Recent Publications

Novel metric for evaluating pre-exposure prophylaxis programme effectiveness in real-world settings

Summary Although large-scale provision of HIV pre-exposure prophylaxis (PrEP) is gaining momentum, no systematic method to evaluate or compare the effectiveness of different scale-up strategies in real-world settings exists. To date, estimating the effectiveness of PrEP has relied on clinical trials or mathematical models. We propose a novel and pragmatic metric to evaluate and compare programme effectiveness using routine implementation data. Using South African and Zambian PrEP guidelines, 

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa

Background Despite the success of prevention of mother to child transmission (PMTCT) program in South Africa, the 30% HIV prevalence among women of childbearing age requires the PMTCT program to be maximally efficient to sustain gains in the prevention of vertical HIV transmission. We aimed to determine the immunologic and virologic status at entry into antenatal care (ANC) and at childbirth among HIV positive women who conceived under the CD4<500 cells/μl antiretroviral therapy (ART) 

Differentiated service delivery models for antiretroviral tratment of HIV in sub-saharan Africa: A rapid systematic review ; AMBIT Project Report Number 04

Throughout sub-Saharan Africa, most national HIV programs are striving to achieve the 90-90-90 (or even 95-95-95) targets for HIV diagnosis, treatment, and viral suppression. The rapid expansion of antiretroviral therapy (ART) programs to reach these targets has created shortfalls in health system capacity and quality.1 In response, many countries are scaling up alternative service delivery approaches, or differentiated service delivery (DSD) models. DSD models differ from conventional HIV care 

Reasons for late presentation for antenatal care, healthcare providers’ perspective

Background: Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers’ understanding of their patient’s behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women’s reasons for starting ANC later than 

Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial

HIV self-testing increases testing uptake in sub-Saharan Africa but scale-up is challenging because of resource constraints. We evaluated an HIV self-testing intervention integrated into high-burden outpatient departments in Malawi. Methods: In this cluster-randomised trial, we recruited participants aged 15 years or older from 15 outpatient departments at high-burden health facilities (including health centres, mission hospitals, and district hospitals) in central and southern Malawi. The 

Correspondence: First International Post-Tuberculosis Symposium

The First International Post-Tuberculosis Symposium was held in Stellenbosch, South Africa, on July 22–23, 2019, to discuss priorities and gaps that need to be addressed in order to provide guidance in this neglected area. The symposium involved 68 delegates across 12 disciplines from five continents, representing more than 27 institutions. Historically, inconsistency and lack of consensus in nomenclature and terminology have hampered work in this field. Using the Delphi process, the 

APPLYING MACHINE LEARNING TO LABORATORY DATA: PREDICTING SUPPRESSION OF NEXT HIV VIRAL LOAD IN SOUTH AFRICA

During 2018, South Africa was estimated to have more than seven million people living with HIV1, representing the largest single country epidemic2 and treatment program. 3 In September 2016, the National Department of Health revised its treatment guidelines to extend the availability of ART to all people living with HIV, irrespective of CD4 cell count and stage of disease3. This policy, widely referred to as “treat all” or “universal test and treat” (UTT) holds promise to offer 

Potential Impact and Cost-Effectiveness of Condomless-Sex–Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance

Introduction. Oral preexposure prophylaxis (PrEP) in the form of tenofovir-disoproxil-fumarate/emtricitabine is being implemented in selected sites in South Africa. Addressing outstanding questions on PrEP cost-effectiveness can inform further implementation. Methods. We calibrated an individual-based model to KwaZulu-Natal to predict the impact and cost-effectiveness of PrEP, with use concentrated in periods of condomless sex, accounting for effects on drug resistance. We consider (1) PrEP 

Design of a randomized controlled trial to Link Infectious and Narcology Care (LINC‑II) in St. Petersburg, Russia

Background: If Russia is to achieve the UNAIDS 90-90-90 HIV targets, better approaches to engage, effectively treat, and retain patients in care are needed. This paper describes the protocol of a randomized controlled trial (RCT) testing the effectiveness of LINC-II, a strength-based case management program for HIV-positive people who inject drugs (PWID) to increase rates of HIV viral suppression, ART initiation, and opioid abstinence. Methods: This RCT will enroll and randomize 240 

Using a Self-Administered Electronic Adherence Questionnaire to Identify Poor Adherence Amongst Adolescents and Young Adults on First-Line Antiretroviral Therapy in Johannesburg, South Africa

Introduction: The best method to measure adherence to antiretroviral therapy (ART) in resource-limited settings has not yet been established, particularly among adolescents and young adults (AYAs). The use of mobile technology may address the need for standardized tools in measuring adherence in this often marginalized population. Methods: We conducted a cross-sectional validation study among AYAs (18–35 years) attending a South African HIV clinic between 07/2015-09/2017.We determine the 

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