Early pregnancy access to prenatal care is essential. Research has linked a lack of antenatal services to a risk of maternal mortality. Younger women typically share traits such as low socioeconomic position, lack of spousal support, work obligations, and unexpected pregnancies. In South Africa more than a third of births occur in young mothers aged <24 years. The influence of early maternal age and caregiving knowledge on pregnancy, birth, and early childhood outcomes is
A strong body of evidence demonstrates that the negative impacts of early adversity on child development in low- and middle-income countries (LMICs) can be mitigated through appropriate early-life interventions. Regular home visits by trained staff who support and counsel caregivers on a diversity of topics, including child health, nutrition, and play-based stimulation, have been shown to be particularly effective. However, important questions remain around how to effectively integrate
South Africa has the largest number of people living with HIV globally, with 4.7 million women ≥15 years old living with HIV as of 2018.1 The country is targeting but has not achieved elimination of mother-to-child HIV transmission. The national estimate of early HIV transmission was 2.6% in 2012-2013.2 South Africa’s policy for providing antiretroviral therapy (ART) to pregnant women living with HIV (WLWH) has changed over time, following the World Health Organization’s (WHO)
South Africa has the largest number of people living with HIV globally, with 4.7 million women ≥15 years old living with HIV as of 2018.1 The country is targeting but has not achieved elimination of mother-to-child HIV transmission. The national estimate of early HIV transmission was 2.6% in 2012-2013.2 South Africa’s policy for providing antiretroviral therapy (ART) to pregnant women living with HIV (WLWH) has changed over time, following the World Health Organization’s (WHO)
The COVID-19 pandemic highlighted vulnerabilities in the global health-system and its capacity to respond timeously to health-crisis South Africa was not an exception, with growing concerns over limited bed capacity in the hospitals to accommodate the rapidly rising case numbers at the start of the pandemic¹ To better prepare health-systems for future pandemics, cost projection models are required to inform budgets and efficient resource-allocation² A key aspect of cost
To address the historical inequalities in the quality of primary health care services and to lay a strong foundation for the implementation of the National Health Insurance (NHI), the Ideal Clinic Realisation and Maintenance (ICRM) programme was established in 2015. The ICRM program implementation will hopefully improve the South African health system's performance in managing priority infectious diseases (e.g HIV, TB) and non-communicable diseases (e.g diabetes, hypertension). This health
South Africa is experiencing a dual TB/HIV epidemic. Approximately 360 000 South African had TB in 2019. TB is the leading cause of death among people living with HIV. Of the 58 000 people who died from TB in South Africa, 36 000 were diagnosed with HIV. With the launch of the 2017-2022 National Strategic PLan (NSP), the South African government aims to eliminate TB by 2030. As an organisation working at the intersection of health economics and epidemiology, HE²RO aims to work towards
In September 2016, South Africa began the implementation of WHO’s Universal Test and Treat (UTT) policy in hopes of reaching the 90-90-90 targets by 2020 and reducing HIV- related morbidity, mortality and HIV transmission rates.1,3 Although 3.8 million HIV positive patients are currently receiving antiretroviral therapy (ART) (March 2017), over 2 million patients will have to be enrolled on HIV treatment for South Africa to reach the 90% on ART target.1,4 While the Department of Health
Abstract Background: Due to toxicities associated with the NRTI stavudine, many countries now recommend initiating HIV patients on tenofovir as the standard NRTI in first-line therapy. Exploiting national guideline changes in South Africa and Zambia, we assessed the causal impact of a policy to initiate tenofovir on ART outcomes using a regression discontinuity design. Objectives: To establish the causal effect of tenofovir (vs. stavudine) on patient outcomes in South Africa and Zambia’s
Abstract Background: The World Health Organization has recommended that national antiretroviral therapy (ART) programs in resource limited settings develop policies for third-line ART. South Africa, with the largest HIV treatment program in the world, is one of the only countries in sub-Saharan Africa that has access to third-line ART for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitors (NNRTI) based ART and second-line protease inhibitor (PI) based
Abstract Background: Clinical trials are not well suited to evaluate the effectiveness and cost-effectiveness of interventions in “real world” settings. Using a quasi-experimental regression-discontinuity design (Bor et al. 2014), we establish the causal effect of early (vs. deferred) ART initiation on patient survival in rural South Africa, and obtain empirical (as opposed to modeled) cost-effectiveness estimates. Methods: Demographic data from a large population surveillance in rural
Abstract Background: Although individual predictors of first line antiretroviral therapy (ART) failure have been identified, few studies in resource-‐limited settings have been large enough for predictive modeling. Understanding the absolute risk of first line failure is useful for patient monitoring and for effectively targeting limited resources for second line ART. The aims of this study are to estimate absolute risk of failure of first line ART over 5 years on treatment as a function
