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In the combination antiretroviral era, there are limited data regarding the pathogenesis of histoplasmosis immune reconstitution inflammatory syndrome (IRIS) in people with human immunodeficiency virus (HIV). We immunologically characterized 10 cases of histoplasmosis, 4 of whom developed histoplasmosis IRIS. CD4+ T cells in histoplasmosis IRIS demonstrated a significant polyfunctional cytokine response to histoplasma antigen.

IntroductionAlthough South Africa adopted the World Health Organization’s Test and Treat strategy for HIV epidemic control in 2016, antiretroviral therapy (ART) treatment initiation and retention remain below target. In 2017, an estimated 56.3% of men living with HIV were on ART. We aimed to investigate factors associated with non-use of ART among men in South Africa.MethodsUtilizing data from the fifth South African National HIV Prevalence, Incidence, Behavior and Communication (SABSSM V) cross-sectional survey conducted in 2017, a subset of data from HIV-positive men was stratified based on presence/absence of antiretroviral drugs (ARVs) detected in dried blood spot samples. Data were weighted to be representative of the national population and analyzed using multivariable logistic regression to assess predictors of non-use of ART; pResultsA total of 6,920 men aged ≥15 years old were enrolled in the study, of whom 953 (13.8%) tested HIV-positive. Among those HIV-positive, 810 (85%) had a known ARV test result: 470 (58%) had ARVs detected, and 340 (42%) did not have ARVs detected. Non-use of ART in men was associated with high-risk alcohol use (adjusted odds ratio (AOR)=3.68, 95% confidence interval (CI): 1.03-13.23), being a widower compared to being unmarried (AOR=6.99, 95%CI: 1.46-33.42), and having drug-resistant HIV (AOR=28.12, 95%CI: 13.89-56.94). Per year increase in age (AOR=0.67, 95%CI: 0.47-0.96), residence in rural tribal localities compared to urban localities (AOR=0.38, 95%CI: 0.18-0.78), or having a co-morbidity such as tuberculosis or diabetes (AOR=0.06, 95%CI: 0.03-0.14) were positively associated with ART use.ConclusionsNon-use of ART was strongly associated with HIV drug resistance. Young men who are living with HIV, those with high-risk alcohol use, and widowers, should be a priority for HIV programming and linkage to care. Identifying interventions that are effective at linking these men to ART will help reduce the burden of HIV in South Africa.

IntroductionIn South Africa, HIV prevalence among adolescent girls and young women (AGYW) was 5.8% (15-19 years) and 15.6% (20-24 years) respectively in 2017. Amongst South African males, HIV prevalence in 2017 was 4.7% (15-19 years), 4.8% (20-24 years), 12.4% (25-29 years) and 18.4% (30-34 years). The National Department of Health adopted the universal test and treat (UTT) strategy in 2016, resulting in increases in same-day antiretroviral therapy initiations and linkage to care. Monitoring progress towards attainment of South Africa’s 95-95-95 targets amongst AGYW and adolescent boys and young men (ABYM) relies on high quality data to identify and address gaps in linkage to care. The purpose of this study is to provide evidence to guide efforts to improve linkage to, and retention in, HIV care among AGYW and ABYM in KwaZulu-Natal, in the context of the UTT strategy.Methods and analysisThis is a mixed methods study, which will be conducted in uMgungundlovu district of KwaZulu-Natal, over a 24-month period, in 22 purposively selected HIV testing and treatment service delivery points (SDPs). For the quantitative component, a sample size of 1100 participants will be recruited into the study. The qualitative component will include 30 participating patients who were successfully linked to care, 30 who were not, and 30 who have never tested for HIV. The questionnaire study population comprises of 231 healthcare providers and AGYW aged 15-24 years and ABYM aged 15-35 years old. Primary outcomes will be evaluated using a logistic regression model. A time to event analysis will also be conducted taking the study design into account. Quantitative data for outcome variables and process indicators will be summarized by domain evaluated with logistic regression to account for potential confounders. For qualitative data, manual thematic content analysis will be conducted.Ethics and disseminationThe protocol was approved by the South African Medical Research Council Health Research Ethics Committee (EC052-11/2020). Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer reviewed journal articles and research capacity building through research degrees.

In the combination antiretroviral era, there are limited data regarding the pathogenesis of histoplasmosis immune reconstitution inflammatory syndrome (IRIS) in people with human immunodeficiency virus (HIV). We immunologically characterized 10 cases of histoplasmosis, 4 of whom developed histoplasmosis IRIS. CD4+ T cells in histoplasmosis IRIS demonstrated a significant polyfunctional cytokine response to histoplasma antigen.