All Journal Articles

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 

Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa

Limited research investigating treatment outcomes for HIV-positive orphans compared with non-orphans has shown mixed results, with several studies indicating that HIV-positive orphans are at greater risk of delayed access to HIV care and poor antiretroviral therapy (ART) adherence, while other data suggest that ART outcomes of orphans can be similar to those of non-orphans. Understanding the impact of orphan status on short-term ART outcomes could improve targeted intervention strategies, and 

Who is seeking antiretroviral treatment for HIV now? Characteristics of patients presenting in Kenya and South Africa in 2017-2018

Many African countries have had at least two years’ experience with universal treatment eligibility for HIV. The literature contains few descriptions, though, of populations starting treatment since adoption of universal eligibility. Using baseline data from a clinical trial of same-day ART initiation, we describe the populations presenting for HIV testing or care at study clinics in Kenya and South Africa in 2017-18, during the era of same-day initiation. Methods: The Simplified Algorithm 

Dietary intake among paediatric HIV-positive patients initiating antiretroviral therapy in Johannesburg, South Africa

In South Africa, prevention of mother to child transmission (PMTCT)has reduced MTCT from 3.6% in 2011 to 1.3% in 2017. However,there are challenges in reaching vulnerable HIV-positive children;those at increased risk of malnutrition or present late with advanced disease. Macro – and micro nutrient deficiencies, common in HIV,may accelerate disease progression. This was a prospective cohort study of paediatric patients (aged 1–10 years) initiating ART between 08/2014 and 09/2016 at a public 

Simplified clinical algorithm for identifying patients eligible for same-day HIV treatment initiation (SLATE): Results from an individually randomized trial in South Africa and Kenya

The World Health Organization recommends "same-day" initiation of antiretroviral therapy (ART) for HIV patients who are eligible and ready. Identifying efficient, safe, and feasible procedures for determining same-day eligibility and readiness is now a priority. The Simplified Algorithm for Treatment Eligibility (SLATE) study evaluated a clinical algorithm that allows healthcare workers to determine eligibility for same-day treatment and to initiate ART at the patient’s first clinic 

Monitoring viral load for the last mile: what will it cost?

Routine viral load testing is the WHO-recommended method for monitoring HIV-infected patients on ART, and many countries are rapidly scaling up testing capacity at centralized laboratories. Providing testing access to the most remote populations and facilities (the “last mile”) is especially challenging. Using a geospatial optimization model, we estimated the incremental costs of accessing the most remote 20% of patients in Zambia by expanding the transportation network required to bring 

Optimizing viral load testing access for the last mile: Geospatial cost model for point of care instrument placement

Viral load (VL) monitoring programs have been scaled up rapidly, but are now facing the challenge of providing access to the most remote facilities (the “last mile”). For the hardestto-reach facilities in Zambia, we compared the cost of placing point of care (POC) viral load instruments at or near facilities to the cost of an expanded sample transportation network (STN) to deliver samples to centralized 

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

This paper compares the impact and cost effectiveness of several potential new testing strategies in South Africa, and assesses the prospects of achieving the UNAIDS target of 95% of HIV-positive adults diagnosed by 2030. We developed a mathematical model to evaluate the potential impact of home-based testing, mobile testing, assisted partner notification, testing in schools and workplaces, and testing of female sex workers (FSWs), men who have sex with men (MSM), family planning clinic 

Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa

We identified 182,890 children (<10 years), young adolescent (10–14), older adolescent (15–19), young adult (20–24), adult (25–49), and older adult (≥50) TB cases without known drug-resistance. ART coverage among HIV co-infected patients was highest for young adolescents (64.3%) and lowest for young adults (54.0%) compared to other age groups (all over 60%). Treatment success exceeded 80% in all age groups (n = 170,017). All-cause mortality increased with age. Compared to adults, 

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