All Posters

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 

Cotrimoxazole use and immune system recovery among newly initiating HIV-infected patients in an urban outpatient HIV clinic in Johannesburg, South Africa

Abstract Background: Previous research has shown that cotrimoxazole (CTX) use reduces mortality for patients initiating antiretroviral therapy (ART). We investigated whether CTX also accelerates immune recovery and reduces loss to follow-up (LTF) at an outpatient HIV clinic in South Africa. Methodology: We included all adult (≥18) ART-naïve patients initiating standard first-line treatment between April 2004 and March 2012 at Themba Lethu Clinic in Johannesburg. Patients were followed from 

Long-term outcomes of over one thousand patients on second-line antiretroviral therapy in South Africa

Abstract Design: We conducted a retrospective cohort study of HIV-infected adults (≥18) who initiated standard first-line antiretroviral therapy (ART), failed first-line ART, and then switched to second-line treatment at one of four public-sector facilities in Johannesburg, South Africa from April 2004 to September 2012. Analysis: We used Kaplan-Meier analysis to estimate attrition (death or loss to follow-up ) over eight years; One-year incidence rates of attrition are presented per 

Eight years experience with attrition and mortality on antiretroviral therapy in South Africa

Abstract Design: We conducted a retrospective cohort analysis of HIV-infected adults (≥18) who initiated standard first-line antiretroviral therapy (ART) at 7 public-sector HIV clinics in Gauteng and Mpumalanga Provinces in South Africa between April 2004 and May 2012. Only patients with a national ID number to allow for linkage with the national death registry were included. Analysis: We used Kaplan-Meier analysis to estimate attrition (death or loss to folluw-up ) over eight years. 

Long-term Virologic Response in a Cohort of HIV-infected Patients in South Africa

Abstract Background: While much is known about virologic response to antiretroviral therapy (ART) in resource rich settings, much less is known about long-term rates of virologic suppression in resource-limited settings. We aimed to describe virologic response on ART over 8 years among a cohort of patients initiating ART the first year of the public sector roll out in South Africa. Methodology: We included all ART-naïve patients, ≥18 years, who initiated first-line ART from April 

Predictors of Time to Switch to Second Line ART after First Line Failure in Johannesburg, South Africa

Abstract Background: Many patients with documented virologic treatment failure on first line antiretroviral therapy (ART) need to be switched to a second line regimen. In South Africa, national treatment guidelines state that patients with two consecutive failing viral load measurements on non-nucleoside reverse transcriptase inhibitor first line treatment should be switched to a protease inhibitor based regimen. Yet, there are often long delays in switching if it occurs at all. To better 

Risk Factors Associated with TB in Children Receiving ART in a South African Multicenter HIV Cohort

Abstract Background: Tuberculosis (TB) in children is a direct consequence of adult TB and is a good marker of current trends in community transmission.  We sought to estimate rates of, and risk factors for, incident TB among HIV-infected children and adolescents receiving antiretroviral treatment (ART) in South Africa. Methods: Prospective cohort analysis of HIV-infected children <18 years old who initiated ART between April 2004 and May 2011 at one of 12 HIV clinics in Gauteng and