All Journal Articles

Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis

Abstract Introduction: Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate  proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods: We systematically searched PubMed and Embase for peer-reviewed 

Self-reported motivators for HIV testing in the treat-all era among HIV positive patients in Johannesburg, South Africa

Abstract To explore associations between self-reported ill-health as a primary motivator for HIV-testing and socio demographic factors. Four local primary healthcare clinics in Johannesburg, South Africa. A total of 529 newly HIV diagnosed adults (≥18 years) enrolled from October 2017 to August 2018, participated in the survey on the same day of diagnosis. Testing out of own initiative or perceived HIV exposure was categorized as asymptomatic. Reporting ill-health as the main reason for 

Tracing People Living With Human Immunodeficiency Virus Who Are Lost to Follow-up at Antiretroviral Therapy Programs in Southern Africa: A Sampling-Based Cohort Study in 6 Countries

Abstract Background: Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with human immunodeficiency virus (PLHIV) who were lost to follow-up (LTFU) during 2014-2017 at ART programs in Southern Africa. Methods: We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were 

Treatment outcomes among patients admitted to hospital with antiretroviral and/or antituberculosis drug-induced liver injury

Background: South Africa (SA) has among the highest rates of HIV and tuberculosis (TB) in the world. Antituberculosis and antiretroviral treatment (ART) can cause drug-induced liver injury (DILI), consequences of which are disease relapse, treatment failure and drug resistance. Objectives: To: (i) determine the demographics of patients with DILI and the proportion of patients on antituberculosis drugs v. antiretroviral therapy or both; (ii) determine the median time to DILI after 

Retention in care and viral suppression after same-day ART initiation: One-year outcomes of the SLATE I and II individually randomized clinical trials in South Africa

Abstract Introduction: Same-day initiation (SDI) of antiretroviral therapy (ART) for HIV consistently increases ART uptake, but concerns remain about higher attrition from care after initiation. We analysed 12-month retention in the SLATE SDI trials. Methods: SLATE I (Simplified Algorithms for Treatment Eligibility I, enrolment 06 March–28 July 2017) and SLATE II (enrolment 14 March–18 September 2018) were individually randomized trials at public outpatient clinics in 

Variation in HIV care and treatment outcomes by facility in South Africa, 2011–2015: A cohort study

Abstract Background Despite widespread availability of HIV treatment, patient outcomes differ across facilities. We propose and evaluate an approach to measure quality of HIV care at health facilities in South Africa’s national HIV program using routine laboratory data. Methods and findings Data were extracted from South Africa’s National Health Laboratory Service (NHLS) Corporate Data Warehouse. All CD4 counts, viral loads (VLs), and other laboratory tests used in HIV 

Designing an optimized diagnostic network to improve access to TB diagnosis and treatment in Lesotho

Abstract Background To reach WHO End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing. Diagnostic network analysis aims to inform instrument placement, sample referral, staffing, geographical prioritization, integration of testing enabling targeted investments and programming to meet priority needs. Methods Supply chain modelling and optimization software was 

Exploring the promise and reality of wardbased primary healthcare outreach teams conducting TB household contact tracing in three districts of South Africa

Abstract Background Tuberculosis (TB) household contact tracing is a form of targeted active case-finding for which community health workers (‘outreach teams’) in South Africa are primarily responsible for its implementation. We conducted an exploratory qualitative study to understand the role of outreach teams in delivering TB household contact tracing. Methods The study took place in three districts of South Africa between May 2016 and February 2017. We conducted 78 in-depth 

HIV-related stigma and uptake of antiretroviral treatment among incarcerated individuals living with HIV/AIDS in South African correctional settings: A mixed methods analysis

Abstract Background Stigma affects engagement with HIV healthcare services. We investigated the prevalence and experience of stigma among incarcerated people living with HIV (PLHIV) in selected South African correctional settings during roll-out of universal test and treat. Methods A cross-sectional mixed-methods study design included 219 incarcerated PLHIV and 30 indepth interviews were conducted with four different types of PLHIV. HIV-related stigma was assessed through survey 

A Failure to Disseminate Transformative Science — HIV Treatment as Prevention, 10 Years On

HPTN 052 altered scientific discourse and HIV policy. But has it changed minds? The global scale-up of HIV treatment is one of the greatpublic health success stories of the 21st century. Millions of people with HIV are living longer and healthier lives because of the substantial resources that have been deployed to increase access to medication. Despite widespread awareness of treatment’s therapeutic benefits, however, recent research revealed large global disparities in knowledge about the 

Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local