Recent Publications

The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case

The paper details the results of the first-ever systematic review of the average (or unit) costs of HIV interventions in South Africa, performed in 2018. We originally did this for the South African HIV Investment Case but have updated to more recent prices (2016/17) and added more interventions since then. It includes recent costs for ART, PMTCT, HCT, MMC, and PrEP, amongst others, together with a table detailling all our findings from the literature review (file S3, attached) and very 

Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058

Our objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.We calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV)epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective usinga 40-year time horizon starting in 2018. Introduction of PrEP in Germany can reduce the HIV epidemic among MSM in a 

Early treatment of acute hepatitis C infection is cost-effective in HIV-infected men-whohave- sex-with-men

Treatment of hepatitis C virus infections (HCV) with direct acting antivirals (DAA) can prevent new infections since cured individuals cannot transmit HCV. However, as DAAs are expensive, many countries defer treatment to advances stages of fibrosis, which results in ongoing transmission. We assessed the epidemiological impact and cost-effectiveness oftreatment initiation in different stages of infection in the Netherlands where the epidemic ismainly concentrated among HIV-infected 

Breast cancer screening, diagnostic and treatment services and integration with HIV-related care in Sub-Saharan Africa: Results from an electronic survey

There is very little data on the availability of breast care screening and treatment services in sub-Saharan Africa, and almost no information on integration of HIV and breast care services in this setting. In this study we assessed the availability of comprehensive breast care services and their integration (or not) with HIV care and treatment services in sub-Saharan Africa, with a special focus on South Africa which has placed an emphasis on integration of HIV and SRH care in its public 

Syndromic management versus point-of-care, and lab based testing for Chlamydia and Gonorrhoea: A cost comparison

In this analysis, syndromic management was the least costly option. It requires skilled personnel but minimal supplies, equipment, and medication.Despite higher costs per case tested, the WHO has recommended etiological testing in countries that can afford it as part of its 2016-2021 strategy for global STI control.3 The added cost of etiological testing is possibly less than that of syndromic management if one considers the costs of caring for the many short- and long-term sequelae of 

High rates of death and loss to follow-up by 12 months of rifampicin resistant TB treatment in South Africa

Treatment success rates of rifampicin resistant (RR)/multi-drug resistant (MDR) tuberculosis (TB) in South Africa range from 43±48%, falling short of the World Health Organization's target of 75%. We present rates and assess predictors of attrition by 12 months on treatment.Prospective observational cohort analysis of adults (18 years) initiating RR/MDR-TB treatment from 01 March 2013 to 30 September 2016. Attrition was defined as a combination of death and loss to follow-up (LTFU; treatment 

Impact of Xpert MTB/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa

We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011–06/2012 (early cohort) and 07/2013–06/2014 (late cohort) with records of patients initiating DR-TB treatment at one of the city’s four public sector treatment sites. We determine the proportion of persons diagnosed with RR-TB who initiated DR-TB treatment and report time to treatment initiation (TTI) before and after the implementation of Xpert MTB/RIF roll-out in Johannesburg, 

Third-Line Antiretroviral Therapy Program in the South African Public Sector: Cohort Description and Virological Outcomes

The World Health Organization recommends that antiretroviral therapy (ART) programs in resource-limited settings develop third-line ART policies. South Africa developed a national third-line ART program for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitor–based ART and second-line protease inhibitor (PI)-based ART. We report on this 

Impact of a borderless sample transport network for scaling up viral load monitoring: results of a geospatial optimization model for Zambia

The World Health Organization recommends viral load (VL) monitoring at six and twelve months and then annually after initiating antiretroviral treatment for HIV. In many African countries, expansion of VL testing has been slow due to a lack of efficient blood sample transportation networks (STN). To assist Zambia in scaling up testing capacity, we modelled an optimal STN to minimize the cost of a national VL STN. The model optimizes a STN in Zambia for the anticipated 1.5 million VL tests that 

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster-randomised evaluation

As loss from HIV care is an ongoing challenge globally, interventions are needed for patients who don’t achieve or maintain ART stability. The 2015 South African National Adherence Guidelines (AGL) for Chronic Diseases include two interventions targeted at unstable patients: early tracing of patients who miss visits (TRIC) and enhanced adherence counselling (EAC). methods As part of a cluster-randomised evaluation at 12 intervention and 12 control clinics in four provinces, intervention sites 

How good are our guidelines? Four years of experience with the SAMJ’s AGREE II review of submitted clinical practice guidelines

In 2014, the SAMJ appointed an editorial subcommittee to review CPGs submitted for publication. This was in response to several concerns, including the global shift in CPG quality requirements, the potential effect of poor-quality CPGs on healthcare quality and cost, and the challenges South African (SA) CPG developers face in meeting new standards. This editorial reflects on the SAMJ CPG review subcommittee’s experience over the past 4 years and describes the value of more robust CPG