All Policy Briefs

THE SLATE ALGORITHM FOR SAME-DAY HIV TREATMENT INITIATION: RESULTS OF THE SLATE TRIAL IN SOUTH AFRICA AND KENYA

The World Health Organization recommends "sameday" initiation of antiretroviral therapy (ART) for HIV patients eligible and ready1. This recommendation has been adopted by both South Africa2 and Kenya3. Identifying efficient, safe, and feasible procedures for determining same-day eligibility and readiness is now a priority. The WHO guidelines cited evidence from clinical trials suggesting that offering treatment to patients at their first clinical encounter has the potential to increase 

MAKING BUDGETING WORK: REFLECTIONS FROM THE FINANCIAL CAPACITY BUILDING FOR PROVINCES (FINCAP) PROJECT IN SOUTH AFRICA

The Financial Capacity Building for Provinces (FINCAP) project, run in partnership by the Centre for Economic Governance and Accountability in Africa (CEGAA) and the Health Economics and Epidemiology Research Office (HE2RO), focuses on providing capacity building and technical support to HIV, STI and TB (HAST) programme and finance managers in provincial departments of health in South Africa. The intervention was designed to improve budget planning, costing, expenditure tracking and reporting 

Budget execution of the comprehensive HIV and AIDS conditional grant: An analysis of expenditure and performance: HE²RO Policy Brief Number 30

South Africa’s government-wide expenditure on HIV/AIDS programmes is estimated to have almost doubled over the past five financial years from R10.6 billion in 2012/13 to R20.3 billion in 2017/18.1* The majority of this expenditure (85.2% in 2017/18) is funded through the HIV, TB, Malaria and Community Outreach Grant, which is a ring-fenced conditional grant (CG) allocated via the National Department of Health (NDOH) to provincial health budgets. The HIV/AIDS component of this grant is one of 

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