All Journal Articles

Volunteering, health and the homeless – the cost of establishing a student-run primary healthcare clinic serving the innercity homeless in South Africa

Abstract Background: Those who are homeless are more prone to communicable, respiratory and cardiovascular  diseases and are less likely to access healthcare services. In South Africa there are no specific public healthcare services tailored to the needs of these communities, particularly if they are immigrants. Trinity Health Services is a student- run inner-city clinic providing free healthcare to the homeless of Johannesburg, South Africa. The clinic operates two nights per month and 

Trends in CD4 and viral load testing 2005 to 2018: multi-cohort study of people living with HIV in Southern Africa

Abstract Introduction: The World Health Organization (WHO) recommends a CD4 cell count before starting antiretroviral therapy (ART) to detect advanced HIV disease, and routine viral load (VL) testing following ART initiation to detect treatment failure. Donor support for CD4 testing has declined to prioritize access to VL monitoring. We examined trends in CD4 and VL testing among adults (≥15 years of age) starting ART in Southern Africa. Methods: We analysed data from 14 HIV treatment 

Delays in repeat HIV viral load testing for those with elevated viral loads: a national perspective from South Africa

Abstract Introduction: In South Africa, HIV patients with an elevated viral load (VL) should receive repeat VL testing after adherence counselling. We set out to use a national HIV Cohort to describe time to repeat viral load testing across South Africa and identify predictors of time to repeat testing. Methods: We conducted a cohort study of prospectively collected laboratory data. HIV treatment guidelines have changed over time in South Africa, but call for repeat VL testing within six 

Understanding the costs and the cost structure of a community-based HIV and gender-based violence (GBV) prevention program: the Woza Asibonisane Community Responses Program in South Africa

Abstract Background: The Woza Asibonisane Community Responses (CR) Programme was developed to prevent HIV infections and gender-based violence (GBV) within four provinces in South Africa. The Centre for Communication Impact (CCI) in collaboration with six partner non-governmental organizations (NGOs) implemented the programme, which was comprised of multiple types of group discussion and education activities organized and facilitated by each NGO. To date, little information exists on the cost 

Pre-treatment HIV drug resistance testing cost-effectiveness

Duarte and colleagues addressed HIV drug resistance as part of clinical care. HIV drug resistance testing, however, is also used for surveillance purposes in which the occurrence of resistance associated mutations is studied in a sample of people living with HIV that initiate treatment or who showed virological failure while on antiretroviral therapy. These surveillance programs allow the timely identification of wide-spread transmission and emergence of drug resistance which in turn could 

Economic evaluation of short treatment for multidrug-resistant tuberculosis, Ethiopia and South Africa: the STREAM trial

Objective To investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for multidrug-resistant (MDR) tuberculosis. Methods We compared the costs to health systems and participants of long (20 to 22 months) and short (9 to 11 months) MDR tuberculosis regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and we estimated health-system costs using bottom-up 

Managing multidrug-resistant tuberculosis in South Africa: a budget impact analysis

S E T T ING: In South Africa prior to 2016, the standard treatment regimen formultidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) was 24 months long and required daily injectable aminoglycoside (IA) treatment during the first 6 months. Recent evidence supports the replacement of IA with well-tolerated oral bedaquiline (BDQ) and a shortened 9–12 month regimen. DESIGN: Using a Markov model, we analyzed the 5- year budgetary impact and cost per successful treatment outcome of four 

Eligibility for differentiated models of HIV treatment service delivery: an estimate from Malawi and Zambia.

Abstract Little is known about the proportion of HIV-positive clients on antiretroviral therapy (ART) who meet stability criteria for differentiated service delivery (DSD) models. We report the proportion of ART clients meeting stability criteria as part of screening for a randomized trial of multimonth dispensing in Malawi and Zambia. METHODS: For a DSD trial now underway, we screened HIV-positive clients aged at least 18 years presenting for HIV treatment in 30 adult ART clinics in 

Tailored HIV programmes and universal health coverage

Improvements in geospatial health data and tailored human immunodeficiency virus (HIV) testing, prevention and treatment have led to greater microtargeting of the HIV response, based on location, risk, clinical status and disease burden. These approaches show promise for achieving control of the HIV epidemic. At the same time, United Nations Member States have committed to achieving broader health and development goals by 2030, including universal health coverage (UHC). HIV epidemic control 

Ending the HIV Epidemic in the USA

Despite the scale-up of HIV prevention, testing, and treatment services, ongoing HIV transmission within the USA remains a major public health problem, with nearly 40 000 new HIV diagnoses in 2018 alone. In 2019 the US President Donald Trump announced a commitment to reduce HIV incidence in the USA by 75% by 2025, and by 90% by 2030, with the ultimate goal of ending the national HIV epidemic.The proposed increase in financial commitment was approved by the US Congress in the same year The 

The impact of self-selection based on HIV risk on the cost-effectiveness of preexposure prophylaxis in South Africa

This study aims to determine the cost-effectiveness of provision of daily oral PrEP in South Africa, a setting with one of the highest HIV prevalence levels in the world, whereas considering the possibility that those at higher risk of contracting HIV may self-select into the PrEP programme. Our focus on self-selection over supply-side targeting was informed by the TWG’s preference that a risk screening tool should not be used to determine whether an individual receives PrEP, to avoid