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The effect of initiating tenofovir on HIV treatment outcomes in adults in southern Africa: a regression discontinuity analysis

Abstract Background: Due to toxicities associated with the NRTI stavudine, many countries now recommend initiating HIV patients on tenofovir as the standard NRTI in first-line therapy. Exploiting national guideline changes in South Africa and Zambia, we assessed the causal impact of a policy to initiate tenofovir on ART outcomes using a regression discontinuity design.  Objectives: To establish the causal effect of tenofovir (vs. stavudine) on patient outcomes in South Africa and Zambia’s 

A descriptive analysis of South Africa’s national third line antiretroviral therapy cohort

Abstract Background: The World Health Organization has recommended that national antiretroviral therapy (ART) programs in resource limited settings develop policies for third-line ART. South Africa, with the largest HIV treatment program in the world, is one of the only countries in sub-Saharan Africa that has access to third-line ART for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitors (NNRTI) based ART and second-line protease inhibitor (PI) based 

The cost-effectiveness of early ART initiation in South Africa: a quasi-experiment

Abstract Background: Clinical trials are not well suited to evaluate the effectiveness and cost-effectiveness of interventions in “real world” settings. Using a quasi-experimental regression-discontinuity design (Bor et al. 2014), we establish the causal effect of early (vs. deferred) ART initiation on patient survival in rural South Africa, and obtain empirical (as opposed to modeled) cost-effectiveness estimates.  Methods: Demographic data from a large population surveillance in rural 

A predictive risk model for first line treatment failure in South Africa

Abstract Background: Although individual predictors of first line antiretroviral therapy (ART) failure have been identified, few studies in resource-­‐limited settings have been large enough for predictive modeling. Understanding the absolute risk of first line failure is useful for patient monitoring and for effectively targeting limited resources for second line ART. The aims of this study are to estimate absolute risk of failure of first line ART over 5 years on treatment as a function 

Delaying second line antiretroviral therapy after first line failiure in South Africa: Moderating effect of CD4 count

Abstract Background: Ideally patients who fail first line antiretroviral therapy (ART) are switched to second line quickly, yet logistical issues, clinician decisions and patient preferences make some delay in switching to second line ART common. Delays in switching to second line may be associated with poor outcomes on second line if resistance mutations develop or CD4 count declines substantially. This study explores the impact of delaying second line ART after first line failure on rates 

Predictors and Outcomes of Incident High Cholesterol in Adults on ART in South Africa

Abstract Background: As the HIV-­‐infected population ages in sub-­‐Saharan Africa, non-­‐communicable chronic disease incidence among patients on ART is likely to rise. Specific antiretroviral drugs are considered independent risk factors for cardiovascular disease (CVD), and high total cholesterol (TC) is a risk factor for CVD, stroke and renal disease. We examined predictors of high TC in ART patients in South Africa.  Methods: Prospective study of HIV-­‐positive, 

Severe Adverse Events in Outpatient Drug-Resistant TB Treatment in South Africa

Abstract Background: South Africa adopted a policy of decentralization of drug-­‐resistant TB treatment to satellite and outpatient sites in 2011. Outcomes of treatment at these new sites are not yet known. We report on the occurrence of adverse events (AE) to treatment at two outpatient, decentralized, drug-­‐resistant tuberculosis (DR-­‐TB) treatment sites in Johannesburg, South Africa.  Methods: Combined retrospective and prospective medical record review of the six-­‐month 

Knowledge of the Spectrum of Breast Disease Presenting at a Public, Tertiary Hospital in Johannesburg, South Africa is Critical to Ensuring Holistic Care

Abstract Introduction: Most breast-related research focuses on cancer. However, it is critical to understand the  total burden of breast diseases for service planning, especially in resource-constrained settings. Objectives/Aims: To characterize the presentation and management of breast disease at a large, public hospital offering comprehensive breast-related services in Johannesburg, South Africa. Methods: A retrospective file review was performed. Patients were eligible if they were ≥18 

Does most early mortality in patients on ART occur in care or lost to follow-up? Evidence from the Themba Lethu Clinic, South Africa

Abstract Objective: In resource-limited settings, early mortality on antiretroviral therapy (ART) is about 10% yet it is unclear how much of that mortality occurs in care or among patients lost to follow-up. Methods: We assessed mortality rates among non-pregnant ART-naïve adults initiating first-line ART between April 2004–May 2012 in South Africa, stratified by person-years (py) in care and lost. Deaths were ascertained from the National Population Register and multiple definitions of 

Impacts of disaggregating programmatic outcomes by documentation of citizenship in South Africa

Abstract  Background: In many resource-limited settings, people in rural areas often migrate to urban hubs in search of w ork. As such, public-sector HIV clinics in urban areas of South Africa often include local residents and patients from outside of the province or other African countries. This analysis compares programmatic outcomes by documentation of citizenship status in an urban resouce-limited setting. Methods: We included all adult ART-naïve patients w ho initiated treatment 

The cost effectiveness of expansion options for adult ART in South Africa: Integrating economic considerations with epidemiological models of Treatment as Prevention

Abstract  Background: The South African government currently discusses further expansion of eligibility for antiretroviral treatment (ART), including to all adults with CD4 cell count <500 cells/micro (500), the positive partner in serodiscordant couples (DC), all HIV-positive pregnant women (PW), or all HIV-positive individuals (UTT). Methods: We modelled 20-year cost and cost effectiveness of each of the four eligibility  options under up to three different patterns of testing and care 

Disaggregating programmatic outcomes by documentation of citizenship in South Africa

Abstract  Background: In many resource-limited settings, people in rural areas often migrate to urban hubs in search of w ork. As such, public-sector HIV clinics in urban areas of South Africa often include local residents and patients from outside of the province or other African countries. This analysis compares programmic outcomes by documentation of citizenship status in the urban resouce-limited setting. Methods: We included all adult ART-naïve patients who initiated treatment from