All Journal Articles

Uptake, Outcomes, and Costs of Antenatal, Well-Baby, and Prevention of Mother-to-Child Transmission of HIV Services under Routine Care Conditions in Zambia

Abstract: Background: Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT) in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A. Methods: We enrolled 99 HIV-infected/HIV-exposed (index) mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 

A randomized clinical trial comparing metabolic parameters after 48 weeks of standard- and low-dose stavudine therapy and tenofovir disoproxil fumarate therapy in HIV-infected South African patients

Abstract: Objectives: Low-dose stavudine therapy may have a lower toxicity profile compared with standard dose. A randomized controlled trial comparing these two doses of stavudine with tenofovir disoproxil fumarate (tenofovir DF) was performed to assess the effects on anthropometry, markers of inflammation, and lipid and glucose metabolism in Black South African patients. Methods: Sixty patients were randomized 1:1:1 to either standard-dose (30–40 mg) or low-dose (20–30 mg) stavudine 

The Impact of Choice of NNRTI on Short-Term Treatment Outcomes among HIV-Infected Patients Prescribed Tenofovir and Lamivudine in Johannesburg

Abstract: Introduction: Recent WHO guidelines for resource-limited settings recommend tenofovir in first-line antiretroviral therapy (ART) yet there are suggestions that patients receiving nevirapine with tenofovir have worse outcomes than those receiving efavirenz. We sought to compare outcomes among those taking nevirapine vs. efavirenz with tenofovir and lamivudine. Methods: We analyzed data on ART naı¨ve, non-pregnant patients, $18 years old without tuberculosis co-infection, initiating 

Impact of nutritional supplementation on immune response, body mass index and bioelectrical impedance in HIV-positive patients starting antiretroviral therapy

Abstract: Background: Challenges to HIV care in resource limited settings (RLS) include malnutrition. Limited evidence supports the benefit of nutritional supplementation when starting antiretroviral therapy (ART) in RLS. Methods: Randomized controlled pilot study. HIV-positive ART-naive adults with self-reported weight loss were randomized to receive ART plus FutureLife porridge® nutritional supplement (NS) (388 kcal/day) or ART alone (Controls) for 6 months. Patients returned for monthly 

Kaposi Sarcoma-Associated Herpes Virus and Response to Antiretroviral Therapy: A Prospective Study of HIV-Infected Adults

Abstract: Background: The possible impact of coinfection with the Kaposi sarcoma-associated herpes virus (KSHV) on the response to antiretroviral therapy (ART) is unknown. Prospective studies are rare, particularly in Africa. Methods: We enrolled a prospective cohort of HIV-infected adults initiating ART in Johannesburg, South Africa. The subjects were defined as seropositive to KSHV if they were reactive to either KSHV lytic K8.1 or latent Orf73 antigen or to both. The subjects were followed 

A Novel Approach to Accounting for Loss to Follow-Up when Estimating the Relationship between CD4 Count at ART Initiation and Mortality

Abstract Background: While CD4 strongly predicts mortality on antiretroviral therapy (ART), estimates from programmatic data suffer from incomplete patient outcomes. Methods: We conducted a pooled analysis of one-year mortality data on ART accounting for lost patients. We identified articles reporting one-year mortality by ART initiation CD4 count. We estimated the average mortality among those lost as the value that maximizes the fit of a regression of the natural log of mortality on the 

Anemia among HIV-Infected Patients Initiating Antiretroviral Therapy in South Africa: Improvement in Hemoglobin regardless of Degree of Immunosuppression and the Initiating ART Regimen

Abstract: Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of anemia in HIV treatment is critical to developing strategies to reduce morbidity and mortality. We conducted a prospective analysis among 10,259 HIV-infected adults initiating first-line ART between April 2004 and August 2009 in Johannesburg, South Africa. The prevalence of anemia at ART initiation was 25.8%. Mean hemoglobin 

Impact and cost of algorithms for the diagnosis of adults with pulmonary tuberculosis in South Africa

Abstract: To the Editor: We wish to respond to the letter commenting on our article ‘Diagnosing Xpert MTB/RIF-negative TB: Impact and cost of alternative algorithms for South Africa’. The National TB Cost Model was established to assist the South African Department of Health in understanding both the costs and the impact of alternative algorithms for the diagnosis of adults with symptoms of pulmonary tuberculosis (PTB) presenting for ambulatory care, with impact measured as the number of 

When and how should we be measuring adherence to antiretroviral therapy in resource-limited settings?

Abstract: The primary goal of treatment with antiretroviral therapy (ART) is to prevent HIV-related morbidity and mortality.  The effectiveness of ART has been clearly demonstrated, as have the positive relationships between adherence to ART and viral suppression, increased CD4 cell count, positive clinical outcomes, and reduced mortality. More recently it has been shown too associated with reduced risk of transmission to uninfected partners. High levels of adherence are critical for 

Treatment Outcomes of HIV-Infected Adolescents Attending Public-Sector HIV Clinics across Gauteng and Mpumalanga, South Africa

Abstract: There is little evidence comparing treatment outcomes between adolescents and other age groups, particularly in resource-limited settings. A retrospective analysis of data from seven HIV clinics across urban Gauteng (n = 5) and rural Mpumalanga (n = 2), South Africa was conducted. The analysis compared HIV-positive antiretroviral treatment (ART)-naive young adolescents (10–14 years), older adolescents (15–19), and young adults (20–24 years) to adults ( ‡ 24 years) initiated 

Retention in Care and Outpatient Costs for Children Receiving Antiretroviral Therapy in Zambia: A Retrospective Cohort Analysis

Abstract: Background: There are few published estimates of the cost of pediatric antiretroviral therapy (ART) in Africa. Our objective was to estimate the outpatient cost of providing ART to children remaining in care at six public sector clinics in Zambia during the first three years after ART initiation, stratified by service delivery site and time on treatment. Methods: Data on resource utilization (drugs, diagnostics, outpatient visits, fixed costs) and treatment outcomes (in care, died, 

When and how should we be measuring adherence to antiretroviral therapy in resource-limited settings?

Abstract: The primary goal of treatment with antiretroviral therapy (ART) is to prevent HIV-related morbidity and mortality.  The effectiveness of ART has been clearly demonstrated, as have the positive relationships between adherence to ART and viral suppression, increased CD4 cell count, positive clinical outcomes, and reduced mortality. More recently it has been shown too associated with reduced risk of transmission to uninfected partners. High levels of adherence are critical for