Recent Publications

Cost and impact of dried blood spot versus plasma separation card for scale-up of viral load testing in resource limited settings

Routine plasma viral load (VL) testing is the WHO-recommended method for monitoring HIV-infected patients on antiretroviral therapy (ART). In Zambia, VL scale-up is limited due to significant logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spot (DBS) technology could circumvent many logistical challenges at the cost of reduced sensitivity and/or specificity. Recently, plasma separation cards (PSC) have become available and, 

Clinical predictor score to identify patients at risk of poor viral load suppression at six months on antiretroviral therapy: results from a prospective cohort study in Johannesburg, South Africa

As countries work toward 90:90:90 targets, early identification of patients with inadequate response to antiretroviral therapy (ART) is critical for achieving optimal HIV treatment outcomes. We developed and evaluated a clinical prediction score (CPS) to identify HIV-positive patients at risk of poor viral load suppression at 6 months on ART. Our findings suggest a 6-month CPS may have the potential to identify patients at risk of poor viral load suppression. The CPS may be used to target 

Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa

Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity of mothers and cause health and developmental problems in children born to affected mothers. We set out to measure the prevalence of PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) HIV-1 infected women and HIV negative women, and to identify predictors of major PPD among these women in a 

TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB – a study protocol

Up to fifty percent of microbiologically cured tuberculosis (TB) patients may be left with permanent, moderate or severe pulmonary function impairment. Very few studies have systematically examined pulmonary outcomes in patients to understand the pathophysiologic basis and long-term socio-economic consequences of this injury. The planned multi-country, multi-centre observational TB cohort study, aims to advance the understanding of the clinical, microbiological, immunological and socio-economic 

“Even if you’re HIV-positive there’s life after if you take your medication”: experiences of people on long-term ART in South Africa: a short report

South Africa’s national antiretroviral treatment (ART) programme, initiated in 2004, is the largest HIV treatment programme in the world with an estimated 4.2 million people on ART. Today, an HIV diagnosis is no longer associated with certain death, but is rather a manageable chronic disease, with all HIV-positive patients now eligible to receive treatment. In this study, we explore patient experiences at the onset of the ART programme, including facilitators and barriers around 

The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case

The paper details the results of the first-ever systematic review of the average (or unit) costs of HIV interventions in South Africa, performed in 2018. We originally did this for the South African HIV Investment Case but have updated to more recent prices (2016/17) and added more interventions since then. It includes recent costs for ART, PMTCT, HCT, MMC, and PrEP, amongst others, together with a table detailling all our findings from the literature review (file S3, attached) and very 

Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058

Our objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.We calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV)epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective usinga 40-year time horizon starting in 2018. Introduction of PrEP in Germany can reduce the HIV epidemic among MSM in a 

Early treatment of acute hepatitis C infection is cost-effective in HIV-infected men-whohave- sex-with-men

Treatment of hepatitis C virus infections (HCV) with direct acting antivirals (DAA) can prevent new infections since cured individuals cannot transmit HCV. However, as DAAs are expensive, many countries defer treatment to advances stages of fibrosis, which results in ongoing transmission. We assessed the epidemiological impact and cost-effectiveness oftreatment initiation in different stages of infection in the Netherlands where the epidemic ismainly concentrated among HIV-infected 

Breast cancer screening, diagnostic and treatment services and integration with HIV-related care in Sub-Saharan Africa: Results from an electronic survey

There is very little data on the availability of breast care screening and treatment services in sub-Saharan Africa, and almost no information on integration of HIV and breast care services in this setting. In this study we assessed the availability of comprehensive breast care services and their integration (or not) with HIV care and treatment services in sub-Saharan Africa, with a special focus on South Africa which has placed an emphasis on integration of HIV and SRH care in its public 

Syndromic management versus point-of-care, and lab based testing for Chlamydia and Gonorrhoea: A cost comparison

In this analysis, syndromic management was the least costly option. It requires skilled personnel but minimal supplies, equipment, and medication.Despite higher costs per case tested, the WHO has recommended etiological testing in countries that can afford it as part of its 2016-2021 strategy for global STI control.3 The added cost of etiological testing is possibly less than that of syndromic management if one considers the costs of caring for the many short- and long-term sequelae of 

High rates of death and loss to follow-up by 12 months of rifampicin resistant TB treatment in South Africa

Treatment success rates of rifampicin resistant (RR)/multi-drug resistant (MDR) tuberculosis (TB) in South Africa range from 43±48%, falling short of the World Health Organization's target of 75%. We present rates and assess predictors of attrition by 12 months on treatment.Prospective observational cohort analysis of adults (18 years) initiating RR/MDR-TB treatment from 01 March 2013 to 30 September 2016. Attrition was defined as a combination of death and loss to follow-up (LTFU; treatment