The “ART” of Linkage: Pre-Treatment Loss to Care after HIV Diagnosis at Two PEPFAR Sites in Durban,South Africa

Background

Although loss to follow-up after antiretroviral therapy (ART) initiation is increasingly recognized, little is known about pre-treatment losses to care (PTLC) after an initial positive HIV test. Our objective was to determine PTLC in newly identified HIV-infected individuals in South Africa.

Methodology/Principal Findings

We assembled the South African Test, Identify and Link (STIAL) Cohort of persons presenting for HIV testing at two sites offering HIV and CD4 count testing and HIV care in Durban, South Africa. We defined PTLC as failure to have a CD4 count within 8 weeks of HIV diagnosis. We performed multivariate analysis to identify factors associated with PTLC. From November 2006 to May 2007, of 712 persons who underwent HIV testing and received their test result, 454 (64%) were HIV-positive. Of those, 206 (45%) had PTLC. Infected patients were significantly more likely to have PTLC if they lived ≥10 kilometers from the testing center (RR = 1.37; 95% CI: 1.11–1.71), had a history of tuberculosis treatment (RR = 1.26; 95% CI: 1.00–1.58), or were referred for testing by a health care provider rather than self-referred (RR = 1.61; 95% CI: 1.22–2.13). Patients with one, two or three of these risks for PTLC were 1.88, 2.50 and 3.84 times more likely to have PTLC compared to those with no risk factors.

Conclusions/Significance

Nearly half of HIV-infected persons at two high prevalence sites in Durban, South Africa, failed to have CD4 counts following HIV diagnosis. These high rates of pre-treatment loss to care highlight the urgent need to improve rates of linkage to HIV care after an initial positive HIV test.     

Using food for different purposes: female responses to prey in the predator Coccinella septempunctata L. (Coleoptera: Coccinellidae)

Abstract.  1. Although predatory insects often feed on diverse prey, their reproductive activity may be linked most strongly to a more restricted range of prey. The propensity of adult females of the ladybird beetle, Coccinella septempunctata L., to attack two natural prey species, pea aphids [ Acyrthosiphon pisum (Harris)] and alfalfa weevil larvae [ Hypera postica (Gyllenhal)], was compared, and the degree to which ladybird egg production depends on consumption of aphids vs. weevils was assessed.
2. Coccinella septempunctata females more readily attacked aphids than weevil larvae. This was true regardless of whether females had fed previously on aphids or on weevil larvae.
3. When females were provided with few to many aphids daily, or few aphids plus an excess number of weevil larvae, their rates of egg production depended primarily on the number of aphids consumed.
4. Addition of weevil larvae to diets of limited numbers of aphids increased egg production, but only modestly. Thus, consumption of weevil larvae may have served mostly for self-maintenance, thereby enabling females to use for egg production more of the nutrients and energy obtained from limited consumption of aphids.
5. The females' linkage of egg production primarily to aphid rather than weevil consumption may be adaptive, as their offspring are much less able as larvae to survive and mature on a diet of weevils rather than aphids.     

Bill harnesses on nestling Tufted Puffins influence adult provisioning behavior

ABSTRACT.   For burrow-nesting seabirds, investigators have examined nestling diet by attaching harnesses to the bills of nestlings to intercept food delivered by the parent. To determine whether this method provides an unbiased estimate of nestling diet, we evaluated its effect on the provisioning behavior of Tufted Puffins ( Fratercula cirrhata ) nesting on Triangle Island, British Columbia. Adults delivering food to nestlings with bill harnesses always hesitated before entering a burrow with food, increasing their susceptibility to kleptoparasitism by gulls, and did not always leave the food intended for the nestling. These responses by adult puffins could lead to underestimates of energy intake rates of nestlings and unreliable comparisons with other species if prey left by adults in nest burrows were the only source of data. We also compared estimates of the species, number, and size of prey delivered by adult puffins as determined by direct observation from blinds to samples of prey collected directly from nest burrows and found that the two sampling techniques produced similar results. However, identifying rare prey species and gathering precise information about prey length, mass, and condition require collection of prey, and we recommend using a combination of techniques to obtain the most reliable estimates of nestling diet.     

Conspecific attraction in a grassland bird, the Baird's Sparrow

ABSTRACT.   Territorial songbirds generally use song to defend territories and attract mates, but conspecific song may also serve as a cue to attract other male songbirds to a breeding site. Although known to occur in some colonial and forest-associated species, only recently have investigators examined conspecific attraction in grassland species. We used a playback experiment to examine the possible role of conspecific attraction for males searching for potentially suitable breeding habitat in a grassland specialist, the Baird's Sparrow ( Ammodramus bairdii ). Experimental playback plots and control plots with similar landscape and vegetation characteristics were established at two sites in North Dakota. Baird's Sparrows colonized three of six experimental plots and none of six control plots. Males on experimental plots established territories adjacent to the playback stations and were sometimes observed counter-singing with the playback of conspecific songs. Vegetation characteristics were similar on all study plots, and did not explain differences in bird density on our treatment plots. Although we found that playback of conspecific songs attracted male Baird's Sparrows to previously unoccupied, potentially suitable habitat, further experiments are needed to examine the importance of conspecific attraction relative to other cues that birds may use, such as vegetation features. The conservation and management implications of conspecific attraction are not completely understood, but the presence of conspecifics should be considered as a potential cue in habitat selection by all species of birds.     

Responses of Nondormant Black Willow (Salix nigra) Cuttings to Preplanting Soaking and Soil Moisture

The use of willow cuttings for streambank stabilization is a common practice in riparian ecosystems throughout the United States. Many environmental factors govern the outcome of such planting. However, other factors such as preplanting treatments, planting methods, and physiological status of cuttings (dormant vs. actively growing) may also be crucial in determining the survival of willow cuttings. Actively growing (nondormant) Black willow (Salix nigra) cuttings, 30 cm in length and 1 cm in diameter at the base, were subjected to three soaking treatments (0, 7, and 15 days) prior to planting. Following the initial treatment, cuttings were grown in a greenhouse in pots under three soil moisture regimes (well‐watered but not flooded, permanently flooded, and intermittently flooded). Plant gas exchange, growth, biomass, and survival were measured. Results demonstrated that soaking for 7 days was beneficial to early development of cuttings in the well‐watered (control) soil moisture regime, enhancing percent bud flush and survival significantly. However, 15 days of soaking proved to be detrimental to survival of cuttings irrespective of soil moisture regimes. Results also demonstrated that the beneficial effects of 7‐day soaking were limited to the well‐watered soil moisture regime but not to the flooded or intermittently flooded regimes. Soaking nondormant cuttings may be worthwhile if the planting site is likely to present ample soil moisture but nonflooded conditions to the transplanted cuttings.