Recent Publications

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 

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