Recent Publications

The outcomes and outpatient costs of different models of antiretroviral treatment delivery in South Africa

Abstract: Objective: Estimate the average outpatient cost per patient in care and responding to treatment 1 year after initiation of antiretroviral therapy (ART) under different models of treatment delivery in South Africa. Methods: At each site, medical records for a sample patients of were reviewed 1 year after ART initiation. Each subject was assigned to one outcome category: in care and responding (IC); in care but not responding (NR); or no longer in care at study site (NIC). Average cost 

Differences in normal activities, job performance and symptom prevalence between patients not yet on antiretroviral therapy and patients initiating therapy in South Africa

Abstract Objectives: Little is known about how antiretroviral therapy (ART) affects patients' economic activities in resource-constrained settings. This study examined the association of ART with functional impairment, symptom prevalence, and employment during the first 6 months on therapy. Methods: Interviews were conducted with 453 patients receiving pre-ART care and 427 patients on ART for 1-6 months in South Africa. Results: Pre-ART subjects were almost twice as likely to report being 

Characteristics of patients accessing care and treatment for HIV/AIDS at public and nongovernmental sites in South Africa

Abstract Little is known about the characteristics of patients accessing antiretroviral therapy (ART) in South Africa. In a random sample of 1069 pre-ART and ART patients attending an urban public hospital, a periurban nongovernmental organization (NGO) clinic, and a rural NGO clinic, 79% were female; average age was 34 for women and 37 for men. Two thirds reported having 1 long-term partner, but most did not live with their partner. Three fourths had completed some secondary school or higher; 

Cost and cost-effectiveness of switching from stavudine to tenofovir in first-line ARV regimens in South Africa

Abstract Background: Most first-line antiretroviral therapy regimens in Africa include stavudine (d4T), despite the high incidence of toxicities related to it. We estimated the cost and cost-effectiveness of switching from d4T to tenofovir disoproxil fumarate (TDF) in South Africa. Methods: A model was developed to estimate the proportion of patients in a hypothetical cohort who experienced d4T- and TDF-related events over the 2 years after antiretroviral therapy initiation. Transition 

Early effects of antiretroviral therapy on work performance: preliminary results from a cohort study of Kenyan agricultural workers

Abstract  Objective: This paper estimates the impact of antiretroviral therapy (ART) on days harvesting tea per month for tea-estate workers in Kenya. Such information is needed to assess the potential economic benefits of providing treatment to working adults. Methods: Data for this analysis come from company payroll records for 59 HIV-infected workers and a comparison group of all workers assigned to the same work teams (reference group, n = 1992) for a period covering 2 years before and 1 

Private Sector Provision and Financing of AIDS Treatment in Africa: Current Developments

Abstract Despite the rapid expansion of public sector highly active antiretroviral (ARV) treatment programs, the private sector continues to be an important source of services and financing for AIDS treatment in Africa. This article reviews currently available information on private sector initiatives, including recent innovations. Private sector providers continue to offer ARV treatment, although adherence problems resulting from high user fees indicate the need for employer, donor, or 

Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review

Abstract Background: Long-term retention of patients in Africa's rapidly expanding antiretroviral therapy (ART) programs for HIV/AIDS is essential for these programs' success but has received relatively little attention. In this paper we present a systematic review of patient retention in ART programs in sub-Saharan Africa. Methods and Findings: We searched Medline, other literature databases, conference abstracts, publications archives, and the “gray literature” (project reports available 

Cost to patients of obtaining treatment for HIV/AIDS in South Africa

Abstract Background: South Africa is providing antiretroviral (ARV) drugs for HIV/AIDS free of charge in order to increase access for poorer patients and promote adherence. However, non-drug costs of obtaining treatment may limit access. We estimated the costs that South African patients incur in obtaining antiretroviral therapy (ART). Methods: A random sample of adult pre-ART and ART patients attending a public urban hospital (site 1), a peri-urban (informal settlement) non-governmental 

The impact of AIDS on government service delivery: the case of the Zambia Wildlife Authority

Abstract The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the capacity of a government agency, the Zambia Wildlife Authority (ZAWA), to patrol Zambia’s national parks. Methods: Data were collected from ZAWA on workforce characteristics, recent mortality, costs, and the number of days spent on patrol between 2003 and 

The private sector and HIV/AIDS in Africa: taking stock of six years of applied research

Abstract Background: Until recently, little was known about the costs of the HIV/AIDS epidemic to businesses in Africa or about business responses to the epidemic. This paper synthesizes the results of a set of studies conducted between 1999 and 2006. Methods: Data for the studies included were drawn from human resource, financial, and medical records of 16 large companies and from 7 surveys of small, medium-sized, and large companies in South Africa, Uganda, Kenya, Zambia, Ethiopia, and 

Prevalence of HIV infection and median CD4 counts among health care workers in South Africa

Abstract Objective: To determine the prevalence of HIV infection and the extent of disease progression based on CD4 count in a public health system workforce in southern Africa. Design: Cross-sectional voluntary, anonymous, unlinked survey including an oral fluid or blood sample and a brief demographic questionnaire. Setting: Two public hospitals in Gauteng, South Africa. Subjects: All 2 032 professional and support staff employed by the two hospitals. Outcome Measures: HIV prevalence and CD4 

Treatment for HIV/AIDS at South Africa’s largest employers: myth and reality

Abstract Objectives: To determine what proportion of employees at the largest private-sector companies in South Africa have access to HIV/AIDS care and treatment, including antiretroviral therapy (ART); how many employees are enrolled in disease management programmes; how many are receiving ART; and which approach to the financing and delivery of care is proving most successful at reaching eligible employees. Design: All 64 private-sector and parastatal companies with more than 6000 employees