Lawrence Long [Research Assistant Professor]

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Lawrence Long

Lawrence Long (MCom, PhD) is a health economist and public health policy researcher. He is a Research Assistant Professor at the Boston University School of Public Health and holds a joint appointment at the University of Witwatersrand (Johannesburg, South Africa). He has more than 12 years of experience conducting applied research on the economic impact of HIV, tuberculosis and associated conditions within South Africa and sub-Saharan Africa. Lawrence did his undergraduate degree in business science with a specialization in economics and finance and then went on to focus on economics and its application to public health in his graduate studies.

Projects

  • AMBIT: Alternative Models of ART Delivery – Optimizing the Benefits

    AMBIT is a 2.5-year research and evaluation project in sub-Saharan Africa supported by the Bill & Melinda Gates Foundation and implemented by the Boston University School of Public Health in the U.S., the Health Economics and Epidemiology Research Office (HE2RO) in South Africa, and other local partners. The project, launched in September 2018, will include data synthesis, data collection, data analysis, and modeling activities aimed at generating information for near- and long-term 
  • Low Prevalence of Depressive Symptoms among Stable Patients on Antiretroviral Therapy in Johannesburg, South Africa

    Depression is a leading cause of morbidity worldwide. It affects more than 300 million individuals globally and depressive disorders are currently the 4th leading cause of Years Lived with Disability (YLD) in South Africa. People living with HIV are disproportionately affected by mental health disorders and while the lifetime prevalence of depression in the general population of South Africa is estimated as 9.7%, estimates from HIV-infected populations have ranged from 14-62%, with variability 
  • Assessing the Impact of Integration of HIV and TB Services into Primary Health Services in the Public Sector in South Africa: An Evaluation of Resource Utilisation at Facility Level

    Early in the HIV epidemic, in South Africa and other low income countries, HIV and TB services were provided in vertical programs as a result of disease-specific funding or approaches to service provision. Provision of separate services for specific health problems or specialisation usually means that patients need to visit separate and specialised clinics for their different health problems or needs, and can result in “missed opportunities” for service provision, fragmented and 
  • Retrospective Cost-Effectiveness Analysis for Nurse Initiated and Managed Antiretroviral Treatment for HIV/AIDS in South Africa

    In HIV/AIDS treatment programs in resource-constrained settings, one response to a shortage of doctors and other highly trained healthcare providers is “task-shifting” from doctors to less trained clinicians, such as nurses and community healthcare workers. In 2010, South Africa issued new guidelines for its antiretroviral treatment (ART) program to allow senior nurses to initiate and manage adult ART patients at primary health clinics. This policy, known as NIMART (Nurse Initiated and 
  • Attrition from HIV Care and Treatment Before and After an Increase in the CD4 Count Eligibility Threshold

    South Africa has recently announced that as of January 2015, it will be increasing its HIV treatment CD4 eligibility threshold from 350 cells/μl to 500 cells/μl1 making more patients eligible for treatment than ever before. However efforts to increase HIV treatment coverage may be minimized if losses to follow up, which have been shown to be high along the continuum of HIV care, offset gains from getting more people onto treatment. HE2RO will conduct a prospective cohort study of adult 
  • A Cost Description of HIV Counselling and Testing (HCT) Models in South Africa

    South Africa’s National Strategic Plan for 2011-2016 (NSP) aims to see a halving of HIV incidence over this period, and a realisation of 80% HIV treatment coverage, or 3 million patients on antiretroviral therapy (ART). The realisation of these goals relies on increased and equitable access to and uptake of HIV Counselling and Testing (HCT). Achieving sustained high levels of HCT in turn requires accurate cost data from which budgeting decisions can be extrapolated. Although a number of 
  • An Evaluation of an Automated Dispensing System for Pharmaceutical Services

    In both developed and developing countries, pharmaceutical management is a critical issue due to escalating health care costs and increased pressure to improve access to services. The past few decades have seen the role of pharmacy staff expanding. For example, in many resource limited settings burdened by HIV, the complexity of HIV-related medication, the increased life span of HIV-positive patients that comes with antiretrovirals, and the comorbidity of HIV/AIDS with other diseases has 
  • An Evaluation of the Acceptability and Feasibility of Booked Appointments in a Large HIV Clinic in Johannesburg, South Africa

    In many resource-limited settings, health care delivery systems face constraints due to increasing need for health expenditure and the large proportion of the population reliant on the public sector. In South Africa, the existing service delivery structure faces additional challenges related to the growing number of HIV-infected South Africans initiating antiretroviral therapy. Long queues, long wait times, and overcrowding are often characteristic of South Africa’s public health care 
  • Analysing the Impact and Cost of Scaling up Xpert MTB/RIF Technology for TB Diagnosis: The National TB Cost Model (NTCM)

    In the South African context, smear microscopy and other conventional TB diagnostic technologies that have been used for decades, are no longer reliable, because many HIV-positive tuberculosis patients are smear-negative, and the long time to diagnosis means that many patients die without having started TB treatment. In December 2010 the GeneXpert System using the Xpert MTB/RIF assay received a strong recommendation from the World Health Organization as the initial test in individuals with HIV 
  • Rewards for TB Contact Screening (RECON)

    Because of the high risk of both TB and HIV among the household contacts of TB patients and the importance of early case detection for both diseases and especially for DR-TB, improving TB case finding is a high priority. Recent studies have shown that having healthcare workers make multiple visits to the homes of TB patients in order to screen household contacts is a logistically challenging and resource- intensive strategy, and it is not routinely undertaken in most public sector settings in 
  • Evaluation of a Standardized Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB (STREAM): Economic Evaluation at Sizwe Tropical Diseases Hospital

    Despite the widespread availability of an efficacious and affordable regimen and strategy for managing drug-susceptible tuberculosis (TB), the emergence of multidrug resistant (MDR) TB remains a major challenge for global TB control efforts. In 2010, data from Bangladesh indicated that a nine-month regimen achieves outcomes comparable to those of the existing, 18-24 month, WHO-approved MDR-TB regimen. The primary objective of the STREAM trial is to assess whether the Bangladesh regimen is 
  • Impact of Nutritional Supplementation on Physical Development, Retention in Care and Adherence to ART in HIV-Positive Infants and Children

    The study aims to determine whether a nutritional supplement, FutureLife HIGH-ENERGY Smart food, given to caregivers/guardians to give to their HIV-positive infants and children for 6 months concurrently with antiretroviral therapy (ART) compared to standard of care results in improved growth and physical development as measured by an increase in height-for-age Z score (HAZ), weight-for-age Z score (WAZ) and mid-upper arm circumference (MUAC) at 6, 12 and 24 months. Secondary outcomes 
  • Investigating the Feasibility of Implementation of Multi-Disciplinary Point-of-Care Testing in an HIV Treatment Clinic Using a Randomised Controlled Trial

    A major challenge to successful implementation of both antiretroviral and anti-tuberculosis therapy in low-resource settings remains the ability to diagnose and monitor the progress of both infections, a process that is hampered by lack of laboratory infrastructure, technical skill and poor integration of HIV and TB services. Recent technological innovations in the Point of Care (POC) testing arena promises to alleviate the problem by providing access to on-site laboratory tests with the future 
  • Pregnant Women

    Treatment outcomes among pregnant women remain a critical indicator for monitoring and evaluation of the national treatment program over time. A long-standing collaboration with researchers from the University of North Carolina has enriched the analysis of longitudinal data on pregnant women by the researchers at 
  • Second and Third-Line Antiretroviral Regimens

    As South Africa continues its rapid expansion of access to first-line antiretroviral therapy (ART), more patients will need to be switched to second-line therapy as these first-line regimens fail. However, with little experience with second-line treatments in resource-limited settings, it is not clear how well patients will do on these medications if their first regimen fails. As the cost of second-line medications is much higher than first-line, it is critical to evaluate whether these 
  • First Line Regimen Durability and Adverse Events

    Understanding the implications of the side effect profile of individual antiretroviral drugs as well as the durability of drug regimens has considerable significance in settings where resources and drug options for HIV remain limited. HE2RO has explored these questions through longitudinal patient datasets with a particular interest in the effects of tenofovir upon introduction into the national programme. These analyses are ongoing as guidelines continue to evolve and current projects include 

Publications

Tools

  • The Healthcare Cost and Outcomes Model

    The Healthcare Cost and Outcomes Model (HCOM) provides a simple tool for analysts and decision-makers to determine the cost-effectiveness of a healthcare intervention in which resources are consumed to produce certain healthcare outcomes.