Recent Publications

South African Health Review 2017 – 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, Naomi Lince-Deroche, collaborated with South African academics and the National Department 

Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa

Background In South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-TB care in 2011. Methods We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 with records of patients initiating RR-TB 

Cohort profile: the Right to Care Clinical HIV Cohort, South Africa

Purpose: The research objectives of the Right to Care Clinical HIV Cohort analyses are to: (1) monitor treatment outcomes (including death, loss to follow-up, viral suppression and CD4 count gain among others) for patients on antiretroviral therapy (ART); (2) evaluate the impact of changes in the national treatment guidelines around when to initiate ART on HIV treatment outcomes; (3) evaluate the impact of changes in the national treatment guidelines around what ART regimens to initiate on drug 

Predicting the need for third-line antiretroviral therapy by identifying patients at high risk for failing second-line antiretroviral therapy in South Africa

Although third-line antiretroviral therapy (ART) is available in South Africa’s public sector, its cost is substantially higher than first and second line. Identifying risk factors for failure on second-line treatment remains crucial to reduce the need for third-line drugs. We conducted a case–control study including 194 adult patients (‡18 years; 70 cases and 124 controls) who initiated second-line ART in Johannesburg, South Africa. Unconditional logistic regression was used to assess 

Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes

Objectives Antiretroviral therapy (ART) has been associated with unfavourable lipid profile changes and increased risk of cardiovascular disease (CVD). With a growing population on ART in South Africa, there has been concern about the increase in noncommunicable diseases such as CVD. We determined risk factors associated with increased total cholesterol (TC) in a large cohort on ART and describe the clinical management thereof. Methods We conducted an observational cohort study of 

A new cascade of HIV care for the era of ‘treat all’

Now that the World Health Organization has recommended antiretroviral therapy for all people infected with HIV regardless of their CD4 count, millions more people will become eligible for HIV treatment. · We and others have previously described the cascade of care for HIV treatment for monitoring retention in care and targeting interventions to improve retention to areas of greatest need. · To inform research and track progress, we propose a new cascade for the "treat all" policy that 

Contraceptive use among Women in Accra, Ghana: 2003 and 2008

Despite a relatively low fertility rate, maternal mortality in Ghana still remains high. According to the Ghana Demographic and Health Surveys, about 22% of Ghanaian women of reproductive age currently use contraception. We analyzed contraceptive use among a representative sample of women in Accra, Ghana, to better understand contraceptive use patterns. We used data from two cross-sectional surveys of a representative cohort of women in Accra. In 2003, 28.9% of sexually active women used a 

Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa

Objective: Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy programs. Retention estimates may be underestimated because of unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). Design: Observational cohort study. Methods: Of 788 women initiating antiretroviral therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit $3 

Characterizing breast conditions at an open-access breast clinic in South Africa: a model that is more than cancer care for a resource-limited setting

Background: While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa. Methods: We performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast 

Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?

The conventional league table method in cost-effectiveness analysis relies on the assumption of independence between interventions. For the South African HIV Investment Case, we added methodology that allowed the simultaneous consideration of a large number of HIV interventions and their potentially diminishing marginal returns to scale. As a result, interventions were less cost-effective when evaluated under the optimisation method, with ICERs being on average 437% higher than under standard 

Citizenship status and engagement in HIV care: an observational cohort study to assess the association between reporting a national ID number and retention in public-sector HIV care in Johannesburg, South Africa

Objective: In many resource-limited settings, people from rural areas migrate to urban hubs in search of work. Thus, urban public-sector HIV clinics in South Africa (SA) often cater to both local residents and patients from other provinces and/or countries. The objective of this analysis was to compare programmatic treatment outcomes by citizenship status in an urban clinic in SA. Setting: An urban public-sector HIV treatment facility in Johannesburg, SA. Participants: We included all 

Progress with scale-up of HIV viral load monitoring — Seven sub-Saharan African countries, January 2015–June 2016

The World Health Organization (WHO) recommends viral load testing as the preferred method for monitoring the clinical response of patients with human immunodeficiency virus (HIV) infection to antiretroviral therapy (ART). Unlike western countries, which have relied on viral load testing to monitor virologic response to ART, low- and middle income countries have historically relied on CD4 cell counts (which monitor immunologic improvement for patients on ART) because of the higher cost of viral