Recent Publications

Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low and middle income countries

Many people living with HIV (PLWH) who are eligible for ART do not initiate treatment, leading to excess morbidity, mortality and viral transmission. As countries move to treat all PLWH at diagnosis, it is critical to understand the reasons for non-initiation. This systematic review found reasons for not starting ART included consistent themes across 

The availability of breast cancer screening, diagnostic and treatment services and integration with HIV-related care in Sub-Saharan Africa: Results from an electronic survey –Manuscript Draft–

Breast cancer and breast disease are often excluded from sexual reproductive health advocacy resulting in missed opportunities for advancing breast care services and engaging patients holistically. We aimed to determine the availability of diagnostic and treatment services for breast disease and integration with HIV-related care in Sub-Saharan Africa with a special focus on South 

Patient related factors that contribute to poor adherence on second-line HIV treatment

We demonstrated that patient-related factors (e.g. use of traditional/herbal medicine, depression, family/social support) but not necessarily provider-related factors, health system factors or treatment related factors contribute to poor adherence on second-line ART.  Based on our findings, there is a need for on-going counselling and education of patients on second-line ART. Strategies to support patients, improved adherence evaluation and intensified monitoring need to be considered and 

Tenofovir stock shortages have limited impact on clinic-and patient-level HIV treatment outcomes in public sector clinics in South Africa

While South Africa has made great strides to extend access to ART and increase the quality of the health services provided, patient care can be affected when stock shortages/outs occur. While our results show little effect on treatment outcomes, this most likely reflects the clinics' ability to mitigate the crisis by continuing to keep patient care and treatment as consistent as 

Can routine data be used to access integration of HIV and other primary healthcare services in South Africa’s public health sector? An assessment from three Johannesburg clinics

Public clinics in South Africa maintain several paper registers for tracking service provision on a daily basis. These form part of the medico-legal recording requirements at the primary health care level. However, we identified duplication across the registers, and many registered that were not filled out consistently or correctly. If completed properly, there is the potential to use the records to track integration of service delivery. Engaging clinic staff as key role players, including 

Effect of eliminating CD4-count thresholds on HIV treatment initiation in South Africa: an empirical modelling study

Bor PLoS One CD4 thresholds and initiationThe World Health Organization recommends initiating antiretroviral therapy (ART) regardless of CD4 count. We assessed the effect of ART eligibility on treatment uptake and simulated the impact of WHO's recommendations in South Africa. We concluded that removing CD4 criteria alone will modestly increase timely uptake of ART. However, our results suggest the majority of newly-eligible patients will not initiate. Improved testing, linkage, and initiation 

Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012

Hypertension has become a major cause of morbidity and premature mortality in South Africa, but population-wide estimates of prevalence and access to care are scarce. Using data from the South African National Health and Nutrition Examination Survey (2011–2012), this analysis evaluates the national prevalence of hypertension and uses a care cascade to examine unmet need for 

The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa

A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi- purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate 

The African Medicines Regulatory Harmonization Initiative: Progress to Date

The African Medicines Regulatory Harmonization Initiative (AMRH) has contributed to reduce marketing authorization timelines in East African Community and the Southern African Development Community member states. Challenges still exist in using the outcome of the regional joint dossier review processes for national decision making processes by the national medicines regulatory 

The WelTel Trial in context and the importance of null findings

The past decade has seen major advances in HIV care. Effective treatment exists, and drugs are becoming cheaper, more effective, and easier to tolerate. Thus, although most important clinical treatment questions have been answered, questions remain about how to get people into care earlier and remain on life-long