All Journal Articles

Cost and impact of dried blood spot versus plasma separation card for scale-up of viral load testing in resource limited settings

Routine plasma viral load (VL) testing is the WHO-recommended method for monitoring HIV-infected patients on antiretroviral therapy (ART). In Zambia, VL scale-up is limited due to significant logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spot (DBS) technology could circumvent many logistical challenges at the cost of reduced sensitivity and/or specificity. Recently, plasma separation cards (PSC) have become available and, 

Clinical predictor score to identify patients at risk of poor viral load suppression at six months on antiretroviral therapy: results from a prospective cohort study in Johannesburg, South Africa

As countries work toward 90:90:90 targets, early identification of patients with inadequate response to antiretroviral therapy (ART) is critical for achieving optimal HIV treatment outcomes. We developed and evaluated a clinical prediction score (CPS) to identify HIV-positive patients at risk of poor viral load suppression at 6 months on ART. Our findings suggest a 6-month CPS may have the potential to identify patients at risk of poor viral load suppression. The CPS may be used to target 

Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa

Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity of mothers and cause health and developmental problems in children born to affected mothers. We set out to measure the prevalence of PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) HIV-1 infected women and HIV negative women, and to identify predictors of major PPD among these women in a 

TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB – a study protocol

Up to fifty percent of microbiologically cured tuberculosis (TB) patients may be left with permanent, moderate or severe pulmonary function impairment. Very few studies have systematically examined pulmonary outcomes in patients to understand the pathophysiologic basis and long-term socio-economic consequences of this injury. The planned multi-country, multi-centre observational TB cohort study, aims to advance the understanding of the clinical, microbiological, immunological and socio-economic 

“Even if you’re HIV-positive there’s life after if you take your medication”: experiences of people on long-term ART in South Africa: a short report

South Africa’s national antiretroviral treatment (ART) programme, initiated in 2004, is the largest HIV treatment programme in the world with an estimated 4.2 million people on ART. Today, an HIV diagnosis is no longer associated with certain death, but is rather a manageable chronic disease, with all HIV-positive patients now eligible to receive treatment. In this study, we explore patient experiences at the onset of the ART programme, including facilitators and barriers around 

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 

Point-of-care assays for early infant diagnosis in Zimbabwe

Delays in diagnosis of HIV and initiation of antiretroviral therapy (ART) for infants significantly increase early infant morbidity and mortality. By contrast, innovations in early infant HIV diagnostics and improvements in turnaround times could reduce infant morbidity and 

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 

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