All Journal Articles

How good are our guidelines? Four years of experience with the SAMJ’s AGREE II review of submitted clinical practice guidelines

In 2014, the SAMJ appointed an editorial subcommittee to review CPGs submitted for publication. This was in response to several concerns, including the global shift in CPG quality requirements, the potential effect of poor-quality CPGs on healthcare quality and cost, and the challenges South African (SA) CPG developers face in meeting new standards. This editorial reflects on the SAMJ CPG review subcommittee’s experience over the past 4 years and describes the value of more robust CPG 

Evaluating the integration of HIV selftesting into low-resource health systems: study protocol for a cluster-randomized control trial from EQUIP Innovations

Throughout sub-Saharan Africa HIV-testing rates remain low. Barriers to testing, such as inconvenient service hours and long wait times, lack of privacy, and fear of unwanted disclosure, continue to impede service utilization. HIV self-testing (HIVST) is one strategy that addresses these barriers and has been shown to increase use of HIV-testing when distributed through community-based settings. However, the scalability of HIVST is limited because it has yet to be fully integrated into 

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

Cervical cancer incidence is significant in countries, such as South Africa, with high burdens of both HIV and human papillomavirus (HPV). Cervical cancer is largely preventable if dysplasia is diagnosed and treated early, but there is debate regarding the best approaches for screening and treatment, especially for low-resource settings. Currently South Africa provides Pap smears followed by colposcopic biopsy and LEEP if needed in its public health facilities. We estimated the costs and 

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

South Africa is moving into a new era of HIV treatment with “treat all” policies where people may be on treatment for most of their lives. We need to understand treatment outcomes and facilitators of long-term antiretroviral treatment (ART) adherence and retention-in-care in the South African context. In one of the first studies to investigate long-term treatment outcomes in South Africa, we aimed to describe ten-year patient outcomes at a large public-sector HIV clinic in Johannesburg and 

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