
PubMed1998

Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa.

Noncommunicable diseases (NCDs) such as hypertension, asthma, diabetes and epilepsy are placing an increasing burden on clinical services in developing countries and innovative strategies are therefore needed to optimize existing services. This article describes the design and implementation of a nurse-led NCD service based on clinical protocols in a resource-poor area of South Africa. Diagnostic and treatment protocols were designed and introduced at all primary care clinics in the district, using only essential drugs and appropriate technology; the convenience of management for the patient was highlighted. The protocols enabled the nurses to control the clinical condition of 68% of patients with hypertension, 82% of those with non-insulin-dependent diabetes, and 84% of those with asthma. The management of NCDs of 79% of patients who came from areas served by village or mobile clinics was transferred from the district hospital to such clinics. Patient-reported adherence to treatment increased from 79% to 87% (P = 0.03) over the 2 years that the service was operating. The use of simple protocols and treatment strategies that were responsive to the local situation enabled the majority of patients to receive convenient and appropriate management of their NCD at their local primary care facility.

Adolescent↗
PubMed1998

Should we take a history of prior treatment, and check sputum status at 2-3 months when treating patients for tuberculosis?

SETTING: Pinetown, South Africa (1975-1983). OBJECTIVE: To determine the value of previous treatment history and sputum smear examination at 2-3 months in predicting treatment failure and relapse in tuberculosis patients treated with four drugs given twice weekly for six months under direct observation. DESIGN: Four cohort studies among 562 ambulant adults with culture positive pulmonary tuberculosis, designed to test the effectiveness of isoniazid 600-900 mg, rifampicin 600 mg, pyrazinamide 2-3 g, and streptomycin 1-2 g, given twice weekly. The same drug regimen was given to all patients irrespective of previous treatment history. Therapy was not changed if smears remained positive at 2-3 months. RESULTS: Positive predictive values of a history of previous treatment for a positive smear at 2-3 months (18.3%), treatment failure (5.2%), and relapse (9.4%) were poor. Although patients with positive smears at 2-3 months were more likely to fail therapy than patients with negative smears (relative risk=4.5, 95% Confidence Interval [CI]: 1.6-12.8), positive predictive value for treatment failure was only 12.5%. Although relapse was more frequent in patients with positive smears than those with negative smears (9.7% vs 6.2%; P=0.4), most patients who relapsed had been smear negative at 2-3 months (18/21). CONCLUSION: A four-drug rifampicin-containing regimen can safely be given twice weekly under direct observation to both new and retreatment cases, and the 2-3 month smear examination can safely be omitted.

Adult↗
PubMed1998

Childhood human immunodeficiency virus and tuberculosis co-infections: reconciling conflicting data.

The impact of the human immunodeficiency virus (HIV) pandemic on childhood tuberculosis (TB) is unclear because of inconsistent and often contradictory findings in different types of studies. We review the evidence which supports or refutes the likelihood that HIV infection in children predisposes them to TB, and conclude that, on balance, HIV during infancy increases the risk of developing TB. Surveillance shows an association between rising TB rates among children and the HIV epidemic in some parts of the world. A number of cross-sectional studies which have taken children with TB as their starting population, have yielded high rates of association with HIV (11%-64% HIV prevalence). Similarly, cross-sectional studies of hospitalised children with HIV show that many also have TB. These rates of association are all over-estimated because of the uncertainty of diagnosis of TB. Birth cohorts of perinatally HIV-infected infants and children prospectively followed up for a few years have generally failed to detect a higher incidence of TB than anticipated. The few TB cases identified in these cohorts were usually over 15-18 months of age. In acute progressive lung disease there is no excess of TB in HIV-infected over non HIV-infected children. These inconsistencies are discussed and attributed mainly to study design and statistical artefact. However, maternal factors in HIV-positive women which might affect transmission of TB to their babies are assessed, and infant immunoparesis due to HIV which may adversely influence resistance to TB is considered.

AIDS-Related Opportunistic Infections↗
PubMed1998

Impact of the human immunodeficiency virus epidemic on mortality among adults with tuberculosis in rural South Africa, 1991-1995.

SETTING: In the Hlabisa district tuberculosis programme, South Africa, the prevalence of human immunodeficiency virus (HIV) infection among adults with tuberculosis increased from 36.0% in 1993 to 65.9% in 1997, and the annual tuberculosis caseload increased from 321 in 1991 to 1250 in 1996. OBJECTIVE: To examine the impact of the HIV epidemic on mortality among adults with tuberculosis from 1991 to 1995. METHODS: Data were extracted from the control programme database. As the programme started in July 1991, data for this year were combined with those for 1992. RESULTS: All-cause mortality among all those diagnosed with tuberculosis increased by 45.6%, from 9.2% (55/599) in 1991/92 to 13.4% (96/714) in 1995 (P = 0.02). Among smear-positive patients only, mortality increased by 134%, from 4.4% to 10.3% (P = 0.003). The case-fatality rate (CFR) increased in most age groups of both sexes, the largest increase (157.5%) being among women aged 15-34 years. CFR was highest among those with smear-negative disease (24.7% in 1995). In multifactorial analysis, independent risk factors for mortality were increasing age (P = 0.0001), HIV infection (odds ratio [OR] 3.5, 95 % confidence interval [CI] 2.3-5.4), smear-negative disease (OR 2.5, 95%CI 1.8-3.5), and diagnosis in 1995 vs 1991/92 (OR 1.8, 95%CI 1.2-2.7). Mortality among the HIV infected continued to accrue throughout treatment, whereas non-HIV-infected patients that died did so early in treatment. CONCLUSION: The HIV epidemic is increasing tuberculosis all-cause mortality. As well as having a direct effect on individuals, increased caseloads due to HIV may also contribute to increased mortality by reducing the health system's ability to provide adequate care.

Adolescent↗
PubMed1997

Comparison of cost effectiveness of directly observed treatment (DOT) and conventionally delivered treatment for tuberculosis: experience from rural South Africa.

OBJECTIVE: To conduct an economic evaluation of directly observed treatment (DOT) and conventionally delivered treatment for the management of new cases of tuberculosis in adults. DESIGN: Community based directly observed treatment, which has been implemented in the Hlabisa district of South Africa since 1991, was compared with a conventional approach to tuberculosis treatment widely used in Africa. Each was assessed in terms of cost, cost effectiveness, and feasibility of implementation within existing resource constraints. SETTING: Hlabisa Health District, South Africa. SUBJECTS: Adult patients with new cases of tuberculosis on smear testing; the number of cases increased from 20 per month to over 100 from 1991 to 1996. MAIN OUTCOME MEASURES: Cost of case management in 1996, cost effectiveness in terms of the cost per case cured, and bed requirements in comparison with bed availability for the 1990, 1993, and 1996 caseload. Costs are expressed in US dollars at values for 1996. RESULTS: Directly observed treatment was 2.8 times cheaper overall than conventional treatment ($740.90 compared with $2047.70) to deliver. Directly observed treatment worked out 2.4-4.2 times more cost effective, costing $890.50 per patient cured compared with either $2095.60 (best case) or $3700.40 (worst case) for conventional treatment. The 1996 caseload of tuberculosis required 47 beds to be dedicated to tuberculosis to implement directly observed treatment, whereas conventionally delivered treatment would have required 160 beds; the current number of beds for tuberculosis treatment in Hlabisa is fixed at 56. CONCLUSIONS: Because of the reduced stay in hospital, directly observed treatment is cheaper, more cost effective, and more feasible than conventional treatment in managing tuberculosis in Hlabisa, given the existing hospital bed capacity and the escalating caseload due to the HIV/AIDS epidemic. Such results may hold elsewhere, and wherever conventional tuberculosis management is practised a switch to directly observed treatment will increase hospital capacity to cope with a growing caseload.

Adult↗
PubMed1997

Increasing HIV prevalence in a rural district of South Africa from 1992 through 1995.

OBJECTIVES: To describe the increasing prevalence of HIV infection in a rural district in South Africa, to compare this with a nearby urban setting, and to estimate the prevalence of infection in the general population of the rural district. DESIGN: Serial anonymous cross-sectional HIV seroprevalence surveys among consecutive women attending antenatal clinics in the rural Hlabisa health district, and the urban King Edward VIII Hospital, Durban, South Africa. RESULTS: Crude antenatal HIV seroprevalence in Hlabisa increased from 4.2% (95% confidence interval [95%CI], 3.0-5.7) in 1992, to 14% (95%CI, 10.4-18.4) in 1995 (p < 0.0001). Age-specific prevalence was highest in women aged 20 to 24 years (21.1% in 1995) and in the more urbanized areas of the district (29.5% in 1995). Prevalence in Durban, at 19% (95%CI, 16.5-21.7), was higher than in Hlabisa in 1995 (p = 0.046), in large part as a result of the higher prevalence in the 15 to 19 year age group in Durban (22.4% vs. 7.4%, p = 0.004). An estimated 5.6% (95%CI, 3.0-9.6) of the general population of the Hlabisa district was HIV infected in 1995. CONCLUSIONS: The HIV epidemic, fueled by a high incidence in young people, has escalated rapidly in this part of rural South Africa. Lower crude rural than urban prevalence is largely a result of a lower prevalence in young rural women; the underlying social reasons for this need to be fully explored. South Africa urgently needs to implement effective prevention programs, to plan for the impact of HIV-related disease on the health service, and to develop community-based care strategies.

Adolescent↗
PubMed1997

Determination of the two major human metabolites of tipredane in human urine by high-performance liquid chromatography with column switching.

An automated method based on column-switching reversed-phase in high-performance liquid chromatography the heart-cutting mode has been developed for the simultaneous determination of the two major human metabolites of tipredane, FPL 66365XX and FPL 66366XX, in human urine. The limit of quantification of the method was 25 ng/ml for both analytes from a urine injection volume of 100 microl. The intra- and inter-assay precision and accuracy were acceptable between 25 and 5000 ng/ml. No significant interferences were observed from either tipredane or a selection of its putative metabolites, or urine constituents in samples from male and female volunteers. Both analytes were found to be stable in human urine when stored at room temperature for two days, at 4 degrees C for six days, in a freezer at or below -20 degrees C for three weeks, and when the urine samples were subjected to three freeze-thaw cycles The method was unusual in that the initial separation was performed on a non-polar, octadecylsilane, column and the final separation on a more polar, trimethylsilane column. These columns were selected only after the investigation of a wide range of reversed-phase columns. The method's success was based on the greatly differing selectivities shown towards the two analytes by the organic modifiers, methanol and acetonitrile, present in the mobile phases used for the extraction and analytical stages

Administration, Topical↗
PubMed1997

Determination of a major metabolite of tipredane in rat urine by high-performance liquid chromatography with column switching.

An automated method, based on column-switching reversed-phase high-performance liquid chromatography, has been developed for the determination of a major metabolite of tipredane in rat urine. Samples are injected directly onto a cyanopropyl extraction column. The portion of eluate containing the metabolite is switched, via an injection loop, onto an octadecylsilane analytical column. The limit of quantification of the method was 25 ng/ml for a 20 microl injection volume of urine. The intra-assay precision (0.7-4.8%) and accuracy (94-105%), and the inter-assay precision (2.7-12.6%) and accuracy (94-105%), were acceptable. The analyte was found to be stable in rat urine when stored at room temperature for six days, in a freezer at or below -20 degrees C for twelve weeks, and when the samples were subjected to two freeze-thaw cycles. No significant interference was observed from tipredane and its major human metabolites, or urine constituents in male and female rats. The method was successfully used to analyse samples from a long-term toxicology study.

Administration, Topical↗