Recent Publications

Modelling costs of community-based HIV self-testing programmes in Southern Africa at scale: an econometric cost function analysis across five countries

ABSTRACT Background: Following success demonstrated with the HIV Self-Testing Africa Initiative, HIV self-testing (HIVST) is being added to national HIV testing strategies in Southern Africa. An analysis of the costs of scaling up HIVST is needed to inform national plans, but there is a dearth of evidence on methods for forecasting costs at scale from pilot projects. Econometric cost functions (ECFs) apply statistical inference to predict costs; however, we often do not have the luxury of 

The cost effectiveness and optimal configuration of HIV self-test distribution in South Africa: a model analysis

ABSTRACT Background: HIV self-testing (HIVST) has been shown to be acceptable, feasible and effective in increasing HIV testing uptake. Novel testing strategies are critical to achieving the UNAIDS target of 95% HIV-positive diagnosis by 2025 in South Africa and globally. Methods: We modelled the impact of six HIVST kit distribution modalities (community fixed-point, taxi ranks, workplace, partners of primary healthcare (PHC) antiretroviral therapy (ART) patients), partners of pregnant 

COVID-19 modelling update: Considerations for a potential third wave

The South African COVID-19 Modelling Consortium (SACMC), of which a number of HE2ROs are members, has released a new report about the core modelling team's projections of a potential third wave of COVID-19 cases in South Africa. This report takes into account the impact of the Delta variant and the progress of the vaccination programme. The report is available below. Additionally, the day-to-day development in case numbers, hospital admissions and deaths can be tracked on 

The Cost and Intermediary Cost-effectiveness of Oral HIV Self-test kit Distribution Across 11 Distribution Models in South Africa

Background: Countries around the world seek innovative ways of closing their remaining gaps towards the target of 95% of people living with HIV (PLHIV) knowing their status by 2030. Offering kits allowing HIV self-testing (HIVST) in private might help close these gaps. Methods: We analysed the cost, use and linkage to onward care of 11 HIVST kit distribution models alongside the Self-Testing Africa Initiative’s distribution of 2.2 million HIVST kits in South Africa in 2018/2019. Outcomes 

Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

ABSTRACT Introduction: As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or 

Role of data from cost and other economic analyses in healthcare decision-making for HIV, TB and sexual/reproductive health programmes in South Africa

Abstract An increasing focus on the use of the results of cost analyses and other economic evaluations in health programme decision-making by governments, donors and technical support partners working in low- and middle-income countries is accompanied by recognition that this use is impeded by several factors, including the lack of skills, data and coordination between spheres of the government. We describe our experience generating economic evaluation data for human immunodeficiency virus, 

The Path From Evidence to Policy Change: Supporting the development of the South African HIV response – Step 1 Identifying the Problem: The HIV Care Cascade

In September 2016, South Africa adopted WHO recommendations to eliminate CD4 thresholds for ART initiation. As part of our commitment to support the South African Government, HE2RO assessed the country-specific implications of these international recommendations. In this step, we show how a team of investigators from HE2RO and Boston University identified shortcomings in the HIV Care Cascade and used country-specific data to inform the local HIV 

Getting resources to those who need them: the evidence we need to budget for underserved populations in sub-Saharan Africa

Abstract Introduction: In recent years, many countries have adopted evidence-based budgeting (EBB) to encourage the best use of limited and decreasing HIV resources. The lack of data and evidence for hard to reach, marginalized and vulnerable populations could cause EBB to further disadvantage those who are already underserved and who carry a disproportionate HIV burden (USDB). We outline the critical data required to use EBB to support USDB people in the context of the HIV epidemics of 

Brief #38: Translating and Adapting The National Strategic Plan for HIV, TB and STIs at The Local Level

A 10% increase in HIV prevalence was noted in the West Rand district municipality of Gauteng province between 2011 and 2015. This was anticipated as mortality rates declined due to a growing ART programme and patient adherence to treatment. Our research investigated how the burden of HIV is managed in the national and local policy frameworks, particularly looking at how South Africa’s National Strategic Plan (NSP) for HIV, TB and STIs is adapted for implementation at the municipal level 

Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia: A Landscape Analysis

ABSTRACT Introduction: Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. Methods: We interviewed DSD model implementing organizations for descriptive information about each of the organization’s 

Inpatient Care Costs of COVID-19 in South Africa’s Public Healthcare System

Background: Coronavirus disease 2019 (COVID-19) has had a devastating impact globally, with severe health and economic consequences. To prepare health systems to deal with the pandemic, epidemiological and cost projection models are required to inform budgets and efficient allocation of resources. This study estimates daily inpatient care costs of COVID-19 in South Africa, an important input into cost projection and economic evaluation models. Methods: We adopted a micro-costing approach, 

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