Recent Publications

Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs [version 3; peer review: 2 approved, 1 approved with reservations]

Abstract Introduction: Access to and the cost of induction treatment for cryptococcal meningitis (CM) is rapidly changing. The newly announced price for flucytosine ($0.75 per 500 mg pill) and possibly lower prices for liposomal amphotericin B (AmB-L) create opportunities to reduce CM treatment costs compared to the current standard treatment in low- and middle-income countries. Methods: We developed an Excel-based cost model to estimate health system treatment costs for CM over a two-week 

Health Technology Assessment in Support of National Health Insurance in South Africa

Abstract South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements 

TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi

ABSTRACT Introduction: Despite growing evidence of the long term impact of tuberculosis (TB) on quality of life, Global Burden of Disease (GBD) estimates of TB-related disability-adjusted life years (DALYs) do not include post TB morbidity, and evaluations of TB interventions typically assume treated patients return to pre-TB health. Using primary data, we estimate years of life lost due to disability (YLDs), years of life lost due to premature mortality (YLL) and DALYs associated with 

Health-related quality of life and psychological distress among adults in Tanzania: a cross-sectional study

Abstract Background: Little data is available on health-related quality of life (HRQoL) and mental health of the general population in Tanzania. We aimed to describe HRQoL and level of psychological distress among adults in Mbeya and Songwe Regions of Tanzania. Methods: We conducted a cross-sectional study between April and October 2019 in Mbeya and Songwe Regions. Data were collected using the Medical Outcomes Short Form-36 (SF-36) questionnaire and the Page Kessler Psychological Distress 

HIV and ART related knowledge among newly diagnosed patients with HIV under the universal-test-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 

Do differentiated service delivery models work for second-line therapy? Outcomes for South African second-line ART clients enrolled in DSD models compared to conventional care

South Africa's National Adherence Guidelines allow for clients receiving second line ART (2L) to enrol in differentiated service delivery (DSD) models for HIV treatment, but outcomes for this group have not been documented. We analyzed routine data to determine whether retention in care and viral suppression are similar for clients receiving 2L who were eligible for but not enrolled in DSD 

Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study

Background:  Approaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead to lower HIV incidence, but their cost-effectiveness is unknown. We aimed to evaluate conditions under which risk-informed PrEP use is cost-effective. Methods:  We applied a mathematical model of HIV transmission to simulate 3000 setting-scenarios reflecting a range of epidemiological characteristics of 

An overview of the pharmaceutical market for Tenofovir-Emtracitabine-Efavirenz (TEE) and Tenofovir-Lamivudine-Dolutegravir (TLD) within the South African private sector

The scale up of access to HIV care and treatment is critical to the success of achieving the UNAIDS 95-95- 95 goals in South Africa (SA)(1). There were an estimated 5.4 million people on Antiretroviral therapy (ART) in the SA public sector in 2021, including 137,655 children (<15 years) and 5,328,800 adults(2). Despite the large HIV burden, it is estimated that only 62% of the 7.5 million people who are living with HIV (PLHIV) in the country are on ART. Recent reports suggest that the 

Developing theory-driven Treatment-as-Prevention and U=U communication materials for persons living with HIV and health workers in South Africa

Background •Messages on HIV treatment-as-prevention (TasP) and undetectable=untransmittable (U=U) have not. Historically been emphasized during HIV counselling in South Africa. •We sought to develop video based communication materials to support HIV counsellors in confidently sharing accurate information on TasP with persons living with HIV (PLWH). Method •We followed the Intervention Mapping protocol, including consultations with a stakeholder planning group, formative 

People who are virally-suppressed cannot transmit HIV sexually! While the science of HIV treatment-as-prevention (TasP) is clear, this message has not been disseminated widely in sub-Saharan Africa, limiting its value in motivating treatment uptake, adherence, and retention HIV care. We sought to understand the TasP communication needs of persons living with HIV (PLWH) and barriers and facilitators to TasP communication among health care workers in South 

Patient losses from HIV care between 2016 and 2020 in six provinces of South Africa

BACKGROUND South Africa’s move to immediate ART for all persons diagnosed with HIV resulted in increased treatment uptake with hopes of reducing patient losses from care after ART initiation. METHODS • We analysed data from 2015-2019 on all patients diagnosed with HIV at public-sector health facilities in six provinces in South Africa: Gauteng (GP), Mpumalanga (MP), KwaZulu Natal (KZN), Limpopo (LP), North West (NW), Northern Cape (NC). Data were obtained from the