Recent Publications

Consolidated spending on HIV and TB in South Africa (2014/15–2016/17)

This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB 

Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa

For this cost-effectiveness analysis, using an intention-to-treat approach and taking into consideration uncertainty in the clinical and cost outcomes, a strategy involving cryotherapy plus LEEP if needed at six months was dominant to LEEP plus LEEP again at six months if needed for retreatment. However, compared to other studies comparing LEEP and cryotherapy, the efficacy results were low in both treatment groups - possibly due to the HIV-positivity of the participants. Further research is 

Does distance to clinic affect utilization of HIV care and treatment services

We assessed the relationship between distance to clinic and progression through the HIV care cascade. We have two key findings. First, distance matters but only for women. Second, for women, distance affected linkage to care, but was not associated with later transitions in the care cascade. It is possible that distance is a less important barrier once people find out their HIV status, learn about treatment, and overcome the hurdle of their first clinic 

Drug side effects and retention on HIV treatment: a prospective cohort study assessing the implementation of Tenofovir in South Africa and Zambia

With its recommendations that all patients initiate Tenofovir, WHO anticipated improved adherence and reduced lost to follow-up, with implications for long health outcomes such as CD4 recovery, viral suppression and survival. We show that the guideline change replacing Stavudine with Tenofovir in first-line ART improved retention in care and reduced single-drug 

“My future is bright… I won’t die with the cause of AIDS”: ten-year patient ART outcomes and experiences in South Africa

This study demonstrates the complexities of long-term chronic HIV treatment with declining all-cause mortality and increasing LTF over ten years. Barriers to long-term retention still present a significant challenge. As more people become eligible for ART in South Africa under 'treatment for all', new healthcare delivery challenges will arise; interventions are needed to ensure long-term programme successes 

Targeting the right interventions to the right people and places: the role of geospatial analysis in HIV program planning

In the current era of of falling donor support and with governments of low-income countries needing to balance many spending priorities, it is vital to maximise the impact and efficiency of the AIDS response. National and international stakeholders have increasingly supported geospatial targeting of resources as a means to accomplish this, and the challenge for program designers has become how best to link the 'who' and 'where' with the 'what' and 'when'. However, a key question is whether 

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study

There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating ART in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. We found that a future transition from first-line regimens containing efavirenz to regimens containing dolutegravir 

Assessing the association between changing NRTIs when initiating second-line ART and treatment outcomes

After first-line ART failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second line is uncertain due to the high potency of protease inhibitors used in second line. Our assessment of clinical data from 6290 adult patients in South Africa and Zambia found that changing NRTI in second line was associated with better clinical outcomes in South 

Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa

Systematic reviews have described high rates of attrition in patients with HIV receiving antiretroviral therapy. However, migration and clinical transfer may lead to an overestimation of attrition (death and loss to follow-up). Using a newly linked national laboratory database in South Africa, we assessed national retention in South Africa's national HIV 

Predictors of switch to and early outcomes on third-line antiretroviral therapy at a large public-sector clinic in Johannesburg, South Africa

While efficacy data exist, there are limited data on the outcomes of patients on third-line antiretroviral therapy (ART) in sub-Saharan Africa in actual practice. Being able to identify predictors of switch to third-line ART will be essential for planning for future need. We identify predictors of switch to third-line ART among patients with significant viraemia on a protease inhibitor (PI)-based second-line ART regimen. Additionally, we describe characteristics of all patients on third-line at