Recent Publications

Outcomes of treatment of drug-susceptible tuberculosis at public sector primary healthcare clinics in Johannesburg, South Africa: A retrospective cohort study

Background. Despite the large number of tuberculosis (TB) patients treated in South Africa (SA), there are few descriptions in the published literature of drug-susceptible TB patient characteristics, mode of diagnosis or treatment outcomes in routine public sector treatment programmes. Objective. To enhance the evidence base for public sector TB treatment service delivery, we reported the characteristics of and outcomes for a retrospective cohort of adult TB patients at public sector 

Intensive adherence counselling for HIV-infected individuals failing second-line antiretroviral therapy in Johannesburg, South Africa

Objective- In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study was performed to describe one such approach to adherence optimisation. Methods- This was a single-arm study of patients on second-line protease inhibitor (PI)-based antiretroviral therapy (ART) with a HIV-1 RNA ≥400 copies/ml in 

Incident tuberculosis in HIV-positive children, adolescents and adults on antiretroviral therapy in South Africa

To evaluate the association between age and incident tuberculosis (TB) among human immunodeficiency virus (HIV) infected patients receiving antiretroviral treatment (ART) in South Africa. DESIGN: Prospective cohort analysis among HIV-infected patients initiating ART between April 2004 and April 2012. Generalized estimating equations (GEE) were used with modified Poisson regression clustered by treatment site as a function of sex, age, nucleoside reverse transcriptase inhibitor, CD4 count, 

Prospects for HIV control in South Africa: a model-based analysis

Background: The goal of virtual elimination of horizontal and mother-to-child HIV transmission in South Africa (SA) has been proposed, but there have been few systematic investigations of which interventions are likely to be most critical to reducing HIV incidence. Objective: This study aims to evaluate SA’s potential to achieve virtual elimination targets and to identify which interventions will be most critical to achieving HIV incidence reductions. Design: A mathematical model was 

Missed appointments among rifampicin-resistant tuberculosis (RR-TB) patients at a decentralised RR- TB outpatient clinic in Johannesburg, South Africa

Background. With the implementation of outpatient (ambulatory) decentralised rifampicin-resistant tuberculosis (RR-TB) treatment in South Africa (SA) since late 2011, the high rates of loss from treatment are a significant concern. Missed appointments lead to treatment interruptions and may contribute to amplification of resistance, ongoing transmission of RR-TB and an increased risk of morbidity and mortality to the patient. Objective. To describe characteristics of patients who missed 

Interventions to improve the rate or timing of initiation of antiretroviral therapy for HIV in sub-Saharan Africa: meta-analyses of effectiveness

Abstract Introduction: As global policy evolves toward initiating lifelong antiretroviral therapy (ART) regardless of CD4 count, initiating individuals newly diagnosed with HIV on ART as efficiently as possible will become increasingly important. To inform progress, we conducted a systematic review of pre-ART interventions aiming to increase ART initiation in sub-Saharan Africa. Methods: We searched PubMed, Embase and the ISI Web of Knowledge from 1 January 2008 to 1 March 2015, extended 

Accelerating the Uptake and Timing of Antiretroviral Therapy Initiation in Sub- Saharan Africa: An Operations Research Agenda

Summary Points • Under 2015 World Health Organization guidelines calling for antiretroviral therapy (ART) for all HIV-infected persons (the “treat all” approach), millions of new patients will be eligible to initiate ART, but existing procedures for treatment initiation are cumbersome and slow, contributing to high loss to follow-up before antiretroviral medications are dispensed. Simpler, more efficient, accelerated algorithms for ART initiation are needed. • The Models for 

Mortality in the First 3 Months on Antiretroviral Therapy Among HIV-Positive Adults in Low- and Middle-income Countries: A Meta-analysis

Abstract: Previous meta-analyses reported mortality estimates of 12-month post-antiretroviral therapy (ART) initiation; however, 40%–60% of deaths occur in the first 3 months on ART, a more sensitive measure of averted deaths through early ART initiation. To determine whether early mortality is dropping as treatment thresholds have increased, we reviewed studies of 3 months on ART initiation in low- to middle-income countries. Studies of 3-month mortality from January 2003 to April 

A meta-analysis assessing all-cause mortality in HIV- exposed uninfected compared with HIV-unexposed uninfected infants and children

Objective: Conduct a meta-analysis examining differential all-cause mortality rates between HIV-exposed uninfected (HEU) infants and children as compared with their HIV-unexposed uninfected (HUU) counterparts. Design: Meta-analysis summarizing the difference in mortality between HEU and HUU infants and children. Reviewed studies comparing children in the two groups for all-cause mortality, in any setting, from 1994 to 2016 from six databases. Methods: Meta-analyses were done 

Marginal Structural Models to Assess Delays in Second-Line HIV Treatment Initiation in South Africa

Background South African HIV treatment guidelines call for patients who fail first-line antiretroviral therapy (ART) to be switched to second-line ART, yet logistical issues, clinician decisions and patient preferences make delay in switching to second-line likely. We explore the impact of delaying second-line ART after first-line treatment failure on rates of death and virologic failure. Methods We include patients with documented virologic failure on first-line ART from an 

Initiating Antiretroviral Therapy at a Patient’s First Clinic Visit: The RapIT Study

The RapIT study was conducted from 2013 to 2015  at two clinics in Johannesburg, South Africa. It was a randomized controlled trial of rapid ART initiation that allowed patients to have treatment eligibility determined, all treatment preparation steps performed, and ARV medications dispensed on the day of their first HIV-related clinic visit. Although it took place at only two clinics, both in urban areas in a single province, the RapIT trial showed that it is possible to start nearly all