Recent Publications

Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa

South Africa (SA) has one of the world’s largest HIV treatment programmes, to which a dramatic increase in life expectancy has been attributed. However, there continue to be concerns regarding the reporting of HIV-related mortality in SA, which varies by source. As accurate HIV mortality estimates are key to measuring the success of the national programme as well as identifying areas for improvement, we propose a complementary approach to monitoring changes in HIV-related mortality using 

Prevalence, incidence, predictors, treatment, and control of hypertension among HIVpositive adults on antiretroviral treatment in public sector treatment programs in South Africa

One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low and middle-income countries, with the biggest increase in sub-Saharan Africa and SouthAfrica at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive 

Implementation of Option B and a fixed-dose combination antiretroviral regimen for prevention of mother-to-child transmission of HIV in South Africa: A model of uptake and adherence to care

Initiating and retaining pregnant women on antiretroviral therapy (ART) to prevent motherto-child HIV transmission (PMTCT) remains a major challenge facing African HIV programs, particularly during the critical final months prior to delivery. In 2013, South Africa implemented its ªOption Bº PMTCT regimen (three-drug ART throughout pregnancy andbreastfeeding, regardless of maternal CD4 count) and introduced once-daily fixed-dose combinations and lifelong ART. Currently, the uptake of Option B 

Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa

The 2015 WHO recommendation to initiate all HIV patients on antiretroviral therapy (ART) at diagnosis could potentially overextend health systems and crowd out sicker patients, mitigating the policy’s impact. We evaluate whether South Africa’s prior eligibility expansion from CD4 ≤ 200 to CD4 ≤ 350 cells/ll reduced ART uptake in the sickest patients. methods Using data on all patients presenting to the Hlabisa HIV 

Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia

We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir for first-line ART. We applied regression discontinuity in a prospective cohort study of 52,294 HIV-infected adults initiating first-line ART within 12months (±12 months) of each guideline change.We compared outcomes in patients presenting just before and afterthe guideline changes using local linear regression and estimated intention-to-treat effects on initiation of 

Syndromic Management vs Point-of-Care, and Lab Based Testing for Chlamydia and Gonorrhoea: a Cost Comparison

Despite higher costs per case tested, the WHO has recommended etiological testing in countries that can afford it as part of its 2016-2021 strategy for global STI control.3The added cost of etiological testing is possibly less than that of syndromic management if one considers the costs of caring for the many short- and long-term sequelae of untreated STIs, including ectopic pregnancy, pelvic inflammatory disease, and infertility in women, and additional complications for newborns. However, 

Consolidated spending on HIV and TB in South Africa (2014/15–2016/17)

This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB 

Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa

For this cost-effectiveness analysis, using an intention-to-treat approach and taking into consideration uncertainty in the clinical and cost outcomes, a strategy involving cryotherapy plus LEEP if needed at six months was dominant to LEEP plus LEEP again at six months if needed for retreatment. However, compared to other studies comparing LEEP and cryotherapy, the efficacy results were low in both treatment groups - possibly due to the HIV-positivity of the participants. Further research is 

Does distance to clinic affect utilization of HIV care and treatment services

We assessed the relationship between distance to clinic and progression through the HIV care cascade. We have two key findings. First, distance matters but only for women. Second, for women, distance affected linkage to care, but was not associated with later transitions in the care cascade. It is possible that distance is a less important barrier once people find out their HIV status, learn about treatment, and overcome the hurdle of their first clinic 

Drug side effects and retention on HIV treatment: a prospective cohort study assessing the implementation of Tenofovir in South Africa and Zambia

With its recommendations that all patients initiate Tenofovir, WHO anticipated improved adherence and reduced lost to follow-up, with implications for long health outcomes such as CD4 recovery, viral suppression and survival. We show that the guideline change replacing Stavudine with Tenofovir in first-line ART improved retention in care and reduced single-drug