Recent Publications

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 

HIV treatment outcomes in South Africa: fixed-dose combination vs. traditional multi-pill ART

Currently, there are a limited number of studies focusing specifically on the effects of active ARV drugs administered as separate pills compared to those same active drugs administered in a fixed dose combination. Thus the current study helps fill a critical gap in literature. Our results suggest that under programmatic conditions, FDCs achieve similar outcomes in terms of attrition and virology suppression compared to a multi-pill regimen. However, FDCs may have an important role to play in 

Changes in elevated cholesterol in the era of Tenofovir: risk factors, clinical management and outcomes

We found South African adults on ART have increased rates of elevated total cholesterol but tenofovir affects total cholesterol less than do other NRTIs. Older patients and patients with increase BMI are at an increased risk of high cholesterol and should therefore be monitored closely and perhaps be prioritised for cholesterol-lowering drugs, while at the same time receiving lifestyle and dietary 

Treatment outcomes of over 1000 patients on second-line, protease inhibitor-based antiretroviral therapy from four public-sector HIV treatment facilities across Johannesburg, South Africa

HIV‐infected patients initiated on standard second‐line ART in South Africa can experience overall low rates of attrition and moderately high rates of virologic suppression shortly after second‐line initiation; however, individuals with poorer immune status at the time of initiation of second‐line treatment are at greater risk for attrition, were less likely to suppress and may need additional adherence support to improve treatment 

Lessons learnt from the introduction of the contraceptive implant in South Africa

In 2014, South Africa (SA) introduced the subdermal contraceptive implant with the aim of expanding the contraceptive method mix and availability of long-acting reversible methods in the public sector. Three years on, concerns have been raised about the decline in uptake, early implant removals and challenges in service delivery. This article explores the lessons learnt from the introduction of contraceptive technologies elsewhere and applies these to the SA context. Drawing on the World Health