All Journal Articles

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 

Routine data underestimates the incidence of first-line antiretroviral drug discontinuations due to adverse drug reactions: Observational study in two South African cohorts

Estimating the incidence of antiretroviral discontinuations due to adverse drug reactions (ADRs) is important to inform antiretroviral treatment (ART) regimen recommendations, and to guide prescribing and monitoring policies. Routinely collected clinical data is a useful source of pharmacovigilance data. We estimated the incidences of first-line antiretroviral discontinuations due to ADRs using routine clinical data, and compared them with incidences estimated using data enhanced by folder 

“I will leave the baby with my mother”: Long-distance travel and follow-up care among HIV-positive pregnant and postpartum women in South Africa

It is common in urban African settings for postpartum women to temporarily return to family in distant settings. We sought to explore mobility among peripartum HIV-positive women to understand the timing and motivation of travel, particularly vis-a-vis delivery, and how it may affect healthcare access. We identified frequent travel in the peripartum period with substantial differences in travel patterns by 

Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low and middle income countries

Many people living with HIV (PLWH) who are eligible for ART do not initiate treatment, leading to excess morbidity, mortality and viral transmission. As countries move to treat all PLWH at diagnosis, it is critical to understand the reasons for non-initiation. This systematic review found reasons for not starting ART included consistent themes across 

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