Recent Publications

Integrating ‘undetectable equals untransmittable’ into HIV counselling in South Africa: the development of locally acceptable communication tools using intervention mapping

Abstract Background The global campaign for “Undetectable equals Untransmittable” (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South 

Future HIV epidemic trajectories in South Africa and projected long-term consequences of reductions in general population HIV testing: a mathematical modelling study

Summary Background After successful intensive interventions to rapidly increase HIV awareness, coverage of antiretroviral therapy (ART), and viral suppression, HIV programmes in eastern and southern Africa are considering scaling back of some interventions, such as widespread general population HIV testing. We aimed to model whether scaling back of general population HIV testing in South Africa could result in a resurgence of the HIV epidemic or substantial slowing of declines in HIV 

HIV and Mental Health Outcomes of Violence Exposed Women in SA

Situation of violence exposed women living with HIV in SA Sub-Saharan Africa have the highest prevalence of intimate partner violence among women aged 15-49, ranging from 33% - 51%, (WHO, 2021) 37% of women living in the poorest countries have experienced some IPV in their life, with some as high as 1 in 2.  The rate of violence against women in South Africa is among the highest in the 

“Emotional stress is more detrimental than the virus itself”: A qualitative study to understand HIV testing and pre-exposure prophylaxis (PrEP) use among internal migrant men in South Africa

Abstract Introduction South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non-migrant men of acquiring HIV yet are less likely to test or use pre-exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. Methods We recruited 30 

Evolving Trends in early ART Initiation in South Africa: An Analysis of Integrated HIV Program Data

Background and Objective South Africa (SA) faces a significant burden of HIV infection, and the country has progressively improved HIV treatment guidelines to ensure rapid and sustained viral suppression. However, despite the implementation of the Universal Test and Treat (UTT) policy, challenges persist in achieving optimal antiretroviral therapy (ART) initiation rates and treatment outcome We describe the trends of the time between HIV diagnosis and the initiation of antiretroviral 

DSD is associated with better outcomes for established clients in the first 3 years on ART

Background Replacing routine clinic visits with differentiated service delivery (DSD) models for HIV treatment could benefit DSD clients and the health system, but its value depends on maintaining or improving patient outcomes. South Africa's DSD models include facility pick-up points, external pick-up points and adherence clubs, which facilitate easier access of medication and can reduce full clinic visits to 2 per year, down from 6 per year. We conducted a prospective record review to 


In 2023, the Health Economics and Epidemiology Research Office (HE²RO) continued to expand its research and evaluation projects in South Africa and neighbouring countries. Some highlights of the year are noted below. A follow on to the Indlela: Behavioural Insights for Better Health project was awarded led by the team at HE²RO. This award will now see the Indlela unit expanding its reach to other countries within the region and extending their behavioural hub (B-Hub) cohort with the 

Patterns of engagement in care during clients’ first 12 months after HIV treatment initiation in South Africa: A retrospective cohort analysis using routinely collected data

Abstract Retention on antiretroviral therapy (ART) during the early treatment period is one of the most serious challenges facing HIV programs, but the timing and patterns of early disengagement from care remain poorly understood. We describe patterns of engagement in HIV care during the first year after treatment initiation. We analysed retrospective datasets of routinely collected electronic medical register (EMR) data for ≥18-year-old clients who initiated ART at public sector clinics in 

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

Background: Pregnant and breastfeeding women (PBW) in sub-Saharan Africa have high HIV incidence rates and associated risk of vertical transmission to their infants. Oral preexposure prophylaxis (PrEP) and injectable PrEP (long-acting cabotegravir, or CAB-LA) can potentially reduce this HIV transmission, but population-level impacts are uncertain. Methods: We extended a previously developed model of HIV and PrEP in South Africa to allow for variable PrEP duration and preference in PBW. We 

Innovating with HIV self-testing for impact in southern Africa: Lessons learned from the STAR (Self-Testing AfRica) Initiative

Abstract Background This study evaluates the implementation and running costs of an HIV self-testing (HIVST) distribution program in Eswatini. HIVST kits were delivered through community-based and workplace models using primary and secondary distribution. Primary clients could self-test onsite or offsite. This study presents total running economic costs of kit distribution per model between April 2019 and March 2020, and estimates average cost per HIVST kit distributed, per client 

Migrant men and HIV care engagement in Johannesburg, South Africa

Abstract Background South Africa (SA) has one of the highest rates of migration on the continent, largely comprised of men seeking labor opportunities in urban centers. Migrant men are at risk for challenges engaging in HIV care. However, rates of HIV and patterns of healthcare engagement among migrant men in urban Johannesburg are poorly understood. Methods We analyzed data from 150 adult men (≥18 years) recruited in 10/2020–11/2020 at one of five sites in Johannesburg, Gauteng Province,