Recent Publications

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 

Provider costs associated with differentiated models of service delivery for HIV treatment in Sub-Saharan Africa AMBIT Project Report Number 02

According to the most recent estimates, 16.4 million people are receiving antiretroviral therapy (ART) for HIV in sub-Saharan Africa.1 Global “90-90-90” targets for HIV diagnosis, treatment, and viral suppression call for universal access and rapid-scale-up of treatment coverage, which would require another 3 million patients to be added to the national HIV treatment programs in eastern and southern Africa.1 Meanwhile, donor spending in low and middle-income countries has declined over the 

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 

BASly – AN AUTOMATED TOOL FOR ANALYSING HIV and TB RELATED EXPENDITURE

The Basic Accounting System (BAS) caters for the South African government’s basic accounting needs. It is the general ledger where all financial transactions are recorded and classified in accordance with the Standard Chart of Accounts (SCoA) system. Transactions are initially recorded in sub-systems i.e. payroll system, inventory and asset management, pharmaceuticals and payment of utilities. Measures are taken to ensure that information in the sub-systems matches transactions captured in 

Patient benefits and costs associated with differentiated models of service delivery for HIV treatment in Sub-Saharan Africa AMBIT Project Report Number 01

Costs and benefits of DSDs to patients themselves (as opposed to costs and benefits to providers and funders) are often omitted from evaluations of specific models of service delivery and from mathematical modeling of potential impact. As part of a larger rapid review of the published and gray literature on the outcomes of DSDs since 2016, in this report we present and discuss the subset of sources that provide empirical information on patient costs and benefits and the acceptability of DSDs 

Optimizing viral load testing access for the last mile: Geospatial cost model for point of care instrument placement

Viral load (VL) monitoring programs have been scaled up rapidly, but are now facing the challenge of providing access to the most remote facilities (the “last mile”). For the hardestto-reach facilities in Zambia, we compared the cost of placing point of care (POC) viral load instruments at or near facilities to the cost of an expanded sample transportation network (STN) to deliver samples to centralized 

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

This paper compares the impact and cost effectiveness of several potential new testing strategies in South Africa, and assesses the prospects of achieving the UNAIDS target of 95% of HIV-positive adults diagnosed by 2030. We developed a mathematical model to evaluate the potential impact of home-based testing, mobile testing, assisted partner notification, testing in schools and workplaces, and testing of female sex workers (FSWs), men who have sex with men (MSM), family planning clinic 

The costs of diagnosing breast-related conditions at a large, public hospital in Johannesburg, South Africa

Breast cancer is the most common cancer among women in South Africa. Offering comprehensive breast care services requires careful planning; yet, there is limited literature on the costs of providing services in low-resource settings. We aimed to estimate the average costs per procedure and patient for the diagnosis of breast conditions in South Africa, including the impact of shifting to lower-cost imaging 

Budget execution of the comprehensive HIV and AIDS conditional grant: An analysis of expenditure and performance: HE²RO Policy Brief Number 30

South Africa’s government-wide expenditure on HIV/AIDS programmes is estimated to have almost doubled over the past five financial years from R10.6 billion in 2012/13 to R20.3 billion in 2017/18.1* The majority of this expenditure (85.2% in 2017/18) is funded through the HIV, TB, Malaria and Community Outreach Grant, which is a ring-fenced conditional grant (CG) allocated via the National Department of Health (NDOH) to provincial health budgets. The HIV/AIDS component of this grant is one of