Recent Publications

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 

Population density and basic reproductive number of COVID-19 across United States counties

Abstract The basic reproductive number (R0) is a function of contact rates among individuals, transmission probability, and duration of infectiousness. We sought to determine the association between population density and R0 of SARS-CoV-2 across U.S. counties. We conducted a cross-sectional analysis using linear mixed models with random intercept and fixed slopes to assess the association of population density and R0, and controlled for state-level effects using random intercepts. We also 

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 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 

Fast-track treatment initiation counselling in South Africa: A cost-outcomes analysis

Abstract Introduction: In 2016, under its new National Adherence Guidelines (AGL), South Africa formalized an existing model of fast-track HIV treatment initiation counselling (FTIC). Rollout of the AGL included an evaluation study at 24 clinics, with staggered AGL implementation. Using routinely collected data extracted as part of the evaluation study, we estimated and compared the costs of HIV care and treatment from the provider’s perspective at the 12 clinics implementing the new,