Recent Publications

What are the 12-month retention and viral suppression outcomes for South African ART clients enrolled in DSD models compared to conventional care?

BACKGROUND • South Africa has implemented several differentiated service delivery (DSD) models for HIV treatment. • Few comparisons of treatment outcomes between the country’s DSD model and conventional care are available. • We analyzed routine data to determine one-year rates of retention and viral suppression of clients enrolled in DSD 

How do nurses spend their time? A time and motion analysis in the context of differentiated service delivery at primary public healthcare facilities in South Africa

BACKGROUND • Among other benefits, differentiated service delivery (DSD) models are expected to reduce the time that clinicians spend with established ART clients enrolled in DSD models and thus increase available provider time for non-DSD ART and non-ART clients. • The actual use of provider time after DSD model implementation has not been reported. • We measured healthcare provider time utilization in the context of DSD model implementation in South 

Does implementing differentiated service delivery models result in greater job satisfaction for providers? Lessons from Malawi, South Africa, and Zambia

 Differentiated service delivery (DSD) models for HIV treatment are expected to improve healthcare providers’ quality of professional life by reducing the patient/provider ratio and allowing providers to spend more time with recipients-of-care in need.   We interviewed various cadres of healthcare providers to evaluate the effect of DSD models on job 

No differences in recipients of care perceived quality of care between differentiated service delivery models and conventional care in South Africa

BACKGROUND • Like many countries across sub-Saharan Africa, South Africa has been scaling up differentiated service delivery (DSD) models to improve ART coverage • DSD models aim to increase HIV treatment programs’ responsiveness to the individual needs of recipients of care (RoC) to improve treatment outcomes and quality of life. • Current evidence shows that compared to conventional care, DSD models of care can lead to slightly improved treatment outcomes, lower costs for 

Patient losses from HIV care across HIV treatment guideline periods between 2016 and 2020 in six provinces of South Africa

Background: South Africa’s move to universal HIV test and treat (UTT) and same-day initiation (SDI) of antiretroviral therapy (ART) improved treatment uptake with hopes of also reducing patient losses from care. Methods: We included all patients diagnosed with HIV at public-sector health facilities in 2015-2019 and represented on the clinical database in participating provinces (six of nine) in South Africa. Patients were followed up from the date of HIV diagnosis to 12 months. We 

Talking about Treatment-as-Prevention and U=U: patient needs and health worker perspectives

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 (PLHIV) and barriers and facilitators to TasP communication among health care workers in South 

Modeling the impact and cost-effectiveness of interventions for retention in HIV care

Universal eligibility for antiretroviral therapy (ART) in sub-Saharan Africa (SSA) has reduced HIV transmissions and deaths among people living with HIV (PLHIV). A growing proportion of transmissions and deaths now occur among PLHIV who have interrupted ART. Dozens of interventions to improve retention on ART have been proposed, but most of them cost more than standard-of-care. Research is needed to inform the upper-bound costs at which such interventions should be adopted. We used three HIV 

Perspectives on the use of modelling and economic analysis to guide HIV programmes in sub-Saharan Africa

HIV modelling and economic analyses have had a prominent role in guiding programmatic responses to HIV in subSaharan Africa. However, there has been little reflection on how the HIV modelling field might develop in future. HIV modelling should more routinely align with national government and ministry of health priorities, recognising their legitimate mandates and stewardship responsibilities, for HIV and other wider health programmes. Importance should also be placed on ensuring collaboration 

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 

Virologic non-suppression and early loss to follow up among pregnant and non-pregnant adolescents aged 15–19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study

Abstract Introduction: Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non-suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods: 

Tracing People Living With Human Immunodeficiency Virus Who Are Lost to Follow-up at Antiretroviral Therapy Programs in Southern Africa: A Sampling-Based Cohort Study in 6 Countries

Background: Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of  people living with human immunodeficiency virus (PLHIV) who were lost to follow-up (LTFU) during 2014–2017 at ART programs in Southern Africa. Methods: We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU