Recent Publications

The impact of antiretroviral therapy on quality of life and economic outcomes for South African patients: five-year follow-up

Abstract Background: The rapid expansion of antiretroviral therapy (ART) programs in resource-constrained countries in the previous decade has led to large numbers of patients reaching !5 years on ART, but little evidence exists about long-term economic outcomes. We report the effect of ART on symptoms, general health, ability to perform normal activities, and employment among patients in South Africa during the first five years on treatment. Methods: A cohort of 1065 adult South African 

Incident pulmonary tuberculosis on antiretroviral therapy: seven years of experience at the Themba Lethu Clinic in Johannesburg, South Africa

Abstract Background: South Africa continues to have the largest HIV treatment program in the w orld alongside one of the w orld's largest tuberculosis (TB) epidemics. While antiretroviral therapy (ART) reduces the risk of acquiring TB for HIV-infected patients, rates of TB for those on ART remain high. After seven years of delivering HIV treatment, w e describe rates and predictors of incident TB over time in patients initiating ART at a large HIV clinic in South Africa. Methods: We 

CD4 criteria improves the sensitivity of a clinical algorithm developed to identify viral failure in HIV-positive patients on first-line antiretroviral therapy

Abstract Background: Routine viral load monitoring of patients on antiretroviral therapy (ART) is neither affordable nor available in most resource-limited settings. We used data from an electronic patient management system to develop an algorithm to identify patients at risk of viral failure using a combination of accessible and inexpensive markers. Methods: We analyzed data from HIV-positive adults initiated on ART at Themba Lethu Clinic, South Africa between April 2004-February 2010. 

Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary health clinic in Johannesburg, South Africa

Abstract Background: A significant challenge to South Africa's national ART program is poor retention among HIV-positive patients. Studies investigating retention typically focus on post-ART retention, or isolated periods of pre-ART care (i.e. CD4 staging), but do not follow a cohort from testing through time on treatment to measure retention throughout early HIV care. We report patient retention at three stages of pre-ART care and two stages of post-ART care to identify when greatest 

Reduced loss to ART initiation among patients initiating cotrimoxazole prophylaxis therapy in Johannesburg, South Africa

Abstract Background: Loss of patients eligible for ART prior to initiation is a major challenge for HIV care throughout sub-Saharan Africa, yet few effective interventions have been identified to mitigate the problem. Cotrimoxazole prophylaxis therapy has been shown to reduce HIV-related opportunistic infections and mortality on antiretroviral therapy, and limited research suggests it may be associated with improved patient retention. We investigated the effect of cotrimoxazole on ART 

Initiation of ART at higher CD4 counts under South Africa’s revised antiretroviral therapy guidelines results in improved patient outcomes

Abstract Background: In August 2011, in accordance with current WHO guidelines, South Africa expanded its ART guidelines to allow treatment initiation at CD4 values ≤350 cells/mm3 for all adults and adolescents. While mortality and morbidity are known to be improved at initiating at higher CD4 levels, the impact on patient loss to follow-up (LTFU) remains unclear. Using data from a Johannesburg primary health clinic that has offered routine ART initiation at CD4 ≤350 since 2010, 

HIV Treatment as Prevention: Modelling the Cost of Antiretroviral Treatment-State of the Art and Future Directions

Abstract: Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting the cost of such scale-up in comparison to the benefits from reduced HIV incidence and mortality. We review the available literature on modelled estimates of the cost of providing ART to different populations around the world, and suggest alternative methods of characterising cost when modelling several decades into the 

HIV Treatment as Prevention: Models, Data, and Questions—Towards Evidence-Based Decision-Making

Abstract Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different 

HIV Treatment Produces Economic Returns Through Increased Work And Education, And Warrants Continued US Support

Abstract: Federal expenditures are under scrutiny in the United States, and the merits of continuing and expanding the President's Emergency Plan for AIDS Relief (PEPFAR) to support access to antiretroviral therapy have become a topic of debate. A growing body of research on the economic benefits of treatment with antiretroviral therapy has important implications for these discussions. For example, research conducted since the inception of PEPFAR shows that HIV-infected adults who receive 

Prevalence of peripheral neuropathy in antiretroviral therapy naïve HIV-positive patients and the impact on treatment outcomes – a retrospective study from a large urban cohort in Johannesburg, South Africa

Abstract: Peripheral neuropathy (PN) is associated with advanced HIV disease and may be a complication of antiretroviral therapy (ART) or anti-tuberculosis (TB) drugs, specifically isoniazid (INH). The effect of non-ART-drug-related PN on treatment outcomes is yet to be determined. We analysed prospectively collected cohort data for HIV-infected ART-naive adults initiating ART at the Themba Lethu Clinic, Johannesburg, South Africa from June 2004 to June 2009. Patients who presented with signs