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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 

Impacts of disaggregating programmatic outcomes by documentation of citizenship in South Africa

Abstract  Background: In many resource-limited settings, people in rural areas often migrate to urban hubs in search of w ork. As such, public-sector HIV clinics in urban areas of South Africa often include local residents and patients from outside of the province or other African countries. This analysis compares programmatic outcomes by documentation of citizenship status in an urban resouce-limited setting. Methods: We included all adult ART-naïve patients w ho initiated treatment 

The cost effectiveness of expansion options for adult ART in South Africa: Integrating economic considerations with epidemiological models of Treatment as Prevention

Abstract  Background: The South African government currently discusses further expansion of eligibility for antiretroviral treatment (ART), including to all adults with CD4 cell count <500 cells/micro (500), the positive partner in serodiscordant couples (DC), all HIV-positive pregnant women (PW), or all HIV-positive individuals (UTT). Methods: We modelled 20-year cost and cost effectiveness of each of the four eligibility  options under up to three different patterns of testing and care 

Disaggregating programmatic outcomes by documentation of citizenship in South Africa

Abstract  Background: In many resource-limited settings, people in rural areas often migrate to urban hubs in search of w ork. As such, public-sector HIV clinics in urban areas of South Africa often include local residents and patients from outside of the province or other African countries. This analysis compares programmic outcomes by documentation of citizenship status in the urban resouce-limited setting. Methods: We included all adult ART-naïve patients who initiated treatment from 

Patients accessing drug-resistant tuberculosis treatment at a decentralized outpatient hospital clinic in Johannesburg: A prospective cohort analysis

Abstract Objective: Describe characteristics of patients receiving drug-resistant (DR) TB treatment at a decentralized, hospital-based clinic in Johannesburg. Methods: Prospective cohort analysis of patients >18 years initiating DR-TB treatment between 1 March - 30 Sept 2013. Results: 75 DR-TB patients initiated treatment during the study period; 11 were never consented. 61 patients consented and were enrolled. Median age was 33 (IQR: 28-39); 48% male. The  HIV-co-infection  rate was 

Predictive and prognostic properties of TB-LAM among HIV-positive patients initiating ART in Johannesburg, South Africa

Abstract Detection of the Mycobacterium tuberculosis cell wall antigen lipoarabinomannan (LAM) in urine is a novel method for the diagnosis of tuberculosis (TB) in HIV-infected patients with advanced immunodeficiency. It is a lateral flow assay that can be used at the point of care and yields results in 30 minutes.  The TB-LAM UA assay works best in HIV-infected patients with advanced immunosuppression, a population in which diagnosis of TB is particularly difficult.  While the diagnostic 

TB treatment outcomes by type of treatment supervision in Johannesburg, South Africa

Abstract Background: With the implementation of Directly Observed Treatment Supervision (DOTS), TB treatment in South Africa is typically supervised by trained healthcare workers or lay caregivers based at community organizations. However, patients may also choose to pick up treatment themselves and ‘self-administer’ or ask a family member to pick up the treatment from the clinic. We reviewed clinic TB cards to describe the proportion of patients receiving supervised treatment and to 

Predictors and impact of suboptimal immune response in HIV-infected patients in South Africa

Abstract Background: In most resource-limited settings, viral load monitoring for antiretroviral therapy (ART) is not available and CD4 count is the primary indication of successful response to ART. We aimed to describe predictors of suboptimal immune response by 12 months and its impact on attrition in Johannesburg, South Africa. Methodology: All ART-naïve adults initiating first-line ART between April 2004 and July 2012 at Themba Lethu HIV Clinic with both a baseline and 12 month CD4 count