Cassim Naseem, Coetzee Lindi Marie, da Silva Manuel Pedro, Stevens Wendy Susan, Glencross Deborah Kim
Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa.
PLoS One. 2023 Sep 28;18(9):e0292062. doi: 10.1371/journal.pone.0292062. eCollection 2023.
Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China. Due to the rapid spread globally, it was declared a pandemic in March 2020. Social distancing and lockdown measures were introduced to limit transmission. These strategies could potentially impact the diagnosis and treatment of patients with advanced HIV who are susceptible to secondary infections like cryptococcal disease. In South Africa, reflexed cryptococcal antigenaemia (CrAg) testing and pre-emptive antifungal treatment are recommended preceding antiretroviral therapy initiation for patients with a CD4<100 cells/μl. This study aimed to assess the impact of COVID-19 on CrAg testing in South Africa.
Specimen-level data was extracted for individuals ≥15 years from the National Health Laboratory Services repository for calendar years 2018 to 2021. Test volumes and CrAg positivity were assessed at national and provincial levels, by age category and gender. The percentage change in annual and monthly CrAg test volumes for 2020 and 2021 (during lockdown levels) are compared to data reported for 2018. The monthly median CD4 and the percentage of samples with a count <25, 25-50, 51-75 and >75-<100 cells/μl were assessed.
Specimen data of 11 944 929 CD4 results included 1 306 456 CrAg tests. Annual CD4 and CrAg test volumes declined by 22.4% and 27.8% for 2020 and 2021 respectively (relative to 2018). There were 23 670 CrAg positive outcomes in 2018 compared to 21 399 (-9.6%) and 17 847 (-24.6%) in 2020 and 2021 respectively. A monthly test volume reduction of up to 36.6%, 35.5%, 36.1% and 13.3% was reported for infection waves one to four. CrAg detection increased from 6.3% in 2018 to 7.5% in 2020. More testing was offered to males (>56%) with a higher detection rate of 8.1% in 2020. Between 81.0% and 81.8% of testing was for patients aged 20 to 49 years. The monthly percentage of specimens <25 cells/μl ranged from 30.2% (June 2019) to 35.3% (August 2020). Overall, the monthly median CD4 ranged from 39 (IQR: 15-70)(August 2020) to 45 (IQR: 19-72)(March 2019) cells/μl. In 2020, the provincial percentage change in CrAg test volumes ranged from 2.9% to -33.7%.
Our findings confirmed the impact of lockdown measures on both the absolute number of CrAg tests performed and detection (increase in 2020). A smaller impact on the median CD4 was noted. The long-term impact on patient management in immune- compromised individuals needs further investigation.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的冠状病毒病（COVID-19）最初在中国武汉被报告。由于其在全球迅速传播，于2020年3月被宣布为大流行病。为限制传播，采取了社交距离和封锁措施。这些策略可能会对晚期HIV患者的诊断和治疗产生影响，这些患者易发生如隐球菌病等继发感染。在南非，对于CD4<100个细胞/μl的患者，建议在开始抗逆转录病毒治疗前进行隐球菌抗原血症（CrAg）检测和先发抗真菌治疗。本研究旨在评估COVID-19对南非CrAg检测的影响。
从国家卫生实验室服务库中提取2018年至2021年日历年度15岁及以上个体的样本水平数据。按年龄类别和性别在国家和省级层面评估检测量和CrAg阳性率。将2020年和2021年（封锁期间）年度和月度CrAg检测量的百分比变化与2018年报告的数据进行比较。评估每月CD4中位数以及计数<25、25 - 50、51 - 75和>75 - <100个细胞/μl的样本百分比。
1,194,4929份CD4结果的样本数据包括1,306,456次CrAg检测。2020年和2021年年度CD4和CrAg检测量分别比2018年下降了22.4%和27.8%。2018年有23,�70次CrAg阳性结果，2020年为21,399次（-9.6%），2021年为17,847次（-24.6%）。报告称，第一至四次感染波期间月度检测量最多减少36.6%、35.5%、36.1%和13.3%。CrAg检测率从2018年的6.3%增至2020年的7.5%。对男性进行的检测更多（>56%），2020年检测率更高，为8.1%。81.0%至81.8%的检测针对20至49岁的患者。每月计数<25个细胞/μl的样本百分比范围为30.2%（2019年6月）至35.3%（2020年8月）。总体而言，每月CD4中位数范围为39（四分位间距：15 - 70）（2020年8月）至45（四分位间距：19 - 72）（2019年3月）个细胞/μl。2020年，省级CrAg检测量的百分比变化范围为2.9%至 - 33.7%。
我们的研究结果证实了封锁措施对所进行的CrAg检测绝对数量和检测率（2020年增加）的影响。注意到对CD4中位数的影响较小。对免疫功能低下个体患者管理的长期影响需要进一步研究。
