Recent Publications


Background South Africa, with a population of approximately 62 million, is considered food secure overall but faces significant challenges with food insecurity and acute malnutrition, especially among vulnerable populations. Urbanization and globalization have altered food acquisition methods, emphasizing cashbased transactions. The COVID-19 pandemic, subsequent lockdowns, and economic recession have exacerbated child hunger and malnutrition. Acute malnutrition, or wasting, remains a 

A randomised trial of “Fresh Start” text messaging to improve return to care in people living with HIV who missed appointments in South Africa

Abstract Objective: Treatment interruptions are a barrier to successful antiretroviral therapy (ART). "Fresh start messages", which leverage significant days on the calendar (e.g., new year, public holiday) in order to prompt action, have the potential to encourage people living with HIV to return to care. We evaluated a "fresh start" intervention (text messages) to increase return to care in PLHIV who had missed their last appointment. Design: A three arm 1:1:1 individual randomised 


EXECUTIVE SUMMARY BACKGROUND AND RATIONALE South Africa is currently facing multiple population health challenges which include HIV, TB, non-communicable diseases and more recently, the COVID-19 pandemic. While access to public health services has improved dramatically, quality health care remains a challenge. The Ideal Clinic Realisation and Maintenance (ICRM) program was instituted to identify, correct, and improve the quality of services offered in public health facilities. Ultimately the 

Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches

Absract In South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST) for samples that were rifampicin-resistant (RR-TB). To guide implementation of the recently launched Xpert® MTB/XDR (MTB/XDR) assay, a cost-outcomes analysis was conducted comparing total costs for genotypic DST (gDST) for persons diagnosed with RR-TB considering three 

The cost of using mobile digital X-ray units to detect pulmonary tuberculosis in South Africa

Background In South Africa, • poor knowledge and awareness of TB symptoms in communities lead to delayed healthcare-seeking and undiagnosed TB • 58% of prevalent TB is asymptomatic  Study in South Africa showed that the addition of dCXR identified two times more patients with undiagnosed TB than did investigation of symptoms alone Piloting of digital chest x-ray technology in 

Understanding mobility patterns in people with drug-resistant tuberculosis in two South African provinces

ABSTRACT Background/Objectives: Estimates suggest 84% of tuberculosis (TB) transmission happens outside the home, yet transmission locales remain unclear. We aimed to study geographic mobility patterns among adults with rifampicin-resistant (RR) and multidrug-resistant (MDR) TB for future active case-finding strategies. Design/Methods: We recruited individuals diagnosed with RR/MDR-TB in North West and Free State provinces. Using ArcGIS, we mapped homes and commonly frequented locations. 

Predictors of disengagement during the early treatment period in South Africa

Background Disengagement from HIV care in the early treatment period is a critical obstacle to achieving UNAIDS’s second 95 target. Underlying drivers of disengagement from care in the early treatment period are not clear. While South Africa’s Service Delivery Guideline on Fast Track Initiation and Counseling (FTIC) define normative procedures, the effect of guideline implementation and the underlying drivers of disengagement remain 

Counseling and treatment literacy remain critical to the early treatment period in South Africa

Background: In many countries, implementation of rapid ART treatment initiation and lower intensity treatment models have reduced counselling and treatment education pre-initiation and in the first 6 months (early treatment period) from multiple sessions over several months to a single session on the day a client tests positive and initiates ART. Little is known about contemporary experiences of and preferences for counselling and literacy during this 

Stigma and Nondisclosure Remain Important Barriers to Early HIV Treatment Retention During the Early Treatment Period in Zambia and South Africa

Background Attrition from HIV treatment programs is highest during the first six months after antiretroviral therapy (ART) initiation Stigma and fear of disclosure remain important reasons for disengagement.  Stigma is a complex multi-layered issue, which affects clients in the community, healthcare facility, interpersonal, and individual levels We explored clients’ experiences around stigma and disclosure during their first six months after ART initiation or