Recent Publications

Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a clusterrandomised, non-blinded, non-inferiority trial

Summary Background: Facility-based, multimonth dispensing of antiretroviral therapy (ART) for HIV could reduce burdens on patients and providers and improve retention in care. We assessed whether 6-monthly ART dispensing was non-inferior to standard of care and 3-monthly ART dispensing. Methods: We did a pragmatic, cluster-randomised, unblinded, non-inferiority trial (INTERVAL) at 30 health facilities in Malawi and Zambia. Eligible participants were aged 18 years or older, HIV-positive, and 

Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients

Abstract Introduction: Lesotho, the country with the second-highest HIV/AIDS prevalence (23.6%) in the world, has made considerable progress towards achieving the “95-95-95” UNAIDS targets, but recent success in improving treatment access to all known HIV positive individuals has severely strained existing healthcare infrastructure, financial and human resources. Lesotho also faces the challenge of a largely rural population who incur a significant time and financial burden to visit 

Cost-effectiveness analysis of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa

Abstract Background: Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135,000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications 

Brief #39: Novel Electronic Technology to Assess Operational Efficiency of HIV Clinics In Johannesburg

Measuring the impact of an intervention or technology on clinical tasks often involves performing a time and motion study. While some studies rely on passive observation and specific activities are timed, others ask staff to keep a log file to estimate the time spent on a specific activity (Kranzer et al, 2012), but both are subject to observer errors. HE²ROand IBM investigators worked together to develop non-invasive electronic devices or “wearable tags” to conduct a time and motion (TIM) 

HIV and ART related knowledge among newly diagnosed patients with HIV under the universaltest-and-treat (UTT) policy in Johannesburg, South Africa

South Africa implemented Universal Test & Treat (UTT) guidelines in September 2016. We examine HIV/ART knowledge among newly diagnosed from a prospective study enrolling newly diagnosed HIV-positive adults, under same-day ART policy, at four primary health clinics in Johannesburg, South Africa. We describe factors associated with high HIV/ART related knowledge score among newly diagnosed patients using Poisson regression. We included 652 HIV positive adults (64.1% female; median age 33 

Attrition in HIV care following HIV diagnosis: a comparison of the pre-UTT and UTT eras in South Africa

Introduction: Policies for Universal Test & Treat (UTT) and same-day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis. Methods: We enrolled three cohorts of newly diagnosed HIV-infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre-UTT, N = 144), May-September 2017 

Adaptation of WHO’s generic tuberculosis patient cost instrument for a longitudinal study in Africa

The WHO developed a generic ‘TB patient cost survey’ tool and a standardized approach to assess the direct and indirect costs of TB incurred by patients and their households, estimate the proportion of patients experiencing catastrophic costs, and measure the impact of interventions to reduce patient costs. While the generic tool is a facility-based cross-sectional survey, this standardized approach needs to be adapted for longitudinal studies. A longitudinal approach may overcome some of 

Perceived barriers to the uptake of health services among first-year university students in Johannesburg, South Africa

In South Africa, the 15-24-year age group are at an increased risk of HIV infection . In 2017, HIV incidence for young adults between the ages of 15–24 was 1.0% (95% CI 0.86–1.15), translating to an estimated 88 400 new infections . In the same year, WHO and other UN partners launched the Accelerated Action for the Health of Adolescents (AA-HA!), which called for the systematic inclusion of adolescents’ expectations and perspectives in health planning processes . However, many 

Brief #3: HIV, Population Dynamics and the Labour Force

AIDS-related mortality among working-age adults reduces GDP growth but has an ambiguous effect on GDP per capita. In the short run, population size decreases due to reduced fertility and increased child mortality owing to HIV, and GDP per capita increases, but this results in lower growth of the working-age population and of GDP in the long run. A smaller elderly cohort due to HIV-related early mortality mitigates the fiscal burden of an ageing population, but as HIV treatment is scaled 

Brief #4: Human Capital

AIDS-related mortality among young adults results in an increase in the number of orphans, and orphanhood is associated with impaired access to education. Early mortality among working-age adults causes a loss of skills and experience and a drop in returns to investment in education. Educational outcomes have weakened in regions with higher HIV prevalence but investments in the HIV response are effectively mitigating HIV’s negative impact on human 

Brief #5: Capital and Investment

The direct effects of health-related productivity shocks on economic output are magnified by their negative impact on investment. Poorer health decreases productivity, which results in lower economic output and consequently lower investment, which again reduces productivity and output over time. Higher mortality reduces incentives for saving and investment. Empirical studies (not HIV-specific) suggest that this could be an important link between HIV and growth, but there is no clear 

Brief #6: Productivity and Employment of People Living With HIV

Early on, there were concerns that AIDS-related mortality would erode state governance and institutions and thus compromise economic development, but there is little evidence to suggest that such effects have been significant. HIV – especially at late stages of disease progression –results in reduced productivity and lower employment of people living with HIV, though the economy-wide effects are unclear. Treatment has been effective in restoring the productivity and – with some