Recent Publications

Short-term impacts of a change in ART initiation threshold for patients co-infected with TB in Johannesburg, South Africa

Abstract Introduction: Recent studies showed earlier antiretroviral therapy (ART) initiation in patients co-infected with tuberculosis (TB) leads to reduced mortality. On April 1st, 2010 South Africa changed its HIV treatment guidelines to initiate patients with TB at CD4 counts <350 cells/mm3, up from <200 cells/mm3.  We evaluated short-term impacts of the guideline change by comparing treatment outcomes for co-infected patients before and after the policy change at the Themba 

What to do with Xpert negatives? The cost of alternative diagnostic algorithms for TB suspects who are Xpert MTB negative in a high HIV/MDR-TB burden setting

Abstract Background: South Africa is rapidly implementing the World Health Organization’s recommendation to adopt Xpert MTB/RIF technology (Xpert) for first-line diagnosis of pulmonary tuberculosis (TB). With a high burden of HIV/TB co-infection and a high proportion of patients with smear-negative TB, however, determining a diagnostic algorithm for Xpert negative TB suspects remains important. South Africa’s current Xpert algorithm calls for HIV-infected TB suspects with an initial 

Increased risk of mortality and loss to follow-up among HIVpositive patients with oropharyngeal candidiasis and malnutrition before antiretroviral therapy initiation: a retrospective analysis from a large urban cohort in Johannesburg, South Africa

Abstract: Objective: We investigated the effect of oropharyngeal candidiasis (OC) and body mass index (BMI) before antiretroviral therapy (ART) initiation on treatment outcomes of human immunodeficiency virus (HIV)–positive patients. Study Design: Treatment outcomes included failure to increase CD4 count by 50 or 100 cells/L or failure to suppress viral load (400 copies/mL) at 6 or 12 months in addition to loss to follow-up (LTFU) and mortality by 12 months. Risk and hazard ratios (HRs) were 

Poorer ART outcomes with increasing age at a large public sector HIV clinic in Johannesburg, South Africa

Abstract: Background: As the current HIV-positive population ages, the absolute number of patients >50 years on treatment is increasing. Methods: We analyze the differences in treatment outcomes by age category (18-29, 30-39, 40-49, 50-59, and ≥ 60) among 9139 HIV-positive adults initiating ART in South Africa. Results: The adjusted hazard ratios (HRs) for all-cause mortality increased with increasing age, with the strongest association in the first 12 months of follow-up among patients 

Low rates of nucleoside reverse transcriptase inhibitor resistance in a well monitored cohort in South Africa on antiretroviral therapy

Abstract: Background: Emergence of complex HIV-1 drug resistance mutations has been linked to the duration of time on a failing antiretroviral (ARV) drug regimen. This study reports on resistance profiles in a closely monitored subtype C infected cohort. Methods: A total of 812 participants were enrolled into the CIPRA-SA ‘safeguard the household’ study, viral loads (VLs) were performed 12 weekly for 96 weeks. Virological failure was defined as either <1.5 log drop in VL at week 12 or 2 

How to calculate the annual costs of NGO-implemented programmes to support orphans and vulnerable children: a six-step approach

Abstract Background: Information on the costs of implementing programmes designed to provide support of orphans and vulnerable children (OVC) in sub-Saharan Africa and elsewhere is increasingly being requested by donors for programme evaluation purposes. To date, little information exists to document the costs and structure of costs of OVC programmes as actually implemented "on the ground" by local non-governmental organizations (NGOs). This analysis provides a practical, six-step approach 

Policy Brief 3: Rapid, Point of Care CD4 testing at mobile and fixed HIV testing sites: Does it increase linkage to HIV care?

Background Effective care and treatment for HIV/AIDS requires the integration of all stages of disease management, which include: (1) HIV testing; (2) referral of those who test HIV-positive to a clinic for assessment; (3) assessment of the patient with CD4 test to determine eligibility for antiretroviral therapy (ART) or pre-ART care; (4) patient enrolment and retention in pre-ART care if not immediately eligible for ART; (5) patient initiation of ART as soon as eligible; and (6) 

Outcomes of stable HIV-positive patients down-referred from a doctor-managed antiretroviral therapy clinic to a nurse-managed primary health clinic for monitoring and treatment

Abstract Objective: Compare clinical, immunologic and virologic outcomes amongst stable HIV-positive patients down-referred (DR) to nurse-managed primary health care clinic (PHC) for treatment maintenance to those who remained at the doctor-managed treatment-initiation site (TI). Design: We conducted a matched cohort analysis amongst stable HIV patients at the Themba Lethu Clinic, in Johannesburg, South Africa. Eligible patients met the criteria for down-referral (undetectable viral load 

Prevalence and predictors of Kaposi sarcoma herpes virus seropositive: a cross-sectional analysis of HIV-infected adults initiating ART in Johannesburg, South Africa

Abstract Background: Kaposi sarcoma (KS) is the most common AIDS-defining tumour in HIV-infected individuals in Africa. Kaposi sarcoma herpes virus (KSHV) infection precedes development of KS. KSHV co-infection may be associated with worse outcomes in HIV disease and elevated KSHV viral load may be an early marker for advanced HIV disease among untreated patients. We examined the prevalence of KSHV among adults initiating antiretroviral therapy (ART) and compared immunological, demographic and 

A longitudinal study of stavudine-associated toxicities in a large cohort of South African HIV infected subjects

Abstract  Background: There has been major improvement in the survival of HIV-1 infected individuals since the South African Government introduced highly active anti-retroviral therapy (HAART) in the public sector in 2004. This has brought new challenges which include the effects of stavudine-related toxicities. Methods: Prospective analysis of a cohort of 9040 HIV-infected adults who were initiated on HAART at the Themba Lethu Clinic (TLC) in Johannesburg between April 1, 2004 to December 

Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir

Abstract: Objective: In April 2010 the South African government added Tenofovir disoproxil fumarate to its first-line antiretroviral therapy (ART) for HIV patients. We analyzed the relationship between renal dysfunction at tenofovir initiation, nephrotoxicity and mortality. Design: Retrospective cohort analysis of HIV-infected adults who received tenofovir and had a creatinine clearance done at initiation at the Themba Lethu Clinic, Johannesburg, South Africa between April 2004-September 2009. 

Pregnancy and Virologic Response to Antiretroviral Therapy in South Africa

Abstract Background: Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in that setting. We examined the effect of incident pregnancy after HAART initiation on virologic response to HAART. Methods and Findings: We evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April