Recent Publications

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 

South African Health Review 2016 – Chapter 17

The South African Health Review (SAHR) has been published by Health Systems Trust (HST) since 1995. Since 2014, it has been internationally recognized as a peer-reviewed journal. According to HST, the Review is considered to be a critical resource for understanding, from a South African perspective, local and international public health issues. In the 2016 edition of the Review, HE2RO Senior Researcher and Boston University Assistant Professor Dr Gesine Meyer-Rath and HE2RO research associate 

South African Health Review 2016 – Chapter 9

The South African Health Review (SAHR) has been published by Health Systems Trust (HST) since 1995. Since 2014, it has been internationally recognized as a peer-reviewed journal. According to HST, the Review is considered to be a critical resource for understanding, from a South African perspective, local and international public health issues. In the 2016 edition of the Review, HE2RO Senior Researcher, Naomi Lince-Deroche, collaborated with South African academics and the National Department 

Pharmacy Automation for HIV Treatment: An Evaluation of Costs

In October 2012, an automated dispensing system (ADS) for dispensing antiretroviral medications (ARVs) was installed in the pharmacy in an outpatient HIV care and treatment site located in a public hospital in Johannesburg, South Africa. This site dispenses ARVs to almost 300 patients per day. The Health Economics and Epidemiology Research Office (HE2RO) evaluated the introduction of the ADS in this facility. In this policy brief, we report the estimated cost per script dispensed under manual 
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SA HIV TB Investment Case Summary Report

On Mar 22, 2016 the reports for Phase 1 of the South African HIV and TB Investment Case were launched by the Deputy President during the World TB Day celebrations. HE2RO staff were heavily involved in all aspects of the development of the Investment Case, from devising the analytical framework to reviewing evidence for interventions and enablers to developing the novel optimisation method driving the model analysis to writing the 
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SA HIV TB Investment Case Full Report

On Mar 22, 2016 the reports for Phase 1 of the South African HIV and TB Investment Case were launched by the Deputy President during the World TB Day celebrations. HE2RO staff were heavily involved in all aspects of the development of the Investment Case, from devising the analytical framework to reviewing evidence for interventions and enablers to developing the novel optimisation method driving the model analysis to writing the 

The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South Africa

Abstract Background:  While most HIV care is provided on an outpatient basis, hospitals continue to treat serious HIV-related admissions, which is relatively resource-intensive and expensive. This study reports the primary reasons for HIV-related admission at a regional, urban hospital in Johannesburg, South Africa and estimates the associated lengths of stay and costs.  Methods and Findings: A retrospective cohort study of adult, medical admissions was conducted. Each admission was 

Performance of the Cellslide automated liquid-based cytology system amongst HIV-positive women

Abstract: Background: Many women undergoing cervical screening as part of a national South African screening programme may be positive for HIV. The performance of liquid-based cytology (LBC) on samples from HIV-positive women needs to be determined.  Objectives: The performance of the Cellslide® automated LBC system was evaluated as a possible alternative to conventional cytology in a national cervical cancer screening programme. Methods: Split samples from 348 HIV-positive women 

Mass HIV Treatment and Sex Disparities in Life Expectancy: Demographic Surveillance in Rural South Africa

Abstract Background: Women have better patient outcomes in HIV care and treatment than men in sub-Saharan Africa. We assessed--at the population level--whether and to what extent mass HIV treatment is associated with changes in sex disparities in adult life expectancy, a summary metric of survival capturing mortality across the full cascade of HIV care. We also determined sex-specific trends in HIV mortality and the distribution of HIV-related deaths in men and women prior to and at each