Incidence of TB and HIV in Prospectively Followed Household Contacts of TB Index Patients in South Africa

Objective

To report the incidence rates of TB and HIV in household contacts of index patients diagnosed with TB.

Design

A prospective cohort study in the Matlosana sub-district of North West Province, South Africa.

Methods

Contacts of index TB patients received TB and HIV testing after counseling at their first household visit and were then followed up a year later, in 2010. TB or HIV diagnoses that occurred during the period were determined.

Results

For 2,377 household contacts, the overall observed TB incidence rate was 1.3 per 100 person years (95% CI 0.9–1.9/100py) and TB incidence for individuals who were HIV-infected and HIV seronegative at baseline was 5.4/100py (95% CI 2.9–9.0/100py) and 0.7/100py (95% CI 0.3–1.4/100py), respectively. The overall HIV incidence rate was 2.2/100py (95% CI 1.3–8.4/100py).

Conclusions

In the year following a household case finding visit when household contacts were tested for TB and HIV, the incidence rate of both active TB and HIV infection was found to be extremely high. Clearly, implementing proven strategies to prevent HIV acquisition and preventing TB transmission and progression to disease remains a priority in settings such as South Africa.     

Restoration potential of invaded abandoned agricultural fields: what does the seed bank tell us?

Soil seed banks can play an important role in the restoration of degraded ecosystems, especially where indigenous species are well represented in, and invasive species are largely absent from, the seed bank. Here, we studied the potential contribution of the soil seed bank to the restoration of invaded, abandoned agricultural fields in the Eastern Cape, South Africa. We recorded the aboveground cover and belowground abundance of all vascular plant species from 120 quadrats that differ in cover of the extralimital woody invader, Pteronia incana. Our results show that higher cover of P. incana is associated with lower species richness, aboveground cover, and belowground seed abundance. Furthermore, community similarity between the above‐ and belowground component was low, with the seed bank and standing vegetation having only 15 species in common and 49 species being recorded only from the seed bank. We suggest that this large number of seed bank‐only species is a relic of previous vegetation, prior to large‐scale invasion by P. incana. The most important finding from our study is the absence of P. incana from the soil seed bank. This finding, combined with the large number of mostly native species from the seed bank, holds promise from a restoration perspective. However, given the susceptibility of the invaded systems to erosion, coupled with the low grazing value of the seed bank species, we suggest that P. incana removal should be accompanied by both erosion control measures and reseeding with palatable grass species, to secure the livelihoods of local communities.     

High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa

Symptom screening is a recommended component of intensified case-finding (ICF) for pulmonary tuberculosis (TB) among HIV-infected individuals. Symptomatic individuals are further investigated to either exclude or diagnose pulmonary TB, thus reducing the number of individuals requiring costly laboratory investigation. Those with laboratory evaluations negative for pulmonary TB or who lack symptoms may be eligible for antiretroviral therapy (ART) and/or TB isoniazid preventive therapy (IPT). A four-part symptom screen has been recommended by the World Health Organization (WHO) for identifying TB suspects and those unlikely to have TB. A meta-analysis of studies among HIV-infected individuals calculated a sensitivity of 90.1% for the four-part symptoms screen - of any of cough, fever, night sweats, or weight loss - among patients in clinical care, making it an effective tool for identifying most patients with TB. An important population for intensified case-finding not included in that meta-analysis was HIV-infected pregnant women. We undertook a cross-sectional survey among HIV-infected pregnant women receiving prenatal care at community clinics in South Africa. We obtained a four-symptom review and sputum smear microscopy and mycobacterial culture on all participants. Among 1415 women, 226 (16%) had a positive symptom screen, and 35 (2.5%) were newly diagnosed with culture-positive TB. Twelve were on TB treatment at the time of screening, yielding 47 (3.3%) women with prevalent TB. Symptom screening among women without known TB had a sensitivity of 28% and specificity of 84%. The poor performance of symptom screening to identify women with TB suggests that other approaches may be needed for intensified case-finding to be effective for this population.