Recent Publications

Second line failure and protease inhibitor resistance in a clinic in Johannesburg, South Africa

Abstract Background: In resource limited settings, where few options exist for patients failing second line antiretroviral therapy (ART), programmatic approaches to treatment failure must be developed. We report on an approach to standardizing care for patients on second-line in South Africa. Methodology: We conducted a retrospective study of 314 patients on second line protease inhibitor (PI) ART with a HIV-1 RNA >400 copies/ml at Themba Lethu Clinic in Johannesburg, South Africa 

Long-term Virologic Response in a Cohort of HIV-infected Patients in South Africa

Abstract Background: While much is known about virologic response to antiretroviral therapy (ART) in resource rich settings, much less is known about long-term rates of virologic suppression in resource-limited settings. We aimed to describe virologic response on ART over 8 years among a cohort of patients initiating ART the first year of the public sector roll out in South Africa. Methodology: We included all ART-naïve patients, ≥18 years, who initiated first-line ART from April 

Predictors of Time to Switch to Second Line ART after First Line Failure in Johannesburg, South Africa

Abstract Background: Many patients with documented virologic treatment failure on first line antiretroviral therapy (ART) need to be switched to a second line regimen. In South Africa, national treatment guidelines state that patients with two consecutive failing viral load measurements on non-nucleoside reverse transcriptase inhibitor first line treatment should be switched to a protease inhibitor based regimen. Yet, there are often long delays in switching if it occurs at all. To better 

Risk Factors Associated with TB in Children Receiving ART in a South African Multicenter HIV Cohort

Abstract Background: Tuberculosis (TB) in children is a direct consequence of adult TB and is a good marker of current trends in community transmission.  We sought to estimate rates of, and risk factors for, incident TB among HIV-infected children and adolescents receiving antiretroviral treatment (ART) in South Africa. Methods: Prospective cohort analysis of HIV-infected children <18 years old who initiated ART between April 2004 and May 2011 at one of 12 HIV clinics in Gauteng and 

Obesity or hypertension at ART initiation and outcomes amongst HIV patients in South Africa

Abstract Background: Aging, antiretroviral therapy (ART) and HIV infection itself have all been associated with increasing rates of chronic comorbidities in HIV patients but there are limited data on chronic disease risk factors and HIV treatment outcomes in resource-limited settings. We evaluated the association between high body mass index (BMI) or hypertension at ART initiation and mortality, loss to follow-up (LTF), and immunological and virologic response among HIV-positive patients on 

Predictors of incident hypertension in HIV-positive adults over 24 months on ART in South Africa

Abstract  Background: As the current HIV population ages and access to antiretroviral therapy (ART) increases in resource-limited settings, the number of patients developing non-communicable chronic diseases on ART will also increase. In view of limited research on this topic in resource-limited settings, we sought to examine predictors of hypertension in a large urban HIV clinic in South Africa. Methods. Prospective study of hypertension over 24 months on ART among 12376 ART naïve adults 

Poor CD4 recovery and risk of subsequent progression to AIDS or death despite viral suppression in a South African cohort

Abstract:  Introduction: The prognostic role of CD4 response in the first six months of treatment in patients achieving early viral suppression during HIV treatment is unclear. Methods: This was a cohort study of HIV-positive adults initiating antiretroviral therapy (ART) between April 2004 and August 2007 who achieved viral suppression (B400 copies/ml) by six months on treatment in South Africa. Immunological response at six months was defined as: (1) absolute CD4 reached (B200 vs. ]200 

A Synopsis of the South African Provincial Strategic Plans and Budget Allocations for HIV/AIDS and TB

Abstract The highest population of people living with HIV/AIDS is found in South Africa. It has the highest HIV prevalence of 17.9% 1, with an estimated 6,100,000 people living with HIV/AIDS. The South African government has over the years taken major steps to avert the disease through implementing health and HIV/AIDS policies, supported by increasing allocations from the national revenue. South Africa has aligned its policies with UNAIDS guidelines for the elimination of the pandemic 

Policy Brief 7: Technical support to the South African government to improve financial management of HIV/AIDS

Background In 2013, the Financial Capacitation for Provincial HIV Managers (FIN-CAP) programme was launched by HE2RO and the Centre for Economic Governance and AIDS in Africa (CEGAA) to help capacitate national and provincial government departments in the areas of financial management, costing, budgeting, and expenditure tracking for HIV, based on the team’s experience in costing the Provincial Strategic Implementation Plans (PSIPs). To reduce duplication or overlap with similar initiatives, 

Prevalence and incidence of symmetrical symptomatic Peripheral Neuropathy in patients with Multidrug-Resistant TB

Abstract Objective: To assess whether use of stavudine both before and during treatment for MDR TB increased the prevalence and incidence of SSPN.  Method: MDR TB patients at Sizwe Tropical Disease Hospital were examined for signs of prevalent SSPN. Age, gender, HIV status, alcohol use, TB and HIV treatment regimens both prior to admission and current, and concomitant medications were recorded.  Results: In this cohort of 246 patients, we found that 24.4% of patients with MDR TB had SSPN at 

Strengthening the HIV cascade to ensure an effective future ART response in sub-Saharan Africa

Abstract Timely linkage to antiretroviral therapy (ART) care is critical for reducing HIV-related morbidity, mortality and transmission. Studies investigating interventions to improve linkage to, and retention in, pre-ART care in sub-Saharan Africa were reviewed. Certain interventions used to overcome economic barriers for ART-patients (i.e. integration of services, medical and food incentives, intensified counselling and peer support) have also shown favourable results in the pre-ART period. 

Non-ignorable loss to follow-up: correcting mortality estimates based on additional outcome ascertainment

Abstract:  Loss to follow-up (LTFU) is a common problem in many epidemiological studies. In antiretroviral treatment (ART) programs for patients with human immunodeficiency virus (HIV), mortality estimates can be biased if the LTFU mechanism is non-ignorable, that is, mortality differs between lost and retained patients. In this setting, routine procedures for handling missing data may lead to biased estimates. To appropriately deal with non-ignorable LTFU, explicit modeling of the missing