Recent Publications

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 

Cost of using a patient tracer to reduce loss to follow up and ascertain patient status in a large antiretroviral therapy program in Johannesburg, South Africa

Abstract Objective: To evaluate a pilot intervention to engage a patient tracer to follow up lost patients at a large public clinic in South Africa. Methods: A social worker spent 4 months contacting by telephone a random sample of patients who had initiated antiretroviral therapy (ART) at least 6 months earlier and were ≥1 month late for a scheduled visit. The tracer was authorized to assist patients to return to care if needed. Cost was calculated from the perspective of the clinic. 

Why are antiretroviral treatment patients lost to follow up? A qualitative study from South Africa

Abstract Objectives: To better understand the reasons why patients default from antiretroviral treatment (ART) programmes to help design interventions that improve treatment retention and ultimately, patient outcomes. Methods: Prospective cohort study at two treatment sites in South Africa followed by qualitative interviews with patients that had defaulted. Results: Respondents overwhelmingly reported that ART improved their health status and quality of life. Nevertheless, despite improved 

Early loss to follow up after enrollment in pre-ART care at a large public clinic in Johannesburg, South Africa

Abstract Objective: To estimate loss to follow up (LTFU) between initial enrolment and the first scheduled return medical visit of a pre-antiretroviral therapy (ART) care program for patients not eligible for ART. Methods: The study was conducted at a public-sector HIV clinic in Johannesburg. We reviewed records of all patients newly enrolled in the pre-ART care program and not yet eligible for ART between January 2007 and February 2008. Crude proportions of patients completing their first 

Strategies to improve patient retention on antiretroviral therapy in sub-Saharan Africa

Abstract The scale-up of antiretroviral therapy (ART) has been one of the success stories of sub-Saharan Africa, where coverage has increased from about 2% in 2003 to more than 40% 5 years later. However, tempering this success is a growing concern about patient retention (the proportion of patients who are alive and remaining on ART in the health system). Based on the personal experience of the authors, 10 key interventions are presented and discussed that might help to improve patient 

Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007‐2009; systematic review

Abstract Objectives: To estimate the proportion of all-cause adult patient attrition from antiretroviral therapy (ART) programs in service delivery settings in sub-Saharan Africa through 36 months on treatment. Methods: We identified cohorts within Ovid Medline, ISI Web of Knowledge, Cochrane Database of Systematic Reviews and four conference abstract archives. We summarized retention rates from studies describing observational cohorts from sub-Saharan Africa reporting on adult HIV 1- infected 

High rates of survival, immune reconstitution, and virologic suppression on second-line antiretroviral therapy in South Africa

Abstract To determine rates of survival, viral suppression, and immunologic change after 1 year on second-line antiretroviral therapy, we conducted a cohort study among 328 patients initiated on zidovudine, didanosine, and lopinavir/ritonavir. All patients who switched to standard second-line therapy at a large urban public-sector clinic in Johannesburg, South Africa, were included. A year after initiating second-line therapy 243/313 , subjects were alive and in care. Further, 203/262 (77%; 

Using vital registration data to update mortality among patients lost to follow-up from ART programmes: evidence from the Themba Lethu Clinic, South Africa

Abstract Objective: To estimate the rates of mortality in patients lost to follow up (LTFU) from a large urban public sector HIV clinic in South Africa. Methods: We compared vital status using the clinic’s database to vital status verified against the Vital Registration system at the South African Department of Home Affairs. We compared rates of mortality before and after updating mortality data. Predictors of mortality were estimated using Kaplan-Meier curves and proportional hazard 

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