All Journal Articles

Growth curve modelling to determine distinct BMI trajectory groups in HIV-positive adults on antiretroviral therapy in South Africa

Objective: Obesity is a major long-term concern in HIV-positive patients due to the pathogenic link between obesity and noncommunicable chronic diseases (NCDs). We aim to characterize changes in BMI over time on antiretroviral therapy (ART) and investigate the association between weight gain and survival in South Africa. Design and methods: A prospective cohort study among HIV-positive adults on first-line ART between April 2004 and 2015 in Johannesburg, South Africa. We used latent class 

Epidemiological impact and cost-effectiveness of providing long-acting pre-exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study

Introduction: Although pre-exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub-Saharan Africa, likely due to non-adherence. Adherence may be improved with the use of injectable long-acting PrEP methods currently being developed. We hypothesize that providing long-acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to 

Data quality of drug-resistant tuberculosis and antiretroviral therapy electronic registers in South Africa

Background: To assess the quality and completeness of treatment and outcome data in the electronic tuberculosis (TB) and antiretroviral treatment (ART) registers in drug-resistant (DR-) TB patients at three treatment facilities in South Africa. Methods: We did a retrospective cohort study using routinely collected data from DR-TB registers of rifampicin-resistant adults (≥18 years old), on ART, initiating DR-TB treatment between January 2012 and December 2013. We linked patient information 

Differentiated models of service delivery for antiretroviral treatment of HIV in sub- Saharan Africa: a rapid review protocol

Background: To meet global targets for the treatment of HIV, high-prevalence countries are launching or expanding differentiated models of service delivery (DSD) for antiretroviral therapy (ART). Ongoing studies report on metrics specific to individual models of care, but little is known about the overall scale, impact, costs, and benefits of widespread implementation of DSD. We will conduct a rapid review of recent literature on DSD currently in use in sub-Saharan Africa and identify gaps in 

Bridging the Efficacy–Effectiveness Gap in HIV Programs: Lessons From Economics

Background: Bridging the efficacy–effectiveness gap in HIV prevention and treatment requires policies that account for human behavior. Setting: Worldwide. Methods: We conducted a narrative review of the literature on HIV in the field of economics, identified common themes within the literature, and identified lessons for implementation science. Results: The reviewed studies illustrate how behaviors are shaped by perceived costs and benefits across a wide range of health and nonhealth 

Time to strengthen HIV treatment and prevention for youth

In The Lancet HIV, Mhairi Maskew and colleagues1 use data from a large national laboratory database in South Africa to examine trends in access to public sector HIV treatment programmes by children and adolescents aged 1–19 years between 2005 and 2016. The authors should be congratulated for highlighting important findings using national data in this often underexamined population, information that is needed to mount a national response. The authors report a ten times increase in the number 

Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving

Introduction: The World Health Organization declared the goal of hepatitis C virus (HC V) elimination by 2030. Micro-elimination, which is the reduction of incidence to zero in targeted populations, is less complex and costly and may be the first step to prove whether elimination is feasible. A suitable target group is HI V-positive men who have sex with men (MSM) because of their high-risk behavior and high incidence rates. Moreover, HC V monitoring is integrated in HI V care. The current HC V 

Effective public-private partnerships for sustainable antiretroviral therapy: outcomes of the Right to Care health services GP down-referral program

The recently increased access to antiretroviral therapy (ART) in South Africa has placed additional strain on human and infrastructure resources of the public health sector. Capacity from private-sector General Practitioners (GPs) could be leveraged to ease the current burden on the public health sector. Methods: We conducted a retrospective record review of routine electronic medical record data on a systematic sample of HIV-infected adults (≥18 years old) initiated on ART at a tertiary 

Differentiated HIV care in South Africa: the effect of fast-track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence

Introduction: In response to suboptimal adherence and retention, South Africa’s National Department of Health developed and implemented National Adherence Guidelines for Chronic Diseases. We evaluated the effect of a package of adherence interventions beginning in January 2016 and report on the impact of Fast-Track Treatment Initiation Counselling (FTIC) on ART initiation, adherence and retention. Methods: We conducted a cluster-randomized mixed-methods evaluation in 4 provinces at 12 

When donor funding leaves: an interrupted time‑series analysis of the impact of integrating direct HIV care and treatment into public health services in a region of Johannesburg

The paper uses an interrupted time series analysis to outline the impact on ART and other services at three primary health care (PHC) clinics in one region of Johannesburg after removal of PEPFAR funding for a co-located ART clinic and integration of HIV treatment into PHC. The three clinics fared differently after PEPFAR funding was removed, but overall, in this study, integration of ART with PHC services did not result in large-scale reductions in overall service delivery. One facility did 

First International Post-Tuberculosis Symposium

The World Health Organisation (WHO) estimates that approximately 54 million people survived TB between 2000 and 2017 alone. There is increasing evidence of long term respiratory complications following TB in a proportion of these patients, preventing them from returning to their normal lives. Patients can suffer from airflow obstruction, restrictive and fibrotic defects, bronchiectasis and aspergillomas amongst other conditions. With chronic obstructive pulmonary disease (COPD) being the 

Adolescent HIV treatment in South Africa’s national HIV programme: a retrospective cohort study

The number of South African adolescents receiving HIV care and treatment in South Africa is growing. By use of routinely collected laboratory data from South Africa’s National HIV Programme, we aimed to quantify the numbers of adolescents accessing HIV care and treatment over time, characterise the role of perinatal infection in these trends, and estimate proportions of adolescents seeking HIV care and antiretroviral therapy (ART) in South Africa’s public sector. Methods: We did a