All Policy Briefs

Breast cancer screening, diagnostic and treatment services and integration with HIV-related care in Sub-Saharan Africa: Results from an electronic survey

There is very little data on the availability of breast care screening and treatment services in sub-Saharan Africa, and almost no information on integration of HIV and breast care services in this setting. In this study we assessed the availability of comprehensive breast care services and their integration (or not) with HIV care and treatment services in sub-Saharan Africa, with a special focus on South Africa which has placed an emphasis on integration of HIV and SRH care in its public 

Syndromic management versus point-of-care, and lab based testing for Chlamydia and Gonorrhoea: A cost comparison

In this analysis, syndromic management was the least costly option. It requires skilled personnel but minimal supplies, equipment, and medication.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.3 The 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 

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