Recent Publications

Economic evaluation of short treatment for multidrug-resistant tuberculosis, Ethiopia and South Africa: the STREAM trial

Objective To investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for multidrug-resistant (MDR) tuberculosis. Methods We compared the costs to health systems and participants of long (20 to 22 months) and short (9 to 11 months) MDR tuberculosis regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and we estimated health-system costs using bottom-up 

Managing multidrug-resistant tuberculosis in South Africa: a budget impact analysis

S E T T ING: In South Africa prior to 2016, the standard treatment regimen formultidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) was 24 months long and required daily injectable aminoglycoside (IA) treatment during the first 6 months. Recent evidence supports the replacement of IA with well-tolerated oral bedaquiline (BDQ) and a shortened 9–12 month regimen. DESIGN: Using a Markov model, we analyzed the 5- year budgetary impact and cost per successful treatment outcome of four 

Eligibility for differentiated models of HIV treatment service delivery: an estimate from Malawi and Zambia.

Abstract Little is known about the proportion of HIV-positive clients on antiretroviral therapy (ART) who meet stability criteria for differentiated service delivery (DSD) models. We report the proportion of ART clients meeting stability criteria as part of screening for a randomized trial of multimonth dispensing in Malawi and Zambia. METHODS: For a DSD trial now underway, we screened HIV-positive clients aged at least 18 years presenting for HIV treatment in 30 adult ART clinics in 

Tailored HIV programmes and universal health coverage

Improvements in geospatial health data and tailored human immunodeficiency virus (HIV) testing, prevention and treatment have led to greater microtargeting of the HIV response, based on location, risk, clinical status and disease burden. These approaches show promise for achieving control of the HIV epidemic. At the same time, United Nations Member States have committed to achieving broader health and development goals by 2030, including universal health coverage (UHC). HIV epidemic control 

Ending the HIV Epidemic in the USA

Despite the scale-up of HIV prevention, testing, and treatment services, ongoing HIV transmission within the USA remains a major public health problem, with nearly 40 000 new HIV diagnoses in 2018 alone. In 2019 the US President Donald Trump announced a commitment to reduce HIV incidence in the USA by 75% by 2025, and by 90% by 2030, with the ultimate goal of ending the national HIV epidemic.The proposed increase in financial commitment was approved by the US Congress in the same year The 

The impact of self-selection based on HIV risk on the cost-effectiveness of preexposure prophylaxis in South Africa

This study aims to determine the cost-effectiveness of provision of daily oral PrEP in South Africa, a setting with one of the highest HIV prevalence levels in the world, whereas considering the possibility that those at higher risk of contracting HIV may self-select into the PrEP programme. Our focus on self-selection over supply-side targeting was informed by the TWG’s preference that a risk screening tool should not be used to determine whether an individual receives PrEP, to avoid 

Colorectal Cancer (CRC) treatment and associated costs in the public sector compared to the private sector in Johannesburg, South Africa

Background: South Africa’s divided healthcare system is believed to be inequitable as the population serviced by each sector and the treatment received differs while annual healthcare expenditure is similar. The appropriateness of treatment received and in particular the cost of the same treatment between the sectors remains debatable and raises concerns around equitable healthcare. Colorectal cancer places considerable pressure on the funders, yet treatment utilization data and the 

Impact of the test and treat policy on delays in antiretroviral therapy initiation among adult HIV positive patients from six clinics in Johannesburg, South Africa: results from a prospective cohort study

To assess delays to antiretroviral therapy (ART) initiation before and after the Universal Test and Treat (UTT) and the same-day initiation (SDI) of ART policy periods in Johannesburg, South Africa. Design Prospective cohort study. Setting Patients were recruited from six primary health clinics in Johannesburg. Participants Overall, 1029 newly diagnosed HIV positive adults (≥18 years) were consecutively enrolled by referral from the testing counsellor between April and December 2015 

Emerging priorities for HIV service delivery

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2018, an estimated 37.9 million people were living with HIV worldwide. There were also 1.7 million new infections and 770,000 deaths. • At the end of June 2019, 24.5 million people were receiving antiretroviral therapy (ART). Nonetheless, increased access to high-quality ART services is needed to further reduce mortality and new infections and to optimize long term outcomes. • In this article, we summarize 

HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa

Introduction: Officially rolled out on 01 September 2016, South Africa’s Universal Test and Treat (UTT) policy calls for first-line antiretroviral treatment (ART) initiation among all known HIV-positive patients, irrespective of CD4 cell count. We evaluate the treatment outcomes of patients initiated on first-line ART directly before and after the implementation of UTT. Methods: We analysed prospectively collected clinical cohort data among ART-naïve adult patients within two HIV clinics in