All Journal Articles

Human papillomavirus (HPV) testing on self-collected specimens: Perceptions among HIV positive women attending rural and urban clinics in South Africa

Abstract:  Introduction: Cervical cancer is the most common cancer among women in Sub-Saharan Africa. Cervical cancer is treatable if detected timeously, yet only 20% of South African women have ever been for a Pap smear in their lifetime due to limited access to screening, transport or child care responsibilities. Objective: To evaluate the acceptability of self-collection for cervical cancer screening. We aimed to identify which self-collection device women prefer and if they would 

Poor CD4 recovery and risk of subsequent progression to AIDS or death despite viral suppression in a South African cohort

Abstract:  Introduction: The prognostic role of CD4 response in the first six months of treatment in patients achieving early viral suppression during HIV treatment is unclear. Methods: This was a cohort study of HIV-positive adults initiating antiretroviral therapy (ART) between April 2004 and August 2007 who achieved viral suppression (B400 copies/ml) by six months on treatment in South Africa. Immunological response at six months was defined as: (1) absolute CD4 reached (B200 vs. ]200 

Prevalence and incidence of symmetrical symptomatic Peripheral Neuropathy in patients with Multidrug-Resistant TB

Abstract Objective: To assess whether use of stavudine both before and during treatment for MDR TB increased the prevalence and incidence of SSPN.  Method: MDR TB patients at Sizwe Tropical Disease Hospital were examined for signs of prevalent SSPN. Age, gender, HIV status, alcohol use, TB and HIV treatment regimens both prior to admission and current, and concomitant medications were recorded.  Results: In this cohort of 246 patients, we found that 24.4% of patients with MDR TB had SSPN at 

Strengthening the HIV cascade to ensure an effective future ART response in sub-Saharan Africa

Abstract Timely linkage to antiretroviral therapy (ART) care is critical for reducing HIV-related morbidity, mortality and transmission. Studies investigating interventions to improve linkage to, and retention in, pre-ART care in sub-Saharan Africa were reviewed. Certain interventions used to overcome economic barriers for ART-patients (i.e. integration of services, medical and food incentives, intensified counselling and peer support) have also shown favourable results in the pre-ART period. 

Non-ignorable loss to follow-up: correcting mortality estimates based on additional outcome ascertainment

Abstract:  Loss to follow-up (LTFU) is a common problem in many epidemiological studies. In antiretroviral treatment (ART) programs for patients with human immunodeficiency virus (HIV), mortality estimates can be biased if the LTFU mechanism is non-ignorable, that is, mortality differs between lost and retained patients. In this setting, routine procedures for handling missing data may lead to biased estimates. To appropriately deal with non-ignorable LTFU, explicit modeling of the missing 

Cost-effectiveness of tenofovir gel in urban South Africa: model projections of HIV impact and threshold product prices

Abstract Background: There is urgent need for effective HIV prevention methods that women can initiate. The CAPRISA 004 trial showed that a tenofovir-based vaginal microbicide had significant impact on HIV incidence among women. This study uses the trial findings to estimate the population-level impact of the gel on HIV and HSV-2 transmission, and price thresholds at which widespread product introduction would be as cost-effective as male circumcision in urban South Africa.  Methods: The 

Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models.

Abstract Background: New WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment 

Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries.

Abstract Objective: To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. Methods: Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were 

Increases in regimen durability associated with the introduction of tenofovir at a large public-sector clinic in Johannesburg, South Africa

Abstract:  Introduction: In April 2010, tenofovir replaced stavudine in public-sector first-line antiretroviral therapy (ART) in South Africa. The association of tenofovir with fewer side effects and toxicities compared to stavudine could translate to increased durability of tenofovir-based regimens. We evaluated changes over time in regimen durability at the Themba Lethu Clinic, Johannesburg, South Africa. Methods: This was a cohort analysis of treatment-naïve, non-pregnant adult patients 

Effect of antiretroviral therapy on patients’ economic well-being: five-year follow-up

Abstract:  Objective: Evaluate the effect of antiretroviral therapy (ART) on South African HIV patients' economic well being, as indicated by symptoms, normal activities, employment, and external support, during the first 5 years on treatment. Methods: Prospective cohort study of 879 adult patients at public or nongovernmental clinics enrolled before ART initiation or on ART less than 6 months and followed for 5.5 years or less. Patients were interviewed during routine clinic visits. Outcomes 

Lamivudine monotherapy as a holding strategy in HIV-infected children in South Africa

Abstract: Background: Treatment options for HIV-infected children failing combination antiretroviral therapy (ART) are limited. We describe lamivudine monotherapy (LM) as a holding strategy for ART-experienced virologically-failing children where a definitive suppressive regimen was not possible. Methods: A retrospective review of data collected until the end of July 2010 from four sites in Johannesburg, South Africa was performed. Inclusion criteria were age ≤16 years with documented HIV-1 

AZT impairs immunological recovery on first-line ART: collaborative analysis of cohort studies in Southern Africa

Abstract: Objectives: Zidovudine (AZT) is recommended for first-line antiretroviral therapy (ART) in resource limited settings. AZT may, however, lead to anemia and impaired immunological response. We compared CD4 counts over 5 years between patients starting ART with and without AZT in Southern Africa. Design: Cohort study. Methods: Patients aged 16 years who started first-line ART in South Africa, Botswana, Zambia or Lesotho were included. We used linear mixed-effect models to compare CD4