Recent Publications

Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa

Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa. Methods: We developed a cost-outcome model utilizing NHLS data, including facility-level 

The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after 

Cost and outcomes of drug-susceptible TB treatment at public and private primary healthcare clinics, Johannesburg South Africa

South Africa carries 3% of the world’s tuberculosis (TB) case burden and is experiencing a dual TB/HIV epidemic: 59% of adult TB patients are also HIV positive. There are no recent published estimates on the costs and outcomes of drug-susceptible TB in South Africa for adults in an out-patient setting with the exception of one paper published in 2003 (using 1997 data) and another in 2006 (using 2001 data) . The proposed National Health Insurance (NHI) system aims to re-engineer primary 

Using intervention mapping in motivational interviewing training to improve ART uptake in Gauteng, South Africa

In South Africa, lay HIV counsellors are at the forefront of many HIV-related behavioural interventions. However, they have limited formal counselling training and little ongoing in-service support, leading to considerable variability in approaches to counselling. We describe the use of Intervention Mapping to develop a motivational interviewing counselling training and support program, titled “Thusa-Thuso - helping you help”, for lay HIV counsellors practising in primary health care 

Delays in repeat HIV viral load testing for those with elevated viral loads: A national perspective from South Africa

The World Health Organization recommends national programs use viral load monitoring for patients on ART1 to determine whether treatment has been successful and to guide clinicians on when to switch treatment to second-line regimens, indicated if the virus is resistant to first-line therapy. Not all countries are able to provide viral load testing as part of national programs but for those that do, patients with an elevated viral load (VL) are recommended to undergo adherence counselling and 


HIV testing represents the primary entry point into HIV care and treatment programs for people living with HIV and is the first of UNAID’s 90-90-901 targets. South Africa made a large effort to expand HIV testing in April 2010 by implementing a national testing campaign2. This campaign, designed to increase awareness of HIV status, sought to test 15 million people by June 2011. The monthly number of people tested for HIV increased from approximately 240,000 per month in the period prior to 

Post-tuberculosis lung health: perspectives from the First International Symposium

ALTHOUGH CURABLE, TB frequently leaves the individual with chronic physical and psycho-social impairment, but these consequences have been largely neglected. The 1st International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to discuss priorities and gaps in addressing this issue. A barrier to progress has been the varied terminology and nomenclature, so the Delphi process was used to achieve consensus on definitions. Lack of sufficient evidence hampered definitive 

Patient Perspectives of Quality of the Same‑Day Antiretroviral Therapy Initiation Process in Gauteng Province, South Africa: Qualitative Dominant Mixed‑Methods Analysis of the SLATE II Trial

HIV patients in South Africa continue to report operational barriers to starting antiretroviral therapy (ART). In the Simplified Algorithm for Treatment Eligibility (SLATE) II trial, same-day initiation (SDI) of ART increased the number of patients commencing ART and achieving HIV viral suppression by using a screening tool to distinguish between patients eligible for SDI and those requiring additional care before starting treatment. We conducted a mixed-methods evaluation to explore trial 

Economic evaluation of facility-based HIV self-testing among adult outpatients in Malawi

HIV self-testing (HIVST) in outpatient departments (OPD) is a promising strategy for HIV testing in Malawi, given high OPD patient volumes and substantial wait times. To evaluate the relative cost and expected impact of facility-based HIVST (FB-HIVST) at OPDs in Malawi for increasing HIV status awareness, we conducted an economic evaluation of an HIVSTcluster-randomized controlled 

Prevalence of TB symptoms, diagnosis and treatment among people living with HIV (PLHIV) not on ART presenting at outpatient clinics in South Africa and Kenya: baseline results from a clinical trial

Objective We used screening data and routine clinic records for intervention arm patients in the Simplified Algorithm for Treatment Eligibility (SLATE) trials to describe the prevalence of tuberculosis (TB) symptoms, diagnosis and treatment among people living with HIV (PLHIV), not on antiretroviral therapy (ART) and presenting at outpatient clinics in South Africa and Kenya. We compared the performance of the WHO four-symptom TB screening tool with a baseline Xpert test. Setting Outpatient HIV 

Models of service delivery for optimizing a patient’s first six months on antiretroviral therapy for HIV: an applied research agenda

Differentiated models of service delivery (DSD models) for HIV treatment in sub-Saharan Africa were conceived as a way to manage rapidly expanding populations of experienced patients who are clinically “stable” on antiretroviral therapy (ART). Entry requirements for most models include at least six months on treatment and a suppressed viral load. These models thus systematically exclude newly-initiated patients, who instead experience the conventional model of care, which requires