Recent Publications

Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa

Objective: Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy programs. Retention estimates may be underestimated because of unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). Design: Observational cohort study. Methods: Of 788 women initiating antiretroviral therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit $3 

Characterizing breast conditions at an open-access breast clinic in South Africa: a model that is more than cancer care for a resource-limited setting

Background: While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa. Methods: We performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast 

Citizenship status and engagement in HIV care: an observational cohort study to assess the association between reporting a national ID number and retention in public-sector HIV care in Johannesburg, South Africa

Objective: In many resource-limited settings, people from rural areas migrate to urban hubs in search of work. Thus, urban public-sector HIV clinics in South Africa (SA) often cater to both local residents and patients from other provinces and/or countries. The objective of this analysis was to compare programmatic treatment outcomes by citizenship status in an urban clinic in SA. Setting: An urban public-sector HIV treatment facility in Johannesburg, SA. Participants: We included all 

Progress with scale-up of HIV viral load monitoring — Seven sub-Saharan African countries, January 2015–June 2016

The World Health Organization (WHO) recommends viral load testing as the preferred method for monitoring the clinical response of patients with human immunodeficiency virus (HIV) infection to antiretroviral therapy (ART). Unlike western countries, which have relied on viral load testing to monitor virologic response to ART, low- and middle income countries have historically relied on CD4 cell counts (which monitor immunologic improvement for patients on ART) because of the higher cost of viral 

Cervical cancer and pap smear screening in HIV-positive women: Awareness, perceived risk, and practices

The Validation of Implementation of Cervical Cancer Screening Applications in HIV-Seropositive Women Study (VICAR 1) was conducted in 2009-2011 to compare three methods for detecting cervical cancer: standard Pap smear, visual inspection with acetic acid, and HPV detection. VICAR 1’s main goal was to estimate sensitivity, specificity, and predictive values for each method. VICAR 1 participants, however, also answered an interviewer-administered, structured questionnaire containing coded 

Delivery of antiretroviral therapy by nurses in South Africa: An evaluation of NIMART by facility type

South Africa now offers two major public sector approaches to NIMART: centralized, hospital-based HIV outpatient clinic and decentralized, full service, primary health clinics (PHCs). While both approaches typically use NIMART, hospitalbased clinics may use both nurses and doctors to manage ART patients whereas PHCs rely primarily on nurses. We evaluated the outcomes and costs of these two approaches to NIMART for HIV treatment 

Changes in second-line regimen durability and continuity of care in relation to national ART guideline changes in South Africa

Introduction: Little is known about the impact of antiretroviral therapy (ART) guideline changes on the durability of second-line ART and continuity of care. This study examines predictors of early drug substitutions and treatment interruptions using a cohort analysis of HIV positive adults switched to second-line ART between January 2004 and September 2013 in Johannesburg, South Africa. Methods: The main outcomes were having a drug substitution or treatment interruption in the first 24 

Treatment Outcomes and Costs of Providing Antiretroviral Therapy at a Primary Health Clinic versus a Hospital-Based HIV Clinic in South Africa

In 2010 South Africa revised its HIV treatment guidelines to allow the initiation and management of patients on antiretroviral therapy (ART) by nurses, rather than solely doctors, under a program called NIMART (Nurse Initiated and Managed Antiretroviral Therapy). We compared the outcomes and costs of NIMART between the two major public sector HIV treatment delivery models in use in South Africa today, primary health clinics and hospital-based HIV 

Towards 90-90-90 How close is South Africa to reaching the UNAIDS HIV treatment targets?

UNAIDS has set a worldwide goal for the year 2020: for 90% of people with HIV to know their status, 90% of those diagnosed with HIV to be on ART, and 90% of those on ART to have viral suppression. Researchers at National Health Laboratory Service (NHLS), HE2RO and Boston University (BU) have been working to set up systems to monitor and evaluate the evolving HIV response in South 

Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa?

Objective: We assessed the relationship between phasing out stavudine in first-line antiretroviral therapy (ART) in accordance with WHO 2010 policy and single-drug substitutions (SDS) (substituting the nucleoside reverse transcriptase inhibitor in first line ART) in sub-Saharan Africa. Design: Prospective cohort analysis (International epidemiological Databases to Evaluate AIDS-Multiregional) including ART-naive, HIV-infected patients aged at least 16 years, initiating ART between January 2005