Recent Publications

The high cost of second line antiretroviral therapy for HIV/AIDS in South Africa

Abstract Objective: The present article estimates the cost and outcomes of second-line antiretroviral therapy. The cost of second-line drugs is generally higher than that of first-line drugs and it is expected that the absolute number of patients on second-line antiretroviral therapy will increase over time. This information is crucial for planning and budgeting. Methods: Resource utilization and outcome data were extracted for patients who initiated standard second-line therapy. Resource 

Barriers to initiation of antiretroviral treatment in rural and urban areas of Zambia: a cross-sectional study of cost, stigma, and perceptions about ART

Abstract Background: While the number of HIV-positive patients on antiretroviral therapy (ART) in resource-limited settings has increased dramatically, some patients eligible for treatment do not initiate ART even when it is available to them. Understanding why patients opt out of care, or are unable to opt in, is important to achieving the goal of universal access. Methods: We conducted a cross-sectional survey among 400 patients on ART (those who were able to access care) and 400 patients 

Cost and Cost-Effectiveness of Antiretroviral Treatment Delivery in Resource Constrained Settings

Abstract: In most countries with high HIV prevalence, the demand for treatment with antiretroviral therapy (ART) has rapidly outstripped the capacity of traditional tertiary health-care facilities (hospitals) to provide that treatment. If national and international targets for treatment access are to be met, ART will therefore need to be delivered in a wide range of settings and at multiple levels of the health-care system, from large referral hospitals in capital cities to primary 

Improvements in physical wellbeing over the first two years on antiretroviral therapy in western Kenya

Abstract Improvements in physical wellbeing during the first six months on antiretroviral therapy (ART) are well known, but little is known regarding more long-term follow-up. We conducted a prospective cohort study among 222 HIV-positive adult tea plantation workers in western Kenya to assess wellbeing over their first two years on ART. Study subjects completed a standardized questionnaire during repeat ART clinic visits. A 30-day recall period was used to elicit the number of days that 

Economic and quality-of-life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review

Abstract The impacts of antiretroviral therapy (ART) on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of ART on these economic and quality of life indicators in developing countries and assess the state of research on these topics. We searched Ovid/Medline, PubMed, Psych Info, Web of Science, Google Scholar, 

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