Recent Publications

Pregnancy and Virologic Response to Antiretroviral Therapy in South Africa

Abstract Background: Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in that setting. We examined the effect of incident pregnancy after HAART initiation on virologic response to HAART. Methods and Findings: We evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April 

Policy Brief 2: Shifting management of stable ART patients from doctors at hospitals to nurses at primary health clinics in South Africa

Background HIV/AIDS is placing the health systems of many resource-constrained countries under tremendous pressure. Shortages of human and infrastructural resources have become a major constraint to continued expansion of access to HIV care and treatment. Shifting clinical responsibilities to lesser trained, less expensive, and generally less scarce cadres of the clinical workforce and to lower level healthcare facilities is widely regarded as one solution to this problem. Policy Brief 

Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review

Abstract Background: Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkage of patients testing positive for HIV to pre–antiretroviral therapy (ART) care and retention in pre-ART care until ART initiation. We conducted a systematic review of pre-ART retention in care in Africa. Methods and Findings: We searched PubMed, ISI Web of Knowledge, conference abstracts, and reference lists for reports on the proportion of adult patients 

Treatment outcomes and cost-effectiveness of shifting management of stable ART patients to nurses in South Africa: an observational cohort

Abstract: Background: To address human resource and infrastructure shortages, resource-constrained countries are being encouraged to shift HIV care to lesser trained care providers and lower level health care facilities. This study evaluated the cost-effectiveness of down-referring stable antiretroviral therapy (ART) patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health care facility in Johannesburg, South Africa. Methods and Findings: Criteria for 

The Cost of the Xpert Diagnostic Algorithm for TB Results of the National TB Cost Model (NTCM) 2011/12 to 2016/17

South Africa bears a large share of the global burden of HIV and tuberculosis co-infection. The GeneXpert System (Cepheid) using the Xpert MTB/RIF assay, a cassette-based cartridge, has provided the possibility of a rapid diagnosis of tuberculosis, while simultaneously providing a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and has received a strong recommendation from the World Health Organization (WHO) in 

Paediatric human immunodeficiency virus treatment outcomes from a resource limited setting in South Africa: Highly active antiretroviral therapy alone is not enough

Abstract Comprehensive care of human immunodeficiency virus (HIV)-infected children in the resource-poor setting is challenging, and published reports on treatment outcomes in this setting are limited. The aim of this study was to evaluate outcomes of HIV-infected children initiated on highly active antiretroviral therapy (HAART) between April 2005 and April 2009 at a primary health-care centre in Alexandra Township, South Africa. Of the 337 patients initiated on HAART, 83% (281 of 337) were 

Policy Brief 1: The Incremental Cost of Introducing Xpert MTB/RIF into the South African National TB Programme

Background South Africa bears a large share of the global burden of HIV/tuberculosis co-infection. The Cepheid GeneXpert System using the Xpert MTB/RIF assay http://www.cepheid.com/systems-and-software/genexpert-system/), a cassette-based cartridge, has provided the possibility of a rapid, point-of-care diagnosis of tuberculosis (TB) and, simultaneously, a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and received a 

The net cost of incorporating resistance testing into HIV/AIDS treatment in South Africa: a Markov model with primary data

Abstract  Background: Current guidelines for providing antiretroviral therapy (ART) in South Africa’s public sector programme call for switching patients from first-line to second-line treatment upon virologic failure as indicated by two consecutive viral loads above 5000 copies/ml, but without laboratory evidence of viral resistance. We modelled the net cost of adding resistance testing for patients with virological failure and retaining patients without resistance on first-line therapy, 

Response to: defaulting from antiretroviral treatment programmes in sub-Saharan Africa: a problem of definition

Abstract: The recent letter to the editors by Grimsrud et al. (2011) in response to our review of rates of retention in antiretroviral treatment programmes in sub-Saharan Africa (Fox & Rosen 2010) raises two concerns that we would like to comment on. First, the authors make the point that there was variability in the definitions of loss to follow-up (LTFU) used by the studies we summarized. This is correct: as is clearly noted in the paper, we did not have access to the primary data used 

Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa

Abstract Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. 

The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa

Abstract Background: Adherence to care and treatment are essential for HIV-infected individuals to benefit from antiretroviral therapy (ART). We sought to quantify the effects on treatment outcomes of missing visits soon after initiating ART. Methods: We analyzed data from HIV-infected patients initiating ART at Themba Lethu Clinic, Johannesburg, South Africa, from April 2004 to August 2008. We used log-binomial regression to evaluate the relative risk of missing visits during the first six 

Economic outcomes of patients receiving antiretroviral therapy for HIV/AIDS in South Africa are sustained through three years on treatment

Abstract Background: Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation. Methodology/Principal Findings: A