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Original Research
District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa
Submitted: 18 January 2018 | Published: 11 October 2018
About the author(s)
Naseem Cassim, Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg,, South AfricaLindi M. Coetzee, Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg,, South Africa
Nelesh P. Govender, National Institute for Communicable Diseases, Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa; and, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,, South Africa
Deborah K. Glencross, Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg,, South Africa
Abstract
Background: Cryptococcal meningitis (CM) is a leading cause of mortality among HIV-positive South Africans. Reflex cryptococcal antigen (CrAg) testing of remnant plasma was offered as a pilot prior to implementation in October 2016 in KwaZulu-Natal province. The national reflex CrAg positivity was 5.4% compared to 7.3% for KwaZulu-Natal.
Objectives: The aim of this study was to interrogate CrAg positivity by health levels to identify hotspots.
Method: Data for the period October 2016 to June 2017 were analysed. Health district CrAg positivity and prevalence were calculated, with the latter using de-duplicated patient data. The district CrAg positivity and the number of CrAg-positive specimens per health facility were mapped using ArcGIS. For districts with the highest CrAg positivity, a sub-district CrAg positivity analysis was conducted.
Results: The provincial CrAg positivity was 7.6%. District CrAg positivity ranged from 5.7% (Ugu) to 9.6% (Umkhanyakude) with prevalence ranging from 5.5% (Ugu) to 9.7% (Umkhanyakude). The highest CrAg positivity was reported for the Umkhanyakude (9.6%) and King Cetswayo (9.5%) districts. In these two districts, CrAg positivity of 10% was noted in the Umhlabuyalingana (10.0%), Jozini (10.2%), uMhlathuze (10.5%) and Nkandla (10.8%) subdistricts. In these subdistricts, 135 CrAg-positive samples were reported for the Ngwelezane hospital followed by 41 and 43 at the Hlabisa and Manguzi hospitals respectively.
Conclusion: Cryptococcal antigen positivity was not uniformly distributed at either the district or sub-district levels, with identified facility hotspots in the Umkhanyakude and King Cetswayo districts. This study demonstrates the value of laboratory data to identify hotspots for planning programmatic interventions.
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