The impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma, 1999-2016: An interrupted time series analysis.

OBJECTIVE: The objective of this study was to quantify the impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma among black South African residents of all ages. METHODS: We performed an interrupted time series analysis using routinely collected, histologically confirmed surveillance data from the South African National Cancer Registry for the years 1999 to 2016. The analysis was performed using R statistical software. The total number of cases was 29,623 (12,475 females and 17,166 males). The background antiretroviral treatment coverage was less than 1% at the time that the antiretroviral programme was introduced and increased to over 50% in 2016. RESULTS: In 1999, the age-standardised rates were 1.48 and 2.82 cases per 100,000 per year for black females and males, respectively. These rates increased to 5.52 and 7.46 in 2008 before declining. The antiretroviral treatment programme was started in 2004. Five years after 2008 (nine years after the antiretroviral programme was introduced), the predicted standardised rates were 58.3% and 50.3% lower for females and males, respectively, than what they would have been without the treatment programme. CONCLUSION: Introduction of the antiretroviral treatment programme was associated with a decrease of over 50% in the predicted age-standardised incidence rates of Kaposi sarcoma.

Repeatability of Manual Coding Of Cancer Reports in the South African National Cancer Registry; 2010

"Data validity is a very important aspect of cancer registries in ensuring data quality for research and interventions. This study focused on evaluating the repeatability of manual coding of cancer reports in the South African National Cancer Registry (NCR). This cross-sectional study used the Delphi technique to classify 48 generic tumour sites into sites that would be most likely (""difficult"") and least likely (""not difficult"") to give rise to discordant results among coders. Reports received from the Charlotte Maxeke Academic Hospital were manually recoded by five coders (2 301 reports; e.g. approximately 400 reports each) for intracoder agreement; and by four coders (400 reports) for inter-coder agreement. Unweighted kappa statistics were calculated and interpreted using Byrts' criteria. After four rounds of the Delphi technique; consensus was reached on the classification of 91.7 (44/48) of the sites. The remaining four sites were classified according to modal expert opinion. The overall kappa was higher for intra-coder agreement (0.92) than for inter-coder agreement (0.89). ""Not difficult"" tumour sites reflected better agreement than ""difficult"" tumour sites. Ten sites (skin other; basal cell carcinoma of the skin; connective tissue; other specified; lung; colorectal; prostate; oesophagus; naso-oropharynx and primary site unknown) were among the top 80 misclassified sites. The repeatability of manual coding at the NCR was rated as ""good"" according to Byrts' criteria. Misclassified sites should be prioritised for coder training and the strengthening of the quality assurance system."

Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former Basotho gold miners.

BACKGROUND: Pulmonary tuberculosis and HIV incidence, mortality, and the progression of silicosis and lung function impairment are described over a 1-year period in migrant ex-gold miners from Lesotho. METHODS: Seven hundred seventy-nine Basotho miners were followed for 1 year starting 18 months after lay-off from a South African gold mine in 1998. At baseline and follow-up, they underwent a respiratory symptom interview, physical examination, HIV test, chest radiograph, and spirometry. RESULTS: Five hundred thirteen of 779 (65.9%) participants attended both baseline and follow-up visits. HIV incidence was 5.4/100 person-years (95% CI: 3.4-8.2). Prevalence of silicosis (ILO score > or =1/1) was 26.6% at baseline and 27.0% at follow-up. Active tuberculosis diagnosed at baseline was a strong predictor of radiological progression of silicosis. Lung function as measured by FEV(1) declined an average of 91 ml between visits (95% CI: 67-116 ml). Calculated minimum incidence of tuberculosis was 3,085/100,000/years (95% CI: 1,797-4,940) at follow-up. Of those seen at baseline, 18 died before their scheduled follow-up visit (mean age: 51 years). CONCLUSIONS: High rates of mortality and of HIV infection and pulmonary tuberculosis were found in this cohort after leaving the South African goldmines. Continuing lung function loss was also apparent. A partnership between the South African mining industry and governments in labor-sending areas of Southern Africa is needed to provide continuity of care and access to HIV and tuberculosis treatment and prevention services. Active silicosis surveillance and an improved statutory compensation system are also needed. These findings can serve as a baseline against which the impact of such interventions can be assessed.

The burden of silicosis, pulmonary tuberculosis and COPD among former Basotho goldminers.

BACKGROUND: The burden of silicosis, pulmonary tuberculosis and COPD is described in 624 South African gold miners 18 months after cessation of work. METHODS: This was a prevalence study. Questionnaires were administered, and spirometry, chest radiography, tuberculosis investigations, and urine HIV antibody assays were performed. RESULTS: Attendance was 80.1% (624/779), mean age 49.4 years, and mean employment duration 25.6 years. Most subjects had had medium (26.5%) or high (65.4%) dust-exposure jobs. Current smoking rate was 35%, with ever smoking 61%. HIV antibodies were detected in the urine in 22.3%. Prevalences were: silicosis 24.6%, past tuberculosis 26%, current tuberculosis 6.2%, airflow obstruction 13.4%, and chronic productive cough 17.7%. Almost 50% of these miners had at least one of these respiratory conditions. CONCLUSIONS: A heavy burden of silicosis, tuberculosis and COPD was present in this group of former goldminers. Intensification of work place dust control measures and TB and HIV prevention activities are needed on South African gold mines. In labor sending communities investment is needed in silicosis and tuberculosis surveillance as well as HIV treatment and care.