All Journal Articles

Improved simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE II): protocol for a randomized evaluation

The SLATE II (Simplified Algorithm for Treatment Eligibility) study is an individually randomized evaluation of a clinical algorithm to reliably determine a patient’s eligibility for immediate ART initiation without waiting for laboratory results or additional clinic visits. It differs from the earlier SLATE I study in management of patients with symptoms of tuberculosis (under SLATE II these patients may be started on ART immediately) and other criteria for immediate initiation. SLATE II 

Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa

South Africa (SA) has one of the world’s largest HIV treatment programmes, to which a dramatic increase in life expectancy has been attributed. However, there continue to be concerns regarding the reporting of HIV-related mortality in SA, which varies by source. As accurate HIV mortality estimates are key to measuring the success of the national programme as well as identifying areas for improvement, we propose a complementary approach to monitoring changes in HIV-related mortality using 

Prevalence, incidence, predictors, treatment, and control of hypertension among HIVpositive adults on antiretroviral treatment in public sector treatment programs in South Africa

One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low and middle-income countries, with the biggest increase in sub-Saharan Africa and SouthAfrica at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive 

Implementation of Option B and a fixed-dose combination antiretroviral regimen for prevention of mother-to-child transmission of HIV in South Africa: A model of uptake and adherence to care

Initiating and retaining pregnant women on antiretroviral therapy (ART) to prevent motherto-child HIV transmission (PMTCT) remains a major challenge facing African HIV programs, particularly during the critical final months prior to delivery. In 2013, South Africa implemented its ªOption Bº PMTCT regimen (three-drug ART throughout pregnancy andbreastfeeding, regardless of maternal CD4 count) and introduced once-daily fixed-dose combinations and lifelong ART. Currently, the uptake of Option B 

Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa

The 2015 WHO recommendation to initiate all HIV patients on antiretroviral therapy (ART) at diagnosis could potentially overextend health systems and crowd out sicker patients, mitigating the policy’s impact. We evaluate whether South Africa’s prior eligibility expansion from CD4 ≤ 200 to CD4 ≤ 350 cells/ll reduced ART uptake in the sickest patients. methods Using data on all patients presenting to the Hlabisa HIV 

Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia

We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir for first-line ART. We applied regression discontinuity in a prospective cohort study of 52,294 HIV-infected adults initiating first-line ART within 12months (±12 months) of each guideline change.We compared outcomes in patients presenting just before and afterthe guideline changes using local linear regression and estimated intention-to-treat effects on initiation of 

Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa

For this cost-effectiveness analysis, using an intention-to-treat approach and taking into consideration uncertainty in the clinical and cost outcomes, a strategy involving cryotherapy plus LEEP if needed at six months was dominant to LEEP plus LEEP again at six months if needed for retreatment. However, compared to other studies comparing LEEP and cryotherapy, the efficacy results were low in both treatment groups - possibly due to the HIV-positivity of the participants. Further research is 

“My future is bright… I won’t die with the cause of AIDS”: ten-year patient ART outcomes and experiences in South Africa

This study demonstrates the complexities of long-term chronic HIV treatment with declining all-cause mortality and increasing LTF over ten years. Barriers to long-term retention still present a significant challenge. As more people become eligible for ART in South Africa under 'treatment for all', new healthcare delivery challenges will arise; interventions are needed to ensure long-term programme successes 

Usage of antibiotics in the intensive care units of an academic tertiary-level hospital

The post-antibiotic era is approaching fast as multidrug-resistant bacteria emerge and the antibiotic pipeline slows to a trickle. Antibiotic stewardship requires that antibiotics be used appropriately and as such this study reviewed the utilisation of antibiotics in five adult intensive care units (ICUs) at Charlotte Maxeke Johannesburg Academic 

Targeting the right interventions to the right people and places: the role of geospatial analysis in HIV program planning

In the current era of of falling donor support and with governments of low-income countries needing to balance many spending priorities, it is vital to maximise the impact and efficiency of the AIDS response. National and international stakeholders have increasingly supported geospatial targeting of resources as a means to accomplish this, and the challenge for program designers has become how best to link the 'who' and 'where' with the 'what' and 'when'. However, a key question is whether