All Journal Articles

Increases in Adult Life Expectancy in Rural South Africa: Valuing the Scale-Up of HIV Treatment

Abstract: The scale-up of antiretroviral therapy (ART) is expected to raise adult life expectancy in populations with high HIV prevalence. Using data from a population cohort of over 101,000 individuals in rural KwaZulu-Natal, South Africa, we measured changes in adult life expectancy for 2000–2011. In 2003, the year before ART became available in the public-sector health system, adult life expectancy was 49.2 years; by 2011, adult life expectancy had increased to 60.5 years—an 11.3-year 

Tuberculosis and the risk of opportunistic infections and cancers in HIV-infected patients starting ART in Southern Africa

Abstract: Objectives: To investigate the incidence of selected opportunistic infections (OIs) and cancers and the role of a history of tuberculosis (TB) as a risk factor for developing these conditions in HIV-infected patients starting antiretroviral treatment (ART) in Southern Africa. Methods: Five ART programmes from Zimbabwe, Zambia and South Africa participated. Outcomes were extrapulmonary cryptococcal disease (CM), pneumonia due to Pneumocystis jirovecii (PCP), Kaposi's sarcoma and 

Gender Differences in Mortality and CD4 Count Response Among HIV-Positive Patients Virally Suppressed Within 6 Months of Antiretroviral Therapy Initiation

Abstract: Background: Treatment outcomes for antiretroviral therapy (ART) patients may vary by gender, but estimates from current evidence may be confounded by disease stage and adherence. We investigated the gender differences in treatment response among HIV-positive patients virally suppressed within 6 months of treatment initiation. Methods: We analyzed data from 7,354 patients initiating ART between April 2004 and April 2010 at Themba Lethu Clinic, a large urban public sector treatment 

Initiating ART when presenting with higher CD4 counts results in reduced loss to follow-up in South Africa

Abstract:  Objective: In August 2011, South Africa expanded its adult antiretroviral treatment (ART) guidelines to allow treatment initiation at CD4 values ≤350 cells/μl. Mortality and morbidity are known to be reduced when initiating at higher CD4 levels; we explored the impact on patient loss to follow-up. Design: An observational cohort study. Methods: We analyzed routine data of 1430 adult patients initiating ART from April-December 2010 from a Johannesburg primary healthcare clinic 

Linkage to Care and Treatment for TB and HIV among People Newly Diagnosed with TB or HIV-Associated TB at a Large, Inner City South African Hospital

Abstract:  Objective: To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes. Design: Cohort study of TB patients diagnosed at an urban hospital. Methods: Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to 

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