Recent Publications

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 

MAKING BUDGETING WORK: REFLECTIONS FROM THE FINANCIAL CAPACITY BUILDING FOR PROVINCES (FINCAP) PROJECT IN SOUTH AFRICA

The Financial Capacity Building for Provinces (FINCAP) project, run in partnership by the Centre for Economic Governance and Accountability in Africa (CEGAA) and the Health Economics and Epidemiology Research Office (HE2RO), focuses on providing capacity building and technical support to HIV, STI and TB (HAST) programme and finance managers in provincial departments of health in South Africa. The intervention was designed to improve budget planning, costing, expenditure tracking and reporting 

When donor funding leaves: an interrupted time‑series analysis of the impact of integrating direct HIV care and treatment into public health services in a region of Johannesburg

The paper uses an interrupted time series analysis to outline the impact on ART and other services at three primary health care (PHC) clinics in one region of Johannesburg after removal of PEPFAR funding for a co-located ART clinic and integration of HIV treatment into PHC. The three clinics fared differently after PEPFAR funding was removed, but overall, in this study, integration of ART with PHC services did not result in large-scale reductions in overall service delivery. One facility did 

First International Post-Tuberculosis Symposium

The World Health Organisation (WHO) estimates that approximately 54 million people survived TB between 2000 and 2017 alone. There is increasing evidence of long term respiratory complications following TB in a proportion of these patients, preventing them from returning to their normal lives. Patients can suffer from airflow obstruction, restrictive and fibrotic defects, bronchiectasis and aspergillomas amongst other conditions. With chronic obstructive pulmonary disease (COPD) being the 

Adolescent HIV treatment in South Africa’s national HIV programme: a retrospective cohort study

The number of South African adolescents receiving HIV care and treatment in South Africa is growing. By use of routinely collected laboratory data from South Africa’s National HIV Programme, we aimed to quantify the numbers of adolescents accessing HIV care and treatment over time, characterise the role of perinatal infection in these trends, and estimate proportions of adolescents seeking HIV care and antiretroviral therapy (ART) in South Africa’s public sector. Methods: We did a 

Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa

Limited research investigating treatment outcomes for HIV-positive orphans compared with non-orphans has shown mixed results, with several studies indicating that HIV-positive orphans are at greater risk of delayed access to HIV care and poor antiretroviral therapy (ART) adherence, while other data suggest that ART outcomes of orphans can be similar to those of non-orphans. Understanding the impact of orphan status on short-term ART outcomes could improve targeted intervention strategies, and 

Who is seeking antiretroviral treatment for HIV now? Characteristics of patients presenting in Kenya and South Africa in 2017-2018

Many African countries have had at least two years’ experience with universal treatment eligibility for HIV. The literature contains few descriptions, though, of populations starting treatment since adoption of universal eligibility. Using baseline data from a clinical trial of same-day ART initiation, we describe the populations presenting for HIV testing or care at study clinics in Kenya and South Africa in 2017-18, during the era of same-day initiation. Methods: The Simplified Algorithm 

Dietary intake among paediatric HIV-positive patients initiating antiretroviral therapy in Johannesburg, South Africa

In South Africa, prevention of mother to child transmission (PMTCT)has reduced MTCT from 3.6% in 2011 to 1.3% in 2017. However,there are challenges in reaching vulnerable HIV-positive children;those at increased risk of malnutrition or present late with advanced disease. Macro – and micro nutrient deficiencies, common in HIV,may accelerate disease progression. This was a prospective cohort study of paediatric patients (aged 1–10 years) initiating ART between 08/2014 and 09/2016 at a public 

Simplified clinical algorithm for identifying patients eligible for same-day HIV treatment initiation (SLATE): Results from an individually randomized trial in South Africa and Kenya

The World Health Organization recommends "same-day" initiation of antiretroviral therapy (ART) for HIV patients who are eligible and ready. Identifying efficient, safe, and feasible procedures for determining same-day eligibility and readiness is now a priority. The Simplified Algorithm for Treatment Eligibility (SLATE) study evaluated a clinical algorithm that allows healthcare workers to determine eligibility for same-day treatment and to initiate ART at the patient’s first clinic 

Monitoring viral load for the last mile: what will it cost?

Routine viral load testing is the WHO-recommended method for monitoring HIV-infected patients on ART, and many countries are rapidly scaling up testing capacity at centralized laboratories. Providing testing access to the most remote populations and facilities (the “last mile”) is especially challenging. Using a geospatial optimization model, we estimated the incremental costs of accessing the most remote 20% of patients in Zambia by expanding the transportation network required to bring