Innovations Research on AIDS (INROADS)

Projects

• Understanding the Predictors of Early ANC Initiation and Patterns of Postpartum Maternal Mobility in Relation to Paediatric HIV Diagnosis and Linkage to HIV Care

  The elimination of vertical transmission of HIV is within reach in South Africa, given the high coverage of the Prevention of Mother to Child Transmission (PMTCT) program. However to achieve the 90-90-90 targets for children, we need to improve early infant diagnosis (EID) efforts by strengthening postpartum retention and participation of women the PMTCT program, including mothers who initially test HIV negative in antenatal care (ANC). This study aims to firstly map out patterns of maternal 

• Building the Capacity of Lay Health Counsellors to Improve ART Uptake among High CD4 Patients under the “Treat All’ Policy in South Africa

  In September 2016, South Africa began implementing test-and-treat, in which everyone who tests HIV positive is offered antiretroviral therapy (ART), in hopes of attaining the UNAIDS 90-90-90 targets. However the success of the test-and-treat approach depends on early HIV testing and lifelong HIV treatment. In South Africa, lay HIV counselors are the first to introduce ART to newly diagnosed patients. However, most are under-trained with little professional supervision and emotional support and 

• 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 

• Using Routinely Collected Laboratory Data to Characterise Trends in the TB Epidemic

  The overall aim of this study is to harness routinely collected laboratory data to characterize the spatial distribution of tuberculosis in South Africa. In collaboration with partners at the University of the Witwatersrand and the National Health Laboratory Service, we are conducting retrospective analyses of de-identified data to highlight areas with greater burden of TB disease and investigate whether burden is changing over time. Results from this work will be informative for planning for 

• 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 

• 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 

• 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 

• Retention and Attrition from HIV Care

  With the rapid expansion of access to antiretroviral therapy (ART) in sub-Saharan Africa, the number of HIV-positive people on treatment has increased dramatically. In South Africa, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients while continuing to expand access to new patients. With increased demand and limited capacity, many HIV-positive patients never access care, and many who do discontinue treatment. HE2RO staff, 

• Linkage to National Databases to Enhance Programme Evaluation

  HIV care involves a web of local clinics and laboratories throughout South Africa. In the emergency phase of the epidemic, monitoring and evaluation took a backseat to HIV care. Currently HIV care takes place at over 3,000 local clinics throughout South Africa. Laboratory test from the labs and patient records from the clinics provide potentially useful sources of data for monitoring and evaluation of the National treatment programme currently and historically. Linkage of patient records to the 

• 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 

• Paediatric and Adolescent Populations

  Children and adolescents have been identified as priority populations with the greatest potential impact on the development of the HIV epidemic. HE2RO has used multiple sources of data to evaluate the outcomes of children and adolescents initiating ART at multiple clinics across Gauteng and Mpumalanga. We also utilize prospective cohorts to identify factors associated with treatment adherence and missed clinic visits among adolescents and plan to use national level laboratory data to produce 

• 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 

• Adult Treatment Outcomes and Opportunistic Infections

  As the HIV epidemic matured in South Africa and the national treatment programme reached 10 years since inception, the team at HE2RO has used longitudinal patient databases to evaluate treatment outcomes among adults initiating ART. We consider diverse factors that may influence the effect of ART and also the impact of changing national guidelines in an on-going 

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