31 results found
van Leeuwen LM, Versteegen P, Zaharie SD, et al., 2019, Bacterial genotyping of CNS tuberculosis in South Africa: heterogenic M. tuberculosis infection and predominance of lineage 4, Journal of Clinical Microbiology, Vol: 57, ISSN: 0095-1137
Background: Tuberculous meningitis (TBM), the most severe extra-pulmonary manifestation of tuberculosis, is caused by the pathogen Mycobacterium tuberculosis. The M. tuberculosis complex includes seven lineages, all described to harbour a unique geographical dissemination pattern and clinical presentation.Method: In this study, we set out to determine whether a certain M. tuberculosis lineage demonstrated tropism to cause TBM in patients from Cape Town, South Africa. DNA was extracted from formalin-fixed paraffin embedded central nervous system (CNS) tissue from a unique neuro-pathological cohort of 83 TBM patients, collected between 1975 and 2012. M. tuberculosis lineages 1, 2, 3 and 4 were determined using an allele specific PCR and Sanger sequencing.Results: Of the 83 patient specimen tested, bacterial characterization could be performed on 46 patients (55%). M. tuberculosis lineage 4 was present in 26 patients (56%) and non-lineage 4 was identified in 10 cases (22%). Moreover, genomic heterogeneity was detected in the CNS specimens of 7 adults and 3 children.Conclusion: We could show that infection of the CNS is not restricted to a single M. tuberculosis lineage and that even young children with rapid progression of disease can harbour more than one M. tuberculosis lineage in the CNS.
van Elsland S, Peters RPH, Grobbelaar CJ, et al., Disclosure of HIV status to children in South Africa: a comprehensive analysis, Southern African Journal of HIV Medicine, ISSN: 1608-9693
van Elsland SL, 2019, Home-based treatment of children with HIV infection or tuberculous meningitis in South Africa
van Elsland SL, Peters RPH, Grobbelaar C, et al., 2019, Disclosure of human immunodeficiency virus status to children in South Africa: A comprehensive analysis., South Afr J HIV Med, Vol: 20
Background: The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives: To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3-14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods: This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results: We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older age of the child and higher education of the caregiver were strongly associated with disclosure. Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens with stavudine and didanosine, and self-reported non-adherence were strongly associated with non-disclosure. Conclusion: When children do well on treatment, caregivers feel less stringent need to disclose. Well-functioning families, higher educated caregivers and better socio-economic status enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure which could negatively affect adherence and viral suppression. There is an urgent need to address disclosure thoughtfully and proactively in the long-term disease management. For the disclosure process to be beneficial, an enabling supportive context is important, which will provide a great opportunity for future interventions.
Kruger M, Makiwane MM, Ramoroka S, et al., Off-label use in ambulatory paediatric clinics in a central South African hospital, Journal of Tropical Pediatrics
van Elsland SL, van Dongen SI, Bosmans JE, et al., 2018, Cost-effectiveness of home-based vs. in-hospital treatment of paediatric tuberculous meningitis., Int J Tuberc Lung Dis, Vol: 22, Pages: 1188-1195
SETTING: Cape Town, South Africa, 2014. OBJECTIVE: To assess the societal costs and cost-effectiveness of home-based vs. in-hospital treatment of paediatric tuberculous meningitis. DESIGN: This was an economic evaluation from a societal perspective using probabilistic analysis. Health care, informal care, lost productivity costs and costs in other sectors, health-related quality of life (HRQoL) and family impact were assessed during interviews with care givers, children, medical staff and management. RESULTS: Societal costs for home-based treatment were USD3857, and USD28 043 for in-hospital treatment. Home-based vs. in-hospital treatment HRQoL scores were 90.9% vs. 84.5%, while family impact scores were 94.8% vs. 73.1%. The point estimate of the incremental cost-effectiveness ratio indicated that improving HRQoL and family impact by 1% was associated with a saving of respectively USD3726 and USD1140 for home-based vs. in-hospital treatment. The probability that home-based treatment was less expensive and more effective than in-hospital treatment was 96.3% for HRQoL and 100% for family impact. CONCLUSION: Societal costs of home-based treatment were lower than for in-hospital treatment. Children treated at home had a better HRQoL and family impact scores. Home-based treatment was a cost-effective alternative to in-hospital treatment of drug-susceptible tuberculous meningitis.
van Elsland SL, Peters RPH, Kok MO, et al., 2018, A treatment-support intervention evaluated in South African paediatric populations with HIV infection or tuberculous meningitis., Trop Med Int Health, Vol: 23, Pages: 1129-1140
OBJECTIVES: To evaluate a paediatric treatment-support intervention for home-based treatment of HIV infection or tuberculous meningitis (TBM). METHODS: A randomised-controlled study comparing local standard care (controls) with standard care plus intervention (combining adherence education, reinforcement and monitoring) in children aged 0-14 years. We recorded adherence measures (self-report, pill-count, drug-assays for isoniazid and rifampicin in urine and pyrazinamide in saliva), difficulties administering medication and PedsQL™questionnaires for health-related quality-of-life (HRQoL) and family impact. RESULTS: In the HIV group (6-months follow-up, n = 195), more children had above-median HRQoL-scores in the intervention group than in the control group (P = 0.009). Problems reported administering medication declined between baseline and follow-up for controls (P = 0.043). Disclosure of HIV status to the child increased between baseline and follow-up in both groups (intervention P < 0.001; control P = 0.031). In the TBM group (3-months follow-up, n = 43), all adherence measures remained high for both intervention and controls, except for rifampicin which declined between baseline and follow-up in the intervention group (P = 0.031). The intervention group maintained above median HRQoL-scores between baseline and follow-up, when the number of children with above-median HRQoL-scores decreased in the controls (P = 0.063). More children in the intervention group had above-median family impact-scores than controls (P = 0.040). CONCLUSIONS: The low-cost, culturally friendly treatment-support intervention had beneficial effects on health-related quality of life, family impact, caregiver disclosure of HIV status to the child, increased caregiver reporting of medication non-adherence and caregiver reporting of difficulties administering medication. Treatment adherence was not significantly affected in either HIV or TBM group.
Zaharie SD, van Elsland S, van der Kuip M, et al., Preliminary findings of the pathogenesis of central nervous system granulomatous inflammatin in tuberculous meningitis in South Africa: a post-mortem immunohistochemistry study, ICN 2018
Kruger M, Wainwright L, Davidson A, et al., 2018, Report of first national collaborative treatment protocol of retinoblastoma in South Africa - an interim analysis, Hoboken, NJ USA, International Society of Paediatric Oncology (SIOP), Publisher: Wiley, Pages: S51-S52, ISSN: 1545-5009
van Elsland SL, Peters RPH, Grobbelaar N, et al., 2018, Paediatric ART Adherence in South Africa: A Comprehensive Analysis., AIDS Behav
Adherence to antiretroviral therapy (ART) remains a challenge for HIV-infected children. In this cross-sectional study, we used structured interview-administered questionnaires and medical records to measure adherence levels and factors associated with adherence and viral suppression. We included 195 South African children aged 2.1-12.9 on ART. Adherence levels ranged between 20.5% (pill count) and 89.1% (self-report). Boys were less adherent according to self-report, girls were less adherent according to pill count. Caregivers ensured medication was taken when the condition directly affected daily life. Well-functioning families and families with high SES provide a context supportive of adherence. Non-disclosure and difficulties administering medication negatively affected adherence and viral suppression. This study shows challenging levels of adherence impacting directly on viral suppression in a South African paediatric HIV program. Gender roles, non-disclosure and difficulty administering medication may undermine adherence and should be taken into account for clinical guidelines, policy design and inform strategies.
Teijema M, Kok MO, van Elsland S, et al., Setting the global research agenda on faith sector engagement for HIV service delivery and HIV prevention services, AIDS 2018
Teijema MT, van Elsland SL, Kok MO, et al., 2017, How to institutionalize faith-health collaboration to improve community driven service delivery to people living with HIV? Needs and realities explained, PHASA conference
Teijema MT, Kok MO, van Elsland S, et al., Setting the global research agenda on engaging the faith sector in providing community based services to people living with HIV, PHASA 2017
Zaharie SD, Franken DJ, van Elsland S, et al., The humoral immune response in tuberculous meningitis: an immunohistochemical analyses, Keystone Symposium
Franken DJ, Zaharie SD, van Elsland S, et al., The innate immune response in tuberculous meningitis patients: an immunohistochemical analysis of human brain, Keystone Symposium
Hasnida A, Borst RA, Johnson AM, et al., 2017, Making health systems research work: time to shift funding to locally-led research in the South, LANCET GLOBAL HEALTH, Vol: 5, Pages: E22-E24, ISSN: 2214-109X
Zaharie SD, van Dam CS, Roest SL, et al., Histology of Tuberculous Meningitis reveals 3 different granuloma types, Keystone
Norder WAJ, Peters RPH, Kok MO, et al., 2015, The church and paediatric HIV care in rural South Africa: a qualitative study, AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, Vol: 27, Pages: 1404-1409, ISSN: 0954-0121
van Elsland S, Kok MO, Quality assurance in HSR: Providing reflexive guidance for enhancing the robustness of health system interventions - How to provide quality assurance for complex health systems interventions?, Third Global Symposium on Health Systems Research
van Elsland SL, Kok MO, Peters RPH, et al., A pragmatic approach to improve care of HIV+ children on antiretroviral therapy (ART) in South Africa (SA), AIDS 2014
Solomons RS, van Elsland SL, Visser DH, et al., 2014, Commercial nucleic acid amplification tests in tuberculous meningitis-a meta-analysis, DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE, Vol: 78, Pages: 398-403, ISSN: 0732-8893
van Toorn R, Schaaf HS, Laubscher JA, et al., 2014, Short Intensified Treatment in Children with Drug-susceptible Tuberculous Meningitis, PEDIATRIC INFECTIOUS DISEASE JOURNAL, Vol: 33, Pages: 248-252, ISSN: 0891-3668
Blok N, Visser DH, Solomons R, et al., 2014, Lipoarabinomannan enzyme-linked immunosorbent assay for early diagnosis of childhood tuberculous meningitis, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 18, Pages: 205-210, ISSN: 1027-3719
Melchers NVSV, van Elsland SL, Lange JMA, et al., 2013, State of affairs of tuberculosis in prison facilities: a systematic review of screening practices and recommendations for best TB control, PLoS ONE, Vol: 8, ISSN: 1932-6203
BackgroundPrisoners are at high risk of developing tuberculosis (TB), causing morbidity and mortality. Prison facilities encounter many challenges in TB screening procedures and TB control. This review explores screening practices for detection of TB and describes limitations of TB control in prison facilities worldwide.MethodsA systematic search of online databases (e.g., PubMed and Embase) and conference abstracts was carried out. Research papers describing screening and diagnostic practices among prisoners were included. A total of 52 articles met the inclusion criteria. A meta-analysis of TB prevalence in prison facilities by screening and diagnostic tools was performed.ResultsThe most common screening tool was symptom questionnaires (63·5%), mostly reporting presence of cough. Microscopy of sputum with Ziehl-Neelsen staining and solid culture were the most frequently combined diagnostic methods (21·2%). Chest X-ray and tuberculin skin tests were used by 73·1% and 50%, respectively, as either a screening and/or diagnostic tool. Median TB prevalence among prisoners of all included studies was 1,913 cases of TB per 100,000 prisoners (interquartile range [IQR]: 332–3,517). The overall annual median TB incidence was 7·0 cases per 1000 person-years (IQR: 2·7–30·0). Major limitations for successful TB control were inaccuracy of diagnostic algorithms and the lack of adequate laboratory facilities reported by 61·5% of studies. The most frequent recommendation for improving TB control and case detection was to increase screening frequency (73·1%).DiscussionTB screening algorithms differ by income area and should be adapted to local contexts. In order to control TB, prison facilities must improve laboratory capacity and frequent use of effective screening and diagnostic tools. Sustainable political will and funding are critical to achieve this.
van Elsland S, Kok MO, Springer P, et al., Managing change at multiple levels to make the transition from in-hospital treatment to home based care: lessons from South Africa, Second Global Symposium on Health Systems Research
van Elsland SL, Springer P, Steenhuis IHM, et al., 2012, Tuberculous Meningitis: Barriers to Adherence in Home Treatment of Children and Caretaker Perceptions, JOURNAL OF TROPICAL PEDIATRICS, Vol: 58, Pages: 275-279, ISSN: 0142-6338
van Elsland SL, van der Hoeven M, Joshi S, et al., 2012, Pressure cooker ownership and food security in Aurangabad, India, PUBLIC HEALTH NUTRITION, Vol: 15, Pages: 818-826, ISSN: 1368-9800
Terwee CB, Bouwmeester W, van Elsland SL, et al., 2011, Instruments to assess physical activity in patients with osteoarthritis of the hip or knee: a systematic review of measurement properties, OSTEOARTHRITIS AND CARTILAGE, Vol: 19, Pages: 620-633, ISSN: 1063-4584
van Elsland S, van der Hoeven M, Joshi S, et al., Owning a pressure cooker is associated with better food security in HIV/AIDS affected households in Aurangabad, india, International Congress of Nutrition
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