All Policy Briefs

Syndromic Management vs Point-of-Care, and Lab Based Testing for Chlamydia and Gonorrhoea: a Cost Comparison

Despite higher costs per case tested, the WHO has recommended etiological testing in countries that can afford it as part of its 2016-2021 strategy for global STI control.3The added cost of etiological testing is possibly less than that of syndromic management if one considers the costs of caring for the many short- and long-term sequelae of untreated STIs, including ectopic pregnancy, pelvic inflammatory disease, and infertility in women, and additional complications for newborns. However, 

Frequent Mobility among Postpartum Women: Implications for HIV Treatment and Care

We found frequent movement between facilities, as well as frequent log-distance travel during the postpartum period. The movement between facilities results in an overestimation of true LTFU. A concerted effort to synchronise data between facilities in real-time is needed both for quality of patient care and program 

Does distance to clinic affect utilization of HIV care and treatment services

We assessed the relationship between distance to clinic and progression through the HIV care cascade. We have two key findings. First, distance matters but only for women. Second, for women, distance affected linkage to care, but was not associated with later transitions in the care cascade. It is possible that distance is a less important barrier once people find out their HIV status, learn about treatment, and overcome the hurdle of their first clinic 

Drug side effects and retention on HIV treatment: a prospective cohort study assessing the implementation of Tenofovir in South Africa and Zambia

With its recommendations that all patients initiate Tenofovir, WHO anticipated improved adherence and reduced lost to follow-up, with implications for long health outcomes such as CD4 recovery, viral suppression and survival. We show that the guideline change replacing Stavudine with Tenofovir in first-line ART improved retention in care and reduced single-drug 

Patient related factors that contribute to poor adherence on second-line HIV treatment

We demonstrated that patient-related factors (e.g. use of traditional/herbal medicine, depression, family/social support) but not necessarily provider-related factors, health system factors or treatment related factors contribute to poor adherence on second-line ART.  Based on our findings, there is a need for on-going counselling and education of patients on second-line ART. Strategies to support patients, improved adherence evaluation and intensified monitoring need to be considered and 

Can routine data be used to access integration of HIV and other primary healthcare services in South Africa’s public health sector? An assessment from three Johannesburg clinics

Public clinics in South Africa maintain several paper registers for tracking service provision on a daily basis. These form part of the medico-legal recording requirements at the primary health care level. However, we identified duplication across the registers, and many registered that were not filled out consistently or correctly. If completed properly, there is the potential to use the records to track integration of service delivery. Engaging clinic staff as key role players, including 

HIV treatment outcomes in South Africa: fixed-dose combination vs. traditional multi-pill ART

Currently, there are a limited number of studies focusing specifically on the effects of active ARV drugs administered as separate pills compared to those same active drugs administered in a fixed dose combination. Thus the current study helps fill a critical gap in literature. Our results suggest that under programmatic conditions, FDCs achieve similar outcomes in terms of attrition and virology suppression compared to a multi-pill regimen. However, FDCs may have an important role to play in 

Changes in elevated cholesterol in the era of Tenofovir: risk factors, clinical management and outcomes

We found South African adults on ART have increased rates of elevated total cholesterol but tenofovir affects total cholesterol less than do other NRTIs. Older patients and patients with increase BMI are at an increased risk of high cholesterol and should therefore be monitored closely and perhaps be prioritised for cholesterol-lowering drugs, while at the same time receiving lifestyle and dietary 

The health service costs of offering female condoms in South Africa’s National Female Condom Program 2015/16

The female condom (FC) was identified by the Reproductive Health Supplies Coalition in 2011 as one of several under-used reproductive health technologies with the potential to expand choice in reproductive health and family planning programs, responding to the needs of diverse clients (1). The FC is also key to increasing HIV protection options for women and men. It is the only female-initiated HIV prevention barrier method. Although FC distribution rates lag far behind those of male condoms 

Cervical cancer and pap smear screening in HIV-positive women: Awareness, perceived risk, and practices

The Validation of Implementation of Cervical Cancer Screening Applications in HIV-Seropositive Women Study (VICAR 1) was conducted in 2009-2011 to compare three methods for detecting cervical cancer: standard Pap smear, visual inspection with acetic acid, and HPV detection. VICAR 1’s main goal was to estimate sensitivity, specificity, and predictive values for each method. VICAR 1 participants, however, also answered an interviewer-administered, structured questionnaire containing coded