Recent Publications

Outcomes of stable HIV-positive patients down-referred from a doctor-managed antiretroviral therapy clinic to a nurse-managed primary health clinic for monitoring and treatment

Abstract Objective: Compare clinical, immunologic and virologic outcomes amongst stable HIV-positive patients down-referred (DR) to nurse-managed primary health care clinic (PHC) for treatment maintenance to those who remained at the doctor-managed treatment-initiation site (TI). Design: We conducted a matched cohort analysis amongst stable HIV patients at the Themba Lethu Clinic, in Johannesburg, South Africa. Eligible patients met the criteria for down-referral (undetectable viral load 

Prevalence and predictors of Kaposi sarcoma herpes virus seropositive: a cross-sectional analysis of HIV-infected adults initiating ART in Johannesburg, South Africa

Abstract Background: Kaposi sarcoma (KS) is the most common AIDS-defining tumour in HIV-infected individuals in Africa. Kaposi sarcoma herpes virus (KSHV) infection precedes development of KS. KSHV co-infection may be associated with worse outcomes in HIV disease and elevated KSHV viral load may be an early marker for advanced HIV disease among untreated patients. We examined the prevalence of KSHV among adults initiating antiretroviral therapy (ART) and compared immunological, demographic and 

A longitudinal study of stavudine-associated toxicities in a large cohort of South African HIV infected subjects

Abstract  Background: There has been major improvement in the survival of HIV-1 infected individuals since the South African Government introduced highly active anti-retroviral therapy (HAART) in the public sector in 2004. This has brought new challenges which include the effects of stavudine-related toxicities. Methods: Prospective analysis of a cohort of 9040 HIV-infected adults who were initiated on HAART at the Themba Lethu Clinic (TLC) in Johannesburg between April 1, 2004 to December 

Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir

Abstract: Objective: In April 2010 the South African government added Tenofovir disoproxil fumarate to its first-line antiretroviral therapy (ART) for HIV patients. We analyzed the relationship between renal dysfunction at tenofovir initiation, nephrotoxicity and mortality. Design: Retrospective cohort analysis of HIV-infected adults who received tenofovir and had a creatinine clearance done at initiation at the Themba Lethu Clinic, Johannesburg, South Africa between April 2004-September 2009. 

Pregnancy and Virologic Response to Antiretroviral Therapy in South Africa

Abstract Background: Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in that setting. We examined the effect of incident pregnancy after HAART initiation on virologic response to HAART. Methods and Findings: We evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April 

Policy Brief 2: Shifting management of stable ART patients from doctors at hospitals to nurses at primary health clinics in South Africa

Background HIV/AIDS is placing the health systems of many resource-constrained countries under tremendous pressure. Shortages of human and infrastructural resources have become a major constraint to continued expansion of access to HIV care and treatment. Shifting clinical responsibilities to lesser trained, less expensive, and generally less scarce cadres of the clinical workforce and to lower level healthcare facilities is widely regarded as one solution to this problem. Policy Brief 

THE INCREMENTAL COST OF INTRODUCING XPERT® MTB/RIF INTO THE SOUTH AFRICAN NATIONAL TUBERCULOSIS PROGRAMME

South Africa bears a large share of the global burden of HIV/tuberculosis co infection. The Cepheid GeneXpert System using the Xpert MTB/RIF assay (http://www.cepheid.com/systems-andsoftware/genexpert-system/), a cassette-based cartridge, has provided the possibility of a rapid, point-of-care diagnosis of tuberculosis (TB) and, simultaneously, a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and received a strong 

Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review

Abstract Background: Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkage of patients testing positive for HIV to pre–antiretroviral therapy (ART) care and retention in pre-ART care until ART initiation. We conducted a systematic review of pre-ART retention in care in Africa. Methods and Findings: We searched PubMed, ISI Web of Knowledge, conference abstracts, and reference lists for reports on the proportion of adult patients 

Treatment outcomes and cost-effectiveness of shifting management of stable ART patients to nurses in South Africa: an observational cohort

Abstract: Background: To address human resource and infrastructure shortages, resource-constrained countries are being encouraged to shift HIV care to lesser trained care providers and lower level health care facilities. This study evaluated the cost-effectiveness of down-referring stable antiretroviral therapy (ART) patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health care facility in Johannesburg, South Africa. Methods and Findings: Criteria for 

The Cost of the Xpert Diagnostic Algorithm for TB Results of the National TB Cost Model (NTCM) 2011/12 to 2016/17

South Africa bears a large share of the global burden of HIV and tuberculosis co-infection. The GeneXpert System (Cepheid) using the Xpert MTB/RIF assay, a cassette-based cartridge, has provided the possibility of a rapid diagnosis of tuberculosis, while simultaneously providing a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and has received a strong recommendation from the World Health Organization (WHO) in 

Paediatric human immunodeficiency virus treatment outcomes from a resource limited setting in South Africa: Highly active antiretroviral therapy alone is not enough

Abstract Comprehensive care of human immunodeficiency virus (HIV)-infected children in the resource-poor setting is challenging, and published reports on treatment outcomes in this setting are limited. The aim of this study was to evaluate outcomes of HIV-infected children initiated on highly active antiretroviral therapy (HAART) between April 2005 and April 2009 at a primary health-care centre in Alexandra Township, South Africa. Of the 337 patients initiated on HAART, 83% (281 of 337) were 

Policy Brief 1: The Incremental Cost of Introducing Xpert MTB/RIF into the South African National TB Programme

Background South Africa bears a large share of the global burden of HIV/tuberculosis co-infection. The Cepheid GeneXpert System using the Xpert MTB/RIF assay http://www.cepheid.com/systems-and-software/genexpert-system/), a cassette-based cartridge, has provided the possibility of a rapid, point-of-care diagnosis of tuberculosis (TB) and, simultaneously, a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and received a