All Journal Articles

How to calculate the annual costs of NGO-implemented programmes to support orphans and vulnerable children: a six-step approach

Abstract Background: Information on the costs of implementing programmes designed to provide support of orphans and vulnerable children (OVC) in sub-Saharan Africa and elsewhere is increasingly being requested by donors for programme evaluation purposes. To date, little information exists to document the costs and structure of costs of OVC programmes as actually implemented "on the ground" by local non-governmental organizations (NGOs). This analysis provides a practical, six-step approach 

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 

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 

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 

The net cost of incorporating resistance testing into HIV/AIDS treatment in South Africa: a Markov model with primary data

Abstract  Background: Current guidelines for providing antiretroviral therapy (ART) in South Africa’s public sector programme call for switching patients from first-line to second-line treatment upon virologic failure as indicated by two consecutive viral loads above 5000 copies/ml, but without laboratory evidence of viral resistance. We modelled the net cost of adding resistance testing for patients with virological failure and retaining patients without resistance on first-line therapy, 

Response to: defaulting from antiretroviral treatment programmes in sub-Saharan Africa: a problem of definition

Abstract: The recent letter to the editors by Grimsrud et al. (2011) in response to our review of rates of retention in antiretroviral treatment programmes in sub-Saharan Africa (Fox & Rosen 2010) raises two concerns that we would like to comment on. First, the authors make the point that there was variability in the definitions of loss to follow-up (LTFU) used by the studies we summarized. This is correct: as is clearly noted in the paper, we did not have access to the primary data used 

Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa

Abstract Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART.