Recent Publications

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 

Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons 

Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub-Saharan Africa: a rapid systematic review

Abstract Introduction: Differentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will better meet the needs of patients, improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes. Methods: We conducted a rapid systematic review of peer-reviewed 

Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa

Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa. Methods: We developed a cost-outcome model utilizing NHLS data, including facility-level 

The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after 

The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after 

Cost and outcomes of drug-susceptible TB treatment at public and private primary healthcare clinics, Johannesburg South Africa

South Africa carries 3% of the world’s tuberculosis (TB) case burden and is experiencing a dual TB/HIV epidemic: 59% of adult TB patients are also HIV positive. There are no recent published estimates on the costs and outcomes of drug-susceptible TB in South Africa for adults in an out-patient setting with the exception of one paper published in 2003 (using 1997 data) and another in 2006 (using 2001 data) . The proposed National Health Insurance (NHI) system aims to re-engineer primary 

Using intervention mapping in motivational interviewing training to improve ART uptake in Gauteng, South Africa

In South Africa, lay HIV counsellors are at the forefront of many HIV-related behavioural interventions. However, they have limited formal counselling training and little ongoing in-service support, leading to considerable variability in approaches to counselling. We describe the use of Intervention Mapping to develop a motivational interviewing counselling training and support program, titled “Thusa-Thuso - helping you help”, for lay HIV counsellors practising in primary health care 

Treatment outcomes and costs of a simplified antiviral treatment strategy for hepatitis C among monoinfected and HIV and/or hepatitis B virus-co-infected patients in Myanmar

Access to hepatitis C virus (HCV) testing and treatment is limited in Myanmar. Weassessed an integrated HIV and viral hepatitis testing and HCV treatment strategy. Sofosbuvir/velpatasvir (SOF/VEL) ± weight-based ribavirin for 12 weeks was provided at three treatment sites in Myanmar and sustained virologic response (SVR) assessed at 12 weeks after treatment. Participants co-infected with HBV were treated concurrently with tenofovir. Cost estimates in 2018 USD were made at Yangon and Mandalay 

Delays in repeat HIV viral load testing for those with elevated viral loads: A national perspective from South Africa

The World Health Organization recommends national programs use viral load monitoring for patients on ART1 to determine whether treatment has been successful and to guide clinicians on when to switch treatment to second-line regimens, indicated if the virus is resistant to first-line therapy. Not all countries are able to provide viral load testing as part of national programs but for those that do, patients with an elevated viral load (VL) are recommended to undergo adherence counselling and