Recent Publications

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 

Routine data underestimates the incidence of first-line antiretroviral drug discontinuations due to adverse drug reactions: Observational study in two South African cohorts

Estimating the incidence of antiretroviral discontinuations due to adverse drug reactions (ADRs) is important to inform antiretroviral treatment (ART) regimen recommendations, and to guide prescribing and monitoring policies. Routinely collected clinical data is a useful source of pharmacovigilance data. We estimated the incidences of first-line antiretroviral discontinuations due to ADRs using routine clinical data, and compared them with incidences estimated using data enhanced by folder 

“I will leave the baby with my mother”: Long-distance travel and follow-up care among HIV-positive pregnant and postpartum women in South Africa

It is common in urban African settings for postpartum women to temporarily return to family in distant settings. We sought to explore mobility among peripartum HIV-positive women to understand the timing and motivation of travel, particularly vis-a-vis delivery, and how it may affect healthcare access. We identified frequent travel in the peripartum period with substantial differences in travel patterns by 

Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low and middle income countries

Many people living with HIV (PLWH) who are eligible for ART do not initiate treatment, leading to excess morbidity, mortality and viral transmission. As countries move to treat all PLWH at diagnosis, it is critical to understand the reasons for non-initiation. This systematic review found reasons for not starting ART included consistent themes across 

Patient related factors that contribute to poor adherence on second-line HIV treatment

We demonstrated that patient-related factors (e.g. use of traditional/herbal medicine, depression, family/social support) but not necessarily provider-related factors, health system factors or treatment related factors contribute to poor adherence on second-line ART.  Based on our findings, there is a need for on-going counselling and education of patients on second-line ART. Strategies to support patients, improved adherence evaluation and intensified monitoring need to be considered and 

Tenofovir stock shortages have limited impact on clinic-and patient-level HIV treatment outcomes in public sector clinics in South Africa

While South Africa has made great strides to extend access to ART and increase the quality of the health services provided, patient care can be affected when stock shortages/outs occur. While our results show little effect on treatment outcomes, this most likely reflects the clinics' ability to mitigate the crisis by continuing to keep patient care and treatment as consistent as 

Can routine data be used to access integration of HIV and other primary healthcare services in South Africa’s public health sector? An assessment from three Johannesburg clinics

Public clinics in South Africa maintain several paper registers for tracking service provision on a daily basis. These form part of the medico-legal recording requirements at the primary health care level. However, we identified duplication across the registers, and many registered that were not filled out consistently or correctly. If completed properly, there is the potential to use the records to track integration of service delivery. Engaging clinic staff as key role players, including 

Effect of eliminating CD4-count thresholds on HIV treatment initiation in South Africa: an empirical modelling study

Bor PLoS One CD4 thresholds and initiationThe World Health Organization recommends initiating antiretroviral therapy (ART) regardless of CD4 count. We assessed the effect of ART eligibility on treatment uptake and simulated the impact of WHO's recommendations in South Africa. We concluded that removing CD4 criteria alone will modestly increase timely uptake of ART. However, our results suggest the majority of newly-eligible patients will not initiate. Improved testing, linkage, and initiation 

Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012

Hypertension has become a major cause of morbidity and premature mortality in South Africa, but population-wide estimates of prevalence and access to care are scarce. Using data from the South African National Health and Nutrition Examination Survey (2011–2012), this analysis evaluates the national prevalence of hypertension and uses a care cascade to examine unmet need for