Recent Publications

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 

A Comparison of Results from Two Sampling Approaches in the South African National HIV Prevalence, Incidence and Behavior Survey, 2012

Background: South Africa implements variations of second-generation surveillance surveys to monitor the human immunodeficiency virus (HIV) epidemic. Objective: This paper compares HIV estimates from two design variations: take all approach and sub-sampling approach to ascertain if any changes in the HIV epidemic are due to methodological changes or the inherent evolution of the 

Novel metric for evaluating pre-exposure prophylaxis programme effectiveness in real-world settings

Summary Although large-scale provision of HIV pre-exposure prophylaxis (PrEP) is gaining momentum, no systematic method to evaluate or compare the effectiveness of different scale-up strategies in real-world settings exists. To date, estimating the effectiveness of PrEP has relied on clinical trials or mathematical models. We propose a novel and pragmatic metric to evaluate and compare programme effectiveness using routine implementation data. Using South African and Zambian PrEP guidelines, 

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa

Background Despite the success of prevention of mother to child transmission (PMTCT) program in South Africa, the 30% HIV prevalence among women of childbearing age requires the PMTCT program to be maximally efficient to sustain gains in the prevention of vertical HIV transmission. We aimed to determine the immunologic and virologic status at entry into antenatal care (ANC) and at childbirth among HIV positive women who conceived under the CD4<500 cells/μl antiretroviral therapy (ART) 

Reasons for late presentation for antenatal care, healthcare providers’ perspective

Background: Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers’ understanding of their patient’s behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women’s reasons for starting ANC later than 

Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial

HIV self-testing increases testing uptake in sub-Saharan Africa but scale-up is challenging because of resource constraints. We evaluated an HIV self-testing intervention integrated into high-burden outpatient departments in Malawi. Methods: In this cluster-randomised trial, we recruited participants aged 15 years or older from 15 outpatient departments at high-burden health facilities (including health centres, mission hospitals, and district hospitals) in central and southern Malawi. The 

Correspondence: First International Post-Tuberculosis Symposium

The First International Post-Tuberculosis Symposium was held in Stellenbosch, South Africa, on July 22–23, 2019, to discuss priorities and gaps that need to be addressed in order to provide guidance in this neglected area. The symposium involved 68 delegates across 12 disciplines from five continents, representing more than 27 institutions. Historically, inconsistency and lack of consensus in nomenclature and terminology have hampered work in this field. Using the Delphi process, the 

APPLYING MACHINE LEARNING TO LABORATORY DATA: PREDICTING SUPPRESSION OF NEXT HIV VIRAL LOAD IN SOUTH AFRICA

During 2018, South Africa was estimated to have more than seven million people living with HIV1, representing the largest single country epidemic2 and treatment program. 3 In September 2016, the National Department of Health revised its treatment guidelines to extend the availability of ART to all people living with HIV, irrespective of CD4 cell count and stage of disease3. This policy, widely referred to as “treat all” or “universal test and treat” (UTT) holds promise to offer 

Potential Impact and Cost-Effectiveness of Condomless-Sex–Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance

Introduction. Oral preexposure prophylaxis (PrEP) in the form of tenofovir-disoproxil-fumarate/emtricitabine is being implemented in selected sites in South Africa. Addressing outstanding questions on PrEP cost-effectiveness can inform further implementation. Methods. We calibrated an individual-based model to KwaZulu-Natal to predict the impact and cost-effectiveness of PrEP, with use concentrated in periods of condomless sex, accounting for effects on drug resistance. We consider (1) PrEP