Recent Publications

Growth curve modelling to determine distinct BMI trajectory groups in HIV-positive adults on antiretroviral therapy in South Africa

Objective: Obesity is a major long-term concern in HIV-positive patients due to the pathogenic link between obesity and noncommunicable chronic diseases (NCDs). We aim to characterize changes in BMI over time on antiretroviral therapy (ART) and investigate the association between weight gain and survival in South Africa. Design and methods: A prospective cohort study among HIV-positive adults on first-line ART between April 2004 and 2015 in Johannesburg, South Africa. We used latent class 

Epidemiological impact and cost-effectiveness of providing long-acting pre-exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study

Introduction: Although pre-exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub-Saharan Africa, likely due to non-adherence. Adherence may be improved with the use of injectable long-acting PrEP methods currently being developed. We hypothesize that providing long-acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to 

Data quality of drug-resistant tuberculosis and antiretroviral therapy electronic registers in South Africa

Background: To assess the quality and completeness of treatment and outcome data in the electronic tuberculosis (TB) and antiretroviral treatment (ART) registers in drug-resistant (DR-) TB patients at three treatment facilities in South Africa. Methods: We did a retrospective cohort study using routinely collected data from DR-TB registers of rifampicin-resistant adults (≥18 years old), on ART, initiating DR-TB treatment between January 2012 and December 2013. We linked patient information 

Applying machine learning to laboratory data: predicting suppression of next HIV viral load in South Africa

With more than seven million HIV-infected people 1, South Africa is home to more people living with HIV than any other country in the world,2 and their national ART program is the world’s largest.3 South Africa adopted a “treat all” policy to provide ART to all HIV-positive people, regardless of CD4 cell count, in September 2016.3 Expanded ART availability has dramatically altered the health and quality of life of people living with HIV/AIDS, with an estimated life expectancy gain of 11.3 

Differentiated models of service delivery for antiretroviral treatment of HIV in sub- Saharan Africa: a rapid review protocol

Background: To meet global targets for the treatment of HIV, high-prevalence countries are launching or expanding differentiated models of service delivery (DSD) for antiretroviral therapy (ART). Ongoing studies report on metrics specific to individual models of care, but little is known about the overall scale, impact, costs, and benefits of widespread implementation of DSD. We will conduct a rapid review of recent literature on DSD currently in use in sub-Saharan Africa and identify gaps in 

Bridging the Efficacy–Effectiveness Gap in HIV Programs: Lessons From Economics

Background: Bridging the efficacy–effectiveness gap in HIV prevention and treatment requires policies that account for human behavior. Setting: Worldwide. Methods: We conducted a narrative review of the literature on HIV in the field of economics, identified common themes within the literature, and identified lessons for implementation science. Results: The reviewed studies illustrate how behaviors are shaped by perceived costs and benefits across a wide range of health and nonhealth 

Time to strengthen HIV treatment and prevention for youth

In The Lancet HIV, Mhairi Maskew and colleagues1 use data from a large national laboratory database in South Africa to examine trends in access to public sector HIV treatment programmes by children and adolescents aged 1–19 years between 2005 and 2016. The authors should be congratulated for highlighting important findings using national data in this often underexamined population, information that is needed to mount a national response. The authors report a ten times increase in the number 

Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving

Introduction: The World Health Organization declared the goal of hepatitis C virus (HC V) elimination by 2030. Micro-elimination, which is the reduction of incidence to zero in targeted populations, is less complex and costly and may be the first step to prove whether elimination is feasible. A suitable target group is HI V-positive men who have sex with men (MSM) because of their high-risk behavior and high incidence rates. Moreover, HC V monitoring is integrated in HI V care. The current HC V 

Effective public-private partnerships for sustainable antiretroviral therapy: outcomes of the Right to Care health services GP down-referral program

The recently increased access to antiretroviral therapy (ART) in South Africa has placed additional strain on human and infrastructure resources of the public health sector. Capacity from private-sector General Practitioners (GPs) could be leveraged to ease the current burden on the public health sector. Methods: We conducted a retrospective record review of routine electronic medical record data on a systematic sample of HIV-infected adults (≥18 years old) initiated on ART at a tertiary 

A Profile of the Health of Homeless at an Inner City Primary Health Care Clinic in South Africa

Abstract: People who are homeless present for care with poor health status, influenced by their physical and social environment. Trinity Health Services is an interprofessional student-run clinic providing free health care to the inner city homeless of Johannesburg, South Africa. This descriptive survey profiled the disease conditions of the homeless through a retrospective review of patient files, documented on a predesigned case report form. The data were analyzed using descriptive 

Differentiated HIV care in South Africa: the effect of fast-track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence

Introduction: In response to suboptimal adherence and retention, South Africa’s National Department of Health developed and implemented National Adherence Guidelines for Chronic Diseases. We evaluated the effect of a package of adherence interventions beginning in January 2016 and report on the impact of Fast-Track Treatment Initiation Counselling (FTIC) on ART initiation, adherence and retention. Methods: We conducted a cluster-randomized mixed-methods evaluation in 4 provinces at 12 

THE SLATE ALGORITHM FOR SAME-DAY HIV TREATMENT INITIATION: RESULTS OF THE SLATE TRIAL IN SOUTH AFRICA AND KENYA

The World Health Organization recommends "sameday" initiation of antiretroviral therapy (ART) for HIV patients eligible and ready1. This recommendation has been adopted by both South Africa2 and Kenya3. Identifying efficient, safe, and feasible procedures for determining same-day eligibility and readiness is now a priority. The WHO guidelines cited evidence from clinical trials suggesting that offering treatment to patients at their first clinical encounter has the potential to increase