All Journal Articles

Exploring the promise and reality of wardbased primary healthcare outreach teams conducting TB household contact tracing in three districts of South Africa

Abstract Background Tuberculosis (TB) household contact tracing is a form of targeted active case-finding for which community health workers (‘outreach teams’) in South Africa are primarily responsible for its implementation. We conducted an exploratory qualitative study to understand the role of outreach teams in delivering TB household contact tracing. Methods The study took place in three districts of South Africa between May 2016 and February 2017. We conducted 78 in-depth 

HIV-related stigma and uptake of antiretroviral treatment among incarcerated individuals living with HIV/AIDS in South African correctional settings: A mixed methods analysis

Abstract Background Stigma affects engagement with HIV healthcare services. We investigated the prevalence and experience of stigma among incarcerated people living with HIV (PLHIV) in selected South African correctional settings during roll-out of universal test and treat. Methods A cross-sectional mixed-methods study design included 219 incarcerated PLHIV and 30 indepth interviews were conducted with four different types of PLHIV. HIV-related stigma was assessed through survey 

A Failure to Disseminate Transformative Science — HIV Treatment as Prevention, 10 Years On

HPTN 052 altered scientific discourse and HIV policy. But has it changed minds? The global scale-up of HIV treatment is one of the greatpublic health success stories of the 21st century. Millions of people with HIV are living longer and healthier lives because of the substantial resources that have been deployed to increase access to medication. Despite widespread awareness of treatment’s therapeutic benefits, however, recent research revealed large global disparities in knowledge about the 

Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local 

Cost and cost-effectiveness of dolutegravir-based antiretroviral regimens: an economic evaluation of a clinical trial

Though the DTG-based trial arms were 2% more costly than TDF/FTC/EFV, both had slightly lower cost-per-outcome ($9783 and $9929/patient virally suppressed for TDF/FTCþDTG and TAF/FTCþDTG, respectively) than TDF/FTC/EFV ($10 365). The trial cost per additional virally suppressed patient, compared with TDF/FTC/EFV, was lower in the TDF/FTCþDTG arm ($2967) compared with TAF/FTCþDTG ($3430). In routine care, cost per virally suppressed patient was estimated as similar between TDF/ FTCþDTG 

Perceived efficacy of HIV treatment-as- prevention among university students in Johannesburg, South Africa

Antiretroviral therapy (ART) nearly eliminates HIV transmission. Yet information on treatment as prevention (TasP) has been slow to diffuse in sub-SaharanAfrica. We assessed TasP knowledge among university students in South Africa. University students in South Africa underestimated the prevention benefits of HIV treatment. Low knowledge of TasP could limit demand for HIVtesting and treatment among young 

Is the Risk Really Shared? A Retrospective Analysis of Healthcare Costs of Patients With Type 2 Diabetes Mellitus on a Capitation Model

Objectives: Private managed healthcare organizations in South Africa (SA) use a capitation model of care for patients within their healthcare delivery systems for the optimal management of type 2 diabetes mellitus (T2DM) to reduce healthcare costs. Few studies have categorized healthcare costs at a patient level to determine the actual healthcare costs incurred by private insurers for T2DM in SA. This study estimated the direct medical costs of patients with T2DM registered with a private 

Optimal use of COVID19 Ag-RDT screening at border crossings to prevent community transmission: a modeling analysis

Countries around the world have implemented restrictions on mobility, especially cross-border travel to reduce or prevent SARS-CoV-2 community transmission. Rapid antigen testing (Ag-RDT), with on-site administration and rapid turnaround time may provide a valuable screening measure to ease cross-border travel while minimizing risk of local transmission. To maximize impact, we developed an optimal AgRDT screening algorithm for cross-border 

The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals

Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) prevents illness and death from HIV disease and transmission of HIV infection. To encourage global scale-up of ART, the Joint UN Program on HIV/AIDS (UNAIDS) issued the “95-95-95” targets for the HIV “cascade of care.” These targets state that by 2030, 95% of individuals living with HIV will know their HIV status, 95% of people with diagnosed HIV infection will receive ART, and 95% of those taking ART will have 

The Critical Importance of Asking Good Questions: The Role of Epidemiology Doctoral Training Programs

Epidemiologic methods have advanced tremendously in the last several decades. As important as they are, even the most sophisticated approaches are unable to provide meaningful answers when the user lacks a clear study question. Yet, instructors have more and more resources on how to conduct studies and analyze data but few resources on how to ask clearly defined study questions that will guide those methods. Training programs have limited time for coursework, and if novel statistical estimation 

Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa

Abstract Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the