All Journal Articles

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 

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study

There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating ART in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. We found that a future transition from first-line regimens containing efavirenz to regimens containing dolutegravir 

Assessing the association between changing NRTIs when initiating second-line ART and treatment outcomes

After first-line ART failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second line is uncertain due to the high potency of protease inhibitors used in second line. Our assessment of clinical data from 6290 adult patients in South Africa and Zambia found that changing NRTI in second line was associated with better clinical outcomes in South 

Predictors of switch to and early outcomes on third-line antiretroviral therapy at a large public-sector clinic in Johannesburg, South Africa

While efficacy data exist, there are limited data on the outcomes of patients on third-line antiretroviral therapy (ART) in sub-Saharan Africa in actual practice. Being able to identify predictors of switch to third-line ART will be essential for planning for future need. We identify predictors of switch to third-line ART among patients with significant viraemia on a protease inhibitor (PI)-based second-line ART regimen. Additionally, we describe characteristics of all patients on third-line at