Recent Publications

The Cost of the Xpert Diagnostic Algorithm for TB Results of the National TB Cost Model (NTCM) 2011/12 to 2016/17

South Africa bears a large share of the global burden of HIV and tuberculosis co-infection. The GeneXpert System (Cepheid) using the Xpert MTB/RIF assay, a cassette-based cartridge, has provided the possibility of a rapid diagnosis of tuberculosis, while simultaneously providing a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and has received a strong recommendation from the World Health Organization (WHO) in 

Paediatric human immunodeficiency virus treatment outcomes from a resource limited setting in South Africa: Highly active antiretroviral therapy alone is not enough

Abstract Comprehensive care of human immunodeficiency virus (HIV)-infected children in the resource-poor setting is challenging, and published reports on treatment outcomes in this setting are limited. The aim of this study was to evaluate outcomes of HIV-infected children initiated on highly active antiretroviral therapy (HAART) between April 2005 and April 2009 at a primary health-care centre in Alexandra Township, South Africa. Of the 337 patients initiated on HAART, 83% (281 of 337) were 

Policy Brief 1: The Incremental Cost of Introducing Xpert MTB/RIF into the South African National TB Programme

Background South Africa bears a large share of the global burden of HIV/tuberculosis co-infection. The Cepheid GeneXpert System using the Xpert MTB/RIF assay http://www.cepheid.com/systems-and-software/genexpert-system/), a cassette-based cartridge, has provided the possibility of a rapid, point-of-care diagnosis of tuberculosis (TB) and, simultaneously, a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and received a 

The net cost of incorporating resistance testing into HIV/AIDS treatment in South Africa: a Markov model with primary data

Abstract  Background: Current guidelines for providing antiretroviral therapy (ART) in South Africa’s public sector programme call for switching patients from first-line to second-line treatment upon virologic failure as indicated by two consecutive viral loads above 5000 copies/ml, but without laboratory evidence of viral resistance. We modelled the net cost of adding resistance testing for patients with virological failure and retaining patients without resistance on first-line therapy, 

Response to: defaulting from antiretroviral treatment programmes in sub-Saharan Africa: a problem of definition

Abstract: The recent letter to the editors by Grimsrud et al. (2011) in response to our review of rates of retention in antiretroviral treatment programmes in sub-Saharan Africa (Fox & Rosen 2010) raises two concerns that we would like to comment on. First, the authors make the point that there was variability in the definitions of loss to follow-up (LTFU) used by the studies we summarized. This is correct: as is clearly noted in the paper, we did not have access to the primary data used 

Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa

Abstract Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. 

The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa

Abstract Background: Adherence to care and treatment are essential for HIV-infected individuals to benefit from antiretroviral therapy (ART). We sought to quantify the effects on treatment outcomes of missing visits soon after initiating ART. Methods: We analyzed data from HIV-infected patients initiating ART at Themba Lethu Clinic, Johannesburg, South Africa, from April 2004 to August 2008. We used log-binomial regression to evaluate the relative risk of missing visits during the first six 

Economic outcomes of patients receiving antiretroviral therapy for HIV/AIDS in South Africa are sustained through three years on treatment

Abstract Background: Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation. Methodology/Principal Findings: A 

Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa

Abstract South Africa has the largest ART programme in the world . Between 2004 (the start of the national ART programme) and 2007, an estimated 370,000 people initiated treatment in the public sector . But despite the scope and rapid growth of this programme there are no data on programme outcomes at a national level. The International Epidemiologic Databases to Evaluate AIDS collaboration of Southern Africa (IeDEA-SA) has assembled a series of HIV treatment cohorts from across the country 

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Abstract Objective: To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion. Methods: In our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested 

Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa

Abstract Objectives: To compare treatment outcomes by starting CD4 counts using data from the CIPRA-South Africa trial. Design: Observational cohort study. Methods: Patients presenting to primary care clinics with CD4 cell counts <350 cells/mm3 were randomized to either doctor- or nurse-managed HIV care and followed for at least two years after ART initiation. Clinical and laboratory outcomes were compared by baseline CD4 count. Results: 812 patients were followed for a median of 27.5 

Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial

Abstract Background: Expanded access to combination antiretroviral therapy (ART) in the resource-poor setting is dependent on “task-shifting” from doctors to other health care providers. We compared “doctor-initiated-nurse-monitored” care to the current standard of care, “doctor-initiated-doctor-monitored” ART. Methods: A randomised strategy trial to determine whether treatment outcomes of “nurse-monitored” ART were non-inferior to “doctor-monitored” ART was conducted at