Recent Publications

Diagnosing Xpert MTB/RIF negative TB: impact and cost of alternative algorithms for South Africa

Abstract:  Background: Use of Xpert MTB/RIF is being scaled up throughout South Africa for improved diagnosis of tuberculosis (TB). A large proportion of HIV-infected patients with possible TB are Xpert-negative on their initial test, and the existing diagnostic algorithm calls for these patients to have sputum culture (Xpert followed by culture (X/C)). We modelled the costs and impact of an alternative diagnostic algorithm in which these cultures are replaced with a second Xpert test (Xpert 

Cost and outcomes of paediatric antiretroviral treatment in South Africa

Abstract: Objective: Little is known about the cost of paediatric antiretroviral treatment (ART) in low- and middle-income countries. We analysed the average cost of providing paediatric  ART in South Africa during the first two years after ART initiation, stratified by patient outcomes. Methods: We collected data on outpatient resource use and treatment outcomes of 288 children in two Johannesburg public hospitals, Empilweni Services and Research Unit (ESRU) and Harriet Shezi Children’s 

Validation of Cervical Cancer Screening Methods in HIV Positive Women from Johannesburg South Africa

Abstract Background: HIV-infected women are at increased risk for developing cervical cancer. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. We evaluated three cervical cancer screening methods to detect cervical intraepithelial neoplasia grade 2 and above (CIN 2+) in HIV-infected women in South Africa; Pap smear, visual inspection with 5% acetic acid (VIA) and human papillomavirus detection (HPV).  Methods: 

ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics

Abstract:  Introduction: After almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability. Methods: Using patient-level data from medical records (n120/site), we estimated the cost of providing ART at three treatment sites in the Rift Valley Province of 

Antiretroviral therapy, labor productivity, and sex: a longitudinal cohort study of tea pluckers in Kenya

Abstract: Objective: To estimate the impact of antiretroviral therapy (ART) on labour productivity and income using detailed employment data from two large tea plantations in western Kenya for HIV-infected tea pluckers who initiated ART. Design: Longitudinal study using primary data on key employment outcomes for a group of HIV-infected workers receiving antiretroviral therapy (ART) and workers in the general workforce. Methods: We used nearest-neighbour matching methods to estimate the 

Costs of inpatient treatment for multi-drug-resistant tuberculosis in South Africa

Abstract: Background: In South Africa, patients with multi-drug-resistant tuberculosis (MDR-TB) are hospitalised from MDR-TB treatment initiation until culture conversion. Although MDR-TB accounts for <3% of incident TB in South Africa, 55% of the public sector TB budget is spent on MDR-TB. To inform new strategies for MDR-TB management, we estimated the per-patient cost (USD 2011) of inpatient MDR-TB treatment. Methods: All resources used by patients admitted to the MDR-TB hospital with 

Cost and Resource Use of Patients on Antiretroviral Therapy in the Urban and Semiurban Public Sectors of South Africa

Abstract: Background: South Africa has the world’s largest number of patients on antiretroviral treatment (ART). As coverage expands beyond urban environments, the cost of care is becoming increasingly important. Methods: Health care cost data for the first year after initiation were analyzed for cohorts of patients in a semiurban and an urban public sector ART clinic in South Africa. We compared mean cost by CD4 cell count and time on ART between clinics. Results: Patients in both clinics 

Defining retention and attrition in pre-antiretroviral HIV care: proposals based on experience in Africa

Abstract: Objective: To propose practical, standardized definitions for reporting retention for pre-ART care. Method: Definitions footed on three stages: Stage 1, testing HIV-positive to initial ART eligibility assessment; Stage 2, initial assessment to ART eligibility; and Stage 3, ART eligibility to ART initiation. For each stage, negative outcomes include death, loss, or not being retained. Results: Stage 1 Retention: proportion of patients who complete initial ART eligibility assessment 

Policy Brief 4: Changing from stavudine to tenofovir in first line antiretroviral therapy in South Africa

Background Under South Africa’s original public sector antiretroviral therapy (ART) guidelines, introduced in 2004, the antiretroviral drug stavudine (d4T) was one of three antiretroviral drugs (ARVs) that formed the mainstay of first-line treatment. Toxicities associated with stavudine use are common, however, and led to calls to substitute for stavudine a drug with fewer side effects. HERO policy brief 4 -- Changing from stavudine to tenofovir - 15 Oct 

Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: An evaluation of a pilot program in South Africa

Abstract: Background: A mobile HIV counseling and testing (HCT) program around Johannesburg piloted the integration of point-of-care CD4 testing, using the Pima™ Analyzer, to improve linkages to HIV care. We report results from this pilot program for patients testing positive (n=508) from May–October 2010. Methods: We analyzed three primary outcomes: assignment to testing group (offered POC CD4 or not; successful follow up (by phone); and completed the referral visit for HIV care within 8 

Treatment outcomes after 7 years of public-sector HIV treatment

Abstract: Objectives: To assess outcomes over the first 7 years of antiretroviral therapy (ART) at Themba Lethu Clinic, Johannesburg, South Africa. Design: Observational cohort study. Methods: Patients are managed according to South African National Treatment Guidelines. Mortality is ascertained through linkage with the national vital registration system. Loss to follow-up is defined as at least 3 months late for the last scheduled appointment. Results: Between April 2004 and March 2010, 13