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Ideal Clinic Realisation and Maintenance program in South Africa.

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 

Combating TB in South Africa

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 

Thusa-Thuso: Helping You Help

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 

The effect of initiating tenofovir on HIV treatment outcomes in adults in southern Africa: a regression discontinuity analysis

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 

A descriptive analysis of South Africa’s national third line antiretroviral therapy cohort

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 

The cost-effectiveness of early ART initiation in South Africa: a quasi-experiment

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 

A predictive risk model for first line treatment failure in South Africa

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 

Delaying second line antiretroviral therapy after first line failiure in South Africa: Moderating effect of CD4 count

Abstract Background: Ideally patients who fail first line antiretroviral therapy (ART) are switched to second line quickly, yet logistical issues, clinician decisions and patient preferences make some delay in switching to second line ART common. Delays in switching to second line may be associated with poor outcomes on second line if resistance mutations develop or CD4 count declines substantially. This study explores the impact of delaying second line ART after first line failure on rates 

Predictors and Outcomes of Incident High Cholesterol in Adults on ART in South Africa

Abstract Background: As the HIV-­‐infected population ages in sub-­‐Saharan Africa, non-­‐communicable chronic disease incidence among patients on ART is likely to rise. Specific antiretroviral drugs are considered independent risk factors for cardiovascular disease (CVD), and high total cholesterol (TC) is a risk factor for CVD, stroke and renal disease. We examined predictors of high TC in ART patients in South Africa.  Methods: Prospective study of HIV-­‐positive, 

Severe Adverse Events in Outpatient Drug-Resistant TB Treatment in South Africa

Abstract Background: South Africa adopted a policy of decentralization of drug-­‐resistant TB treatment to satellite and outpatient sites in 2011. Outcomes of treatment at these new sites are not yet known. We report on the occurrence of adverse events (AE) to treatment at two outpatient, decentralized, drug-­‐resistant tuberculosis (DR-­‐TB) treatment sites in Johannesburg, South Africa.  Methods: Combined retrospective and prospective medical record review of the six-­‐month 

Knowledge of the Spectrum of Breast Disease Presenting at a Public, Tertiary Hospital in Johannesburg, South Africa is Critical to Ensuring Holistic Care

Abstract Introduction: Most breast-related research focuses on cancer. However, it is critical to understand the  total burden of breast diseases for service planning, especially in resource-constrained settings. Objectives/Aims: To characterize the presentation and management of breast disease at a large, public hospital offering comprehensive breast-related services in Johannesburg, South Africa. Methods: A retrospective file review was performed. Patients were eligible if they were ≥18 

Does most early mortality in patients on ART occur in care or lost to follow-up? Evidence from the Themba Lethu Clinic, South Africa

Abstract Objective: In resource-limited settings, early mortality on antiretroviral therapy (ART) is about 10% yet it is unclear how much of that mortality occurs in care or among patients lost to follow-up. Methods: We assessed mortality rates among non-pregnant ART-naïve adults initiating first-line ART between April 2004–May 2012 in South Africa, stratified by person-years (py) in care and lost. Deaths were ascertained from the National Population Register and multiple definitions of