All Journal Articles

Tenofovir stock shortages have limited impact on clinic-and patient-level HIV treatment outcomes in public sector clinics in South Africa

While South Africa has made great strides to extend access to ART and increase the quality of the health services provided, patient care can be affected when stock shortages/outs occur. While our results show little effect on treatment outcomes, this most likely reflects the clinics' ability to mitigate the crisis by continuing to keep patient care and treatment as consistent as 

Effect of eliminating CD4-count thresholds on HIV treatment initiation in South Africa: an empirical modelling study

Bor PLoS One CD4 thresholds and initiationThe World Health Organization recommends initiating antiretroviral therapy (ART) regardless of CD4 count. We assessed the effect of ART eligibility on treatment uptake and simulated the impact of WHO's recommendations in South Africa. We concluded that removing CD4 criteria alone will modestly increase timely uptake of ART. However, our results suggest the majority of newly-eligible patients will not initiate. Improved testing, linkage, and initiation 

Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012

Hypertension has become a major cause of morbidity and premature mortality in South Africa, but population-wide estimates of prevalence and access to care are scarce. Using data from the South African National Health and Nutrition Examination Survey (2011–2012), this analysis evaluates the national prevalence of hypertension and uses a care cascade to examine unmet need for 

The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa

A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi- purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate 

The African Medicines Regulatory Harmonization Initiative: Progress to Date

The African Medicines Regulatory Harmonization Initiative (AMRH) has contributed to reduce marketing authorization timelines in East African Community and the Southern African Development Community member states. Challenges still exist in using the outcome of the regional joint dossier review processes for national decision making processes by the national medicines regulatory 

The WelTel Trial in context and the importance of null findings

The past decade has seen major advances in HIV care. Effective treatment exists, and drugs are becoming cheaper, more effective, and easier to tolerate. Thus, although most important clinical treatment questions have been answered, questions remain about how to get people into care earlier and remain on life-long 

Treatment outcomes of over 1000 patients on second-line, protease inhibitor-based antiretroviral therapy from four public-sector HIV treatment facilities across Johannesburg, South Africa

HIV‐infected patients initiated on standard second‐line ART in South Africa can experience overall low rates of attrition and moderately high rates of virologic suppression shortly after second‐line initiation; however, individuals with poorer immune status at the time of initiation of second‐line treatment are at greater risk for attrition, were less likely to suppress and may need additional adherence support to improve treatment 

Lessons learnt from the introduction of the contraceptive implant in South Africa

In 2014, South Africa (SA) introduced the subdermal contraceptive implant with the aim of expanding the contraceptive method mix and availability of long-acting reversible methods in the public sector. Three years on, concerns have been raised about the decline in uptake, early implant removals and challenges in service delivery. This article explores the lessons learnt from the introduction of contraceptive technologies elsewhere and applies these to the SA context. Drawing on the World Health 

Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural South Africa

Objectives: To assess the relationship between CD4 count at presentation and ART uptake and assess predictors of timely treatment initiation in rural KwaZulu-Natal, South Africa. Methods We used Kaplan-Meier and Cox proportional hazards models to assess the association between first CD4 count and time from first CD4 to ART initiation among all adults presenting to the Hlabisa HIV Treatment and Care Programme between August 2011 and December 2012 with treatment-eligible CD4 counts (≤ 350