All Journal Articles

Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa

In this study, we found comparable DMD outcomes versus standard of care at facilities, a benefit for retention of patients in care with ACs, and apparent benefits in terms of retention (for AC patients) and sustained viral suppression (for DMD patients) among men. This suggests the importance of alternative service delivery models for men and of communitybased strategies to decongest primary healthcare facilities. Because these strategies also reduce patient inconvenience and decongest 

Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis

The paper investigates the use of "cost per new HIV diagnosis" as a metric of the cost effectiveness of new HIV testing strategies, in contrast to more commonly used metrics, for two packages of testing modalities across several southern African countries. We found a very strong relationship between cost-per-diagnosis and cost-per-DALY-averted, with incremental cost-effectiveness ratios being below $500 per-DALY-averted as long as the cost-per-diagnosis was below $315. Across modalities and 

Cervical cancer risk in women living with HIV across four continents: A multicohort study

Vast global inequities in the burden of invasive cervical cancer (ICC) exist. While access to effective screening and treatment of precancerous cervical lesions has substantially reduced the risk of developing ICC in high-income countries, ICC remains a common cause of premature mortality and morbidity in women in low- and middle-income countries. ICC disproportionally affects women living with human immunodeficiency virus (HIV), who are more likely to have persistent coinfection with high-risk 

The impact of adverse events on healthrelated quality of life among patients receiving treatment for drug-resistant tuberculosis in Johannesburg, South Africa

Adverse events (AEs) are common during treatment of drug-resistant tuberculosis (DR-TB). Little is known about the health-related quality of life (HRQoL) of patients receiving treatment for DR-TB or the effect of AEs on HRQoL. We enrolled 149 DR-TB patients (median age 36 years IQR 29–43, 55% male, 77.9% HIV-positive, 81% on ART, 61.8% on a standard long-course regimen and 44.3% on DR-TB treatment for less than 6 months). 58/149 (38.9%) patients reported a total of 122 AEs in the preceding 

Cost and impact of dried blood spot versus plasma separation card for scale-up of viral load testing in resource limited settings

Routine plasma viral load (VL) testing is the WHO-recommended method for monitoring HIV-infected patients on antiretroviral therapy (ART). In Zambia, VL scale-up is limited due to significant logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spot (DBS) technology could circumvent many logistical challenges at the cost of reduced sensitivity and/or specificity. Recently, plasma separation cards (PSC) have become available and, 

Clinical predictor score to identify patients at risk of poor viral load suppression at six months on antiretroviral therapy: results from a prospective cohort study in Johannesburg, South Africa

As countries work toward 90:90:90 targets, early identification of patients with inadequate response to antiretroviral therapy (ART) is critical for achieving optimal HIV treatment outcomes. We developed and evaluated a clinical prediction score (CPS) to identify HIV-positive patients at risk of poor viral load suppression at 6 months on ART. Our findings suggest a 6-month CPS may have the potential to identify patients at risk of poor viral load suppression. The CPS may be used to target 

Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa

Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity of mothers and cause health and developmental problems in children born to affected mothers. We set out to measure the prevalence of PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) HIV-1 infected women and HIV negative women, and to identify predictors of major PPD among these women in a 

TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB – a study protocol

Up to fifty percent of microbiologically cured tuberculosis (TB) patients may be left with permanent, moderate or severe pulmonary function impairment. Very few studies have systematically examined pulmonary outcomes in patients to understand the pathophysiologic basis and long-term socio-economic consequences of this injury. The planned multi-country, multi-centre observational TB cohort study, aims to advance the understanding of the clinical, microbiological, immunological and socio-economic 

“Even if you’re HIV-positive there’s life after if you take your medication”: experiences of people on long-term ART in South Africa: a short report

South Africa’s national antiretroviral treatment (ART) programme, initiated in 2004, is the largest HIV treatment programme in the world with an estimated 4.2 million people on ART. Today, an HIV diagnosis is no longer associated with certain death, but is rather a manageable chronic disease, with all HIV-positive patients now eligible to receive treatment. In this study, we explore patient experiences at the onset of the ART programme, including facilitators and barriers around 

The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case

The paper details the results of the first-ever systematic review of the average (or unit) costs of HIV interventions in South Africa, performed in 2018. We originally did this for the South African HIV Investment Case but have updated to more recent prices (2016/17) and added more interventions since then. It includes recent costs for ART, PMTCT, HCT, MMC, and PrEP, amongst others, together with a table detailling all our findings from the literature review (file S3, attached) and very 

Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058

Our objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.We calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV)epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective usinga 40-year time horizon starting in 2018. Introduction of PrEP in Germany can reduce the HIV epidemic among MSM in a 

Point-of-care assays for early infant diagnosis in Zimbabwe

Delays in diagnosis of HIV and initiation of antiretroviral therapy (ART) for infants significantly increase early infant morbidity and mortality. By contrast, innovations in early infant HIV diagnostics and improvements in turnaround times could reduce infant morbidity and