All Policy Briefs

Brief #39: Novel Electronic Technology to Assess Operational Efficiency of HIV Clinics In Johannesburg

Measuring the impact of an intervention or technology on clinical tasks often involves performing a time and motion study. While some studies rely on passive observation and specific activities are timed, others ask staff to keep a log file to estimate the time spent on a specific activity (Kranzer et al, 2012), but both are subject to observer errors. HE²ROand IBM investigators worked together to develop non-invasive electronic devices or “wearable tags” to conduct a time and motion (TIM) 

Brief #3: HIV, Population Dynamics and the Labour Force

AIDS-related mortality among working-age adults reduces GDP growth but has an ambiguous effect on GDP per capita. In the short run, population size decreases due to reduced fertility and increased child mortality owing to HIV, and GDP per capita increases, but this results in lower growth of the working-age population and of GDP in the long run. A smaller elderly cohort due to HIV-related early mortality mitigates the fiscal burden of an ageing population, but as HIV treatment is scaled 

Brief #4: Human Capital

AIDS-related mortality among young adults results in an increase in the number of orphans, and orphanhood is associated with impaired access to education. Early mortality among working-age adults causes a loss of skills and experience and a drop in returns to investment in education. Educational outcomes have weakened in regions with higher HIV prevalence but investments in the HIV response are effectively mitigating HIV’s negative impact on human 

Brief #5: Capital and Investment

The direct effects of health-related productivity shocks on economic output are magnified by their negative impact on investment. Poorer health decreases productivity, which results in lower economic output and consequently lower investment, which again reduces productivity and output over time. Higher mortality reduces incentives for saving and investment. Empirical studies (not HIV-specific) suggest that this could be an important link between HIV and growth, but there is no clear 

Brief #6: Productivity and Employment of People Living With HIV

Early on, there were concerns that AIDS-related mortality would erode state governance and institutions and thus compromise economic development, but there is little evidence to suggest that such effects have been significant. HIV – especially at late stages of disease progression –results in reduced productivity and lower employment of people living with HIV, though the economy-wide effects are unclear. Treatment has been effective in restoring the productivity and – with some 

Brief #7: Economic Growth – Overview

HIV has increased mortality and slowed population growth. As a consequence, GDP is lower and will remain lower than it would have been without the impact of HIV. Economic modelling suggests that the short- to medium-term impacts of HIV on GDP per capita are unclear, with important effects working in opposite directions. In the longer run, the effects are likely dominated by adverse impacts on education and skills. The empirical evidence on the link between HIV and growth of GDP per capita 

Brief #17: The Economics of HIV and of HIV Programmes in the Era of COVID-19

The Covid-19 pandemic has profound negative implications for the economies of countries most affected by HIV, as well as for donor countries that support the global HIV response. It undermines underlying economic fundamentals and adds considerations for HIV policymaking. This paper explores three interrelated ways in which the Covid-19 pandemic and the response to Covid-19 affect people living with HIV and the HIV response: (1) the health impacts of those living with or at risk of acquiring 

Cost and outcomes of drug-susceptible TB treatment at public and private primary healthcare clinics, Johannesburg South Africa

South Africa carries 3% of the world’s tuberculosis (TB) case burden and is experiencing a dual TB/HIV epidemic: 59% of adult TB patients are also HIV positive. There are no recent published estimates on the costs and outcomes of drug-susceptible TB in South Africa for adults in an out-patient setting with the exception of one paper published in 2003 (using 1997 data) and another in 2006 (using 2001 data) . The proposed National Health Insurance (NHI) system aims to re-engineer primary 

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

The World Health Organization recommends national programs use viral load monitoring for patients on ART1 to determine whether treatment has been successful and to guide clinicians on when to switch treatment to second-line regimens, indicated if the virus is resistant to first-line therapy. Not all countries are able to provide viral load testing as part of national programs but for those that do, patients with an elevated viral load (VL) are recommended to undergo adherence counselling and 


HIV testing represents the primary entry point into HIV care and treatment programs for people living with HIV and is the first of UNAID’s 90-90-901 targets. South Africa made a large effort to expand HIV testing in April 2010 by implementing a national testing campaign2. This campaign, designed to increase awareness of HIV status, sought to test 15 million people by June 2011. The monthly number of people tested for HIV increased from approximately 240,000 per month in the period prior to 


During 2018, South Africa was estimated to have more than seven million people living with HIV1, representing the largest single country epidemic2 and treatment program. 3 In September 2016, the National Department of Health revised its treatment guidelines to extend the availability of ART to all people living with HIV, irrespective of CD4 cell count and stage of disease3. This policy, widely referred to as “treat all” or “universal test and treat” (UTT) holds promise to offer 


The World Health Organization recommends "sameday" initiation of antiretroviral therapy (ART) for HIV patients eligible and ready1. This recommendation has been adopted by both South Africa2 and Kenya3. Identifying efficient, safe, and feasible procedures for determining same-day eligibility and readiness is now a priority. The WHO guidelines cited evidence from clinical trials suggesting that offering treatment to patients at their first clinical encounter has the potential to increase