Using routinely collected laboratory data to evaluate South Africa’s national HIV treatment program through a national HIV cohort

Research Themes: HIV Treatment Outcomes and Guidelines Linkage, Retention and Adherence for HIV Treatment in South Africa

Despite South Africa’s massive public investment in HIV treatment and nearly 4 million patients receiving antiretroviral therapy (ART), little empirical analysis has been done to evaluate the ART program at the national level. As a result, key questions remain: What role does attrition from HIV care play in limiting program success? Have changes in the HIV care and treatment program improved retention in care? Have eligibility expansions – including the switch to ‘test and treat’ – increased HIV care seeking and treatment uptake among patients with higher CD4 counts? What geographic areas have achieved program success, and which continue to face large burdens of unmet need? Answering these questions will help the government optimize resource allocation and maximize the effectiveness and sustainability of the national treatment program.

To answer these questions, this project leverages the National Health Laboratory Service (NHLS) Corporate Data Warehouse (CDW) as a tool to monitor and evaluate the effectiveness of the public sectors Comprehensive Care, Management, and Treatment (CCMT) programme for HIV/AIDS in South Africa. This database includes all CD4, viral load and other lab tests ever conducted within South Africa’s national ART program with the exception of KwaZulu Natal which joined the NHLS in 2010.

Working closely with the NHLS, National Institute for Communicable Diseases, the University of the Witwatersrand, Right to Care and Boston University, with financial support from the United States Agency for International Development, the United States National Institutes of Health, the United States Center for Disease Control and Prevention, and the World Bank, we have created a diverse set of outputs including the NHLS National HIV Cohort, HIV Monitoring Dashboards, Reports for Action, and research publications.

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