Recent Publications

Perceived barriers to the uptake of health services among first-year university students in Johannesburg, South Africa

In South Africa, the 15-24-year age group are at an increased risk of HIV infection . In 2017, HIV incidence for young adults between the ages of 15–24 was 1.0% (95% CI 0.86–1.15), translating to an estimated 88 400 new infections . In the same year, WHO and other UN partners launched the Accelerated Action for the Health of Adolescents (AA-HA!), which called for the systematic inclusion of adolescents’ expectations and perspectives in health planning processes . However, many 

Brief #3: HIV, Population Dynamics and the Labour Force

AIDS-related mortality among working-age adults reduces GDP growth but has an ambiguous effect on GDP per capita. In the short run, population size decreases due to reduced fertility and increased child mortality owing to HIV, and GDP per capita increases, but this results in lower growth of the working-age population and of GDP in the long run. A smaller elderly cohort due to HIV-related early mortality mitigates the fiscal burden of an ageing population, but as HIV treatment is scaled 

Brief #4: Human Capital

AIDS-related mortality among young adults results in an increase in the number of orphans, and orphanhood is associated with impaired access to education. Early mortality among working-age adults causes a loss of skills and experience and a drop in returns to investment in education. Educational outcomes have weakened in regions with higher HIV prevalence but investments in the HIV response are effectively mitigating HIV’s negative impact on human 

Brief #5: Capital and Investment

The direct effects of health-related productivity shocks on economic output are magnified by their negative impact on investment. Poorer health decreases productivity, which results in lower economic output and consequently lower investment, which again reduces productivity and output over time. Higher mortality reduces incentives for saving and investment. Empirical studies (not HIV-specific) suggest that this could be an important link between HIV and growth, but there is no clear 

Brief #6: Productivity and Employment of People Living With HIV

Early on, there were concerns that AIDS-related mortality would erode state governance and institutions and thus compromise economic development, but there is little evidence to suggest that such effects have been significant. HIV – especially at late stages of disease progression –results in reduced productivity and lower employment of people living with HIV, though the economy-wide effects are unclear. Treatment has been effective in restoring the productivity and – with some 

Health provider perspectives on the implementation of the same‑day‑ART initiation policy in the Gauteng province of South Africa

Results: The data indicates inconsistencies across facilities and incongruities between counsellor and nursing provider perspectives regarding the SDI policy implementation. While nurses highlighted the clinical benefits of early  ART initiation, they expressed concerns that immediate ART may be overwhelming for some patients, who may be unprepared and likely to disengage from care soon after the initial acceptance of ART. Accordingly, the SDI implementation was slow due to limited patient 

Brief #7: Economic Growth – Overview

HIV has increased mortality and slowed population growth. As a consequence, GDP is lower and will remain lower than it would have been without the impact of HIV. Economic modelling suggests that the short- to medium-term impacts of HIV on GDP per capita are unclear, with important effects working in opposite directions. In the longer run, the effects are likely dominated by adverse impacts on education and skills. The empirical evidence on the link between HIV and growth of GDP per capita 

Brief #17: The Economics of HIV and of HIV Programmes in the Era of COVID-19

The Covid-19 pandemic has profound negative implications for the economies of countries most affected by HIV, as well as for donor countries that support the global HIV response. It undermines underlying economic fundamentals and adds considerations for HIV policymaking. This paper explores three interrelated ways in which the Covid-19 pandemic and the response to Covid-19 affect people living with HIV and the HIV response: (1) the health impacts of those living with or at risk of acquiring 

Community-based delivery of HIV treatment in Zambia: costs and outcomes

The DSD models assessed cost more per patient/year than conventional care. Costs ranged from an annual $116 to $199 for the DSD models, compared with $100 for conventional care. CAGs and UAGs increased retention by 2 and 14%, respectively. All DSD models cost more per patient retained at 12 months than conventional care. The CAG had the lowest cost/patient retained for DSD models ($140–157). Conclusions: Although they achieve equal or improved retention in care, out-of-facility models of 

Opportunities from a new disease for an old threat: Extending COVID-19 efforts to address tuberculosis in South Africa

The COVID-19 pandemic and phased nationwide lockdown have impacted negatively on individuals with tuberculosis (TB) and routine TB services. Through a literature review and the perspective of members of a national TB Think Tank task team, we describe the impact of the pandemic and lockdown on TB patients and services as well as the potential long-term setback to TB control in South Africa (SA). Strategies to mitigate risk and impact are explored, together with opportunities to leverage 

Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions

Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on population needs, and resource and infrastructure constraints. A diagnostic network additionally incorporates screening and includes point-of-care testing that may occur outside 

Incidence and predictors of sexually transmitted infections among adult HIV-positive patients receiving antiretroviral therapy at Themba Lethu HIV clinic in Johannesburg, South Africa

Background. Sexually transmitted infections (STIs) among people living with HIV/AIDS can facilitate the spread of HIV. Objectives. To estimate STI incidence and identify predictors of STI acquisition among HIV-positive patients during their first 24 months of antiretroviral therapy (ART) in Johannesburg, South Africa. Methods. We conducted a cohort study using prospectively collected routine data on patients who initiated ART between January 2004 and January 2015 at the Themba Lethu HIV