Recent Publications

Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study

Abstract: Background: Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART. Methods and Findings: Analyses included 46,201 ART-naı¨ve adults starting ART between January 2002 and December 2009 in eight ART programmes across South Africa (SA). Patients were followed from initiation of ART to outcome or analysis closure. The primary outcome was 

Scaling up Xpert MTB/RIF technology: the costs of laboratory- vs. clinic-based roll-out in South Africa

Abstract: Objective: The World Health Organization recommends using Xpert MTB/RIF for diagnosis of pulmonary tuberculosis (PTB), but there is little evidence on the optimal placement of Xpert instruments in public health systems. We used recent South African data to compare the cost of placing Xpert at points of TB treatment (all primary clinics and hospitals) with the cost of placement at sub-district laboratories. Methods: We estimated Xpert’s cost/test in a primary clinic pilot and in the 

Prevalent Pregnancy, Biological Sex, and Virologic Response to Antiretroviral Therapy

Abstract: Objective: Pregnancy is a common indication for initiation of highly active antiretroviral therapy (HAART) in sub-Saharan Africa. Our objective was to evaluate how pregnancy at treatment initiation predicts virologic response to HAART. Methods: We evaluated an open cohort of 9,173 patients who initiated HAART between April 2004 and September 2009 in the Themba Lethu Clinic in Johannesburg, South Africa. Risk ratios were estimated using log-binomial regression; hazard ratios were 

Feasibility, Yield, and Cost of Active Tuberculosis Case Finding Linked to a Mobile HIV Service in Cape Town, South Africa: A Cross-sectional Study

The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing 

Feasibility, Yield, and Cost of Active Tuberculosis Case Finding Linked to a Mobile HIV Service in Cape Town, South Africa: A Cross-sectional Study

Abstract: Background: The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service. Methods and Findings: The study was conducted at a mobile HIV 

TB/HIV integration at primary care level: A quantitative assessment at 3 clinics in Johannesburg, South Africa

Abstract: Background. In 2004 the World Health Organization (WHO) released the Interim Policy on Collaborative TB/HIV activities. According to the policy, for people living with HIV (PLWH), activities include intensified case finding, isoniazid preventive therapy (IPT) and infection control. For TB patients, activities included HIV counselling and testing (HCT), prevention messages, and cotrimoxazole preventive therapy (CPT), care and support, and antiretroviral therapy (ART) for those with 

Estimated use of abacavir among adults and children enrolled in public sector antiretroviral therapy programmes in Gauteng Province, South Africa

Abstract: In South Africa, abacavir (ABC) is currently recommended as part of first- and second-line antiretroviral therapy (ART) for HIV-positive paediatric patients. Concerns about overprescribing of the drug, particularly to adults, led to an analysis of ABC use in public sector ART programmes. We investigated current prescription of the drug to adults and children accessing ART in 4 public sector programmes across Gauteng Province, South Africa. ABC was almost exclusively prescribed to 

Rates and Predictors of Failure of First-line Antiretroviral Therapy and Switch to Second-line ART in South Africa

Abstract: Objectives: To measure rates and predictors of virologic failure and switch to second-line antiretroviral therapy (ART) in South Africa. Design: Observational cohort study. Methods: We included ART-naive adult patients initiated on public sector ART (January 2000 to July 2008) at 5 sites in South Africa who completed ≥6 months of follow-up. We estimated cumulative risk of virologic failure (viral load ≥400 copies/mL with confirmation above varying thresholds) and switching to 

IAEN: 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 hospitalized from treatment initiation until culture conversion.  To evaluate the potential savings from outpatient MDR-TB treatment, we estimated the cost of inpatient care per patient admitted to the North West provincial drug-resistant TB hospital. Methods:  All resources utilized by patients admitted to the MDR-TB hospital between March 2009 and February 2010 were abstracted from medical 

AIDS 2012: 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. Viral 

AIDS 2012: 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