Recent Publications

How do nurses spend their time? A time and motion analysis in the context of differentiated service delivery at primary public healthcare facilities in South Africa

Among other benefits, differentiated service delivery (DSD) models are expected to reduce the time that clinicians spend with established ART clients enrolled in DSD models and thus potentially increase available provider time for non-DSD ART and non-ART clients. The actual use of provider time after DSD model implementation has not been reported. We measured healthcare provider time utilization in the context of DSD model implementation in South 

The relative cost-effectiveness of long-acting injectable cabotegravir versus oral pre-exposure prophylaxis: a modelled economic evaluation and threshold analysis in South Africa based on the HPTN 083 and 084 trials

Long-acting cabotegravir (CAB-LA), administered 2-monthly, is more effective at preventing HIV infection than daily oral tenofovir (TDF)/emtricitabine (FTC), but its cost-effectiveness in a high-prevalence setting is not known. We estimated the cost-effectiveness of CAB-LA compared to TDF/FTC in South Africa and determined the threshold price at which CAB-LA is as cost-effective as 

Observed time to HIV treatment initiation in the era of same-day initiation in Malawi, South Africa, and Zambia

Since 2017 global guidelines have recommended “same-day initiation” (SDI) of antiretroviral treatment (ART) for patients considered ready for treatment on the day of HIV diagnosis. Many countries in sub-Saharan Africa have incorporated a SDI option into national guidelines, but uptake of SDI is not well documented. We estimated average time to ART initiation at 12 public healthcare facilities in Malawi, 5 in South Africa, and 12 in 

Do differentiated models of care for HIV treatment result in lower costs for recipients of care in Zambia?

One of the benefits that differentiated service delivery (DSD) models for HIV treatment are assumed to generate is a reduction in direct and indirect costs to recipients of care (RoC), but the savings that come with reduced costs must vary among the widely diverse DSD models. We estimated the costs to RoC of nine discrete models currently in routine use in Zambia, compared to conventional 

Scale-up of “same-day ART initiation” in South Africa

Initiation of HIV antiretroviral therapy (ART) on day of diagnosis has been shown to increase treatment uptake in randomized trials. South Africa implemented “same-day ART” in September 2017, a year after expanding ART eligibility to all patients under Universal Test-and-Treat (UTT). We assessed the impact of same-day ART and UTT on time from diagnosis to ART 

Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs [version 3; peer review: 2 approved, 1 approved with reservations]

Abstract Introduction: Access to and the cost of induction treatment for cryptococcal meningitis (CM) is rapidly changing. The newly announced price for flucytosine ($0.75 per 500 mg pill) and possibly lower prices for liposomal amphotericin B (AmB-L) create opportunities to reduce CM treatment costs compared to the current standard treatment in low- and middle-income countries. Methods: We developed an Excel-based cost model to estimate health system treatment costs for CM over a two-week 

Health Technology Assessment in Support of National Health Insurance in South Africa

Abstract South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements 

TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi

ABSTRACT Introduction: Despite growing evidence of the long term impact of tuberculosis (TB) on quality of life, Global Burden of Disease (GBD) estimates of TB-related disability-adjusted life years (DALYs) do not include post TB morbidity, and evaluations of TB interventions typically assume treated patients return to pre-TB health. Using primary data, we estimate years of life lost due to disability (YLDs), years of life lost due to premature mortality (YLL) and DALYs associated with