Matthew Fox [Division Head]

T: +1 (617) 414 1270  

Matthew Fox, DSc, MPH, has served as a Co-Director of the Health Economics and Epidemiology Research Office (HE2RO) since 2008 where he oversees a portfolio of research on epidemiologic impacts of the HIV treatment rollout in South Africa. He is also a Professor in the Center for Global Health & Development and in the Department of Epidemiology at Boston University. His research interests include treatment outcomes in HIV-treatment programs, infectious disease epidemiology (with specific interests in HIV and pneumonia), and epidemiologic methods. Dr. Fox is currently funded through a K award from the National Institutes of Allergy and Infectious Diseases, to work on ways to improve retention in HIV-care programs in South Africa from the time of testing HIV-positive through long-term treatment. As part of this work, he is involved in analyses of whether treating patients at higher CD4 counts leads to improved long-term retention and treatment outcomes. Dr. Fox also does research on quantitative sensitivity analysis and recently co-authored a book on these methods, Applying Quantitative Bias Analysis to Epidemiologic Data. He currently teaches a third-level epidemiologic methods class, Advanced Epidemiology. Dr. Fox is a graduate of the Boston University School of Public Health with a master’s degree in epidemiology and biostatistics and a doctorate in epidemiology.

Projects

  • Low Prevalence of Depressive Symptoms among Stable Patients on Antiretroviral Therapy in Johannesburg, South Africa

    Depression is a leading cause of morbidity worldwide. It affects more than 300 million individuals globally and depressive disorders are currently the 4th leading cause of Years Lived with Disability (YLD) in South Africa. People living with HIV are disproportionately affected by mental health disorders and while the lifetime prevalence of depression in the general population of South Africa is estimated as 9.7%, estimates from HIV-infected populations have ranged from 14-62%, with variability 

  • Using Routinely Collected Laboratory Data to Characterise Trends in the TB Epidemic

    The overall aim of this study is to harness routinely collected laboratory data to characterize the spatial distribution of tuberculosis in South Africa. In collaboration with partners at the University of the Witwatersrand and the National Health Laboratory Service, we are conducting retrospective analyses of de-identified data to highlight areas with greater burden of TB disease and investigate whether burden is changing over time. Results from this work will be informative for planning for 

  • SLATE: Simplified Algorithm for Treatment Eligibility

    In its 2015 revision of the global guidelines for HIV care and treatment, the World Health Organization called for initiating lifelong antiretroviral treatment (ART) for all patients testing positive for HIV, regardless of CD4 cell count. As countries adopt the new recommendation, known as “treat all,” millions of additional patients are becoming eligible for ART worldwide. In sub-Saharan Africa, where most of these patients are located, studies continue to document high losses of 

  • Retrospective Cost-Effectiveness Analysis for Nurse Initiated and Managed Antiretroviral Treatment for HIV/AIDS in South Africa

    In HIV/AIDS treatment programs in resource-constrained settings, one response to a shortage of doctors and other highly trained healthcare providers is “task-shifting” from doctors to less trained clinicians, such as nurses and community healthcare workers. In 2010, South Africa issued new guidelines for its antiretroviral treatment (ART) program to allow senior nurses to initiate and manage adult ART patients at primary health clinics. This policy, known as NIMART (Nurse Initiated and 

  • Attrition from HIV Care and Treatment Before and After an Increase in the CD4 Count Eligibility Threshold

    South Africa has recently announced that as of January 2015, it will be increasing its HIV treatment CD4 eligibility threshold from 350 cells/μl to 500 cells/μl1 making more patients eligible for treatment than ever before. However efforts to increase HIV treatment coverage may be minimized if losses to follow up, which have been shown to be high along the continuum of HIV care, offset gains from getting more people onto treatment. HE2RO will conduct a prospective cohort study of adult 

  • Modelling the Cost of the National ART Programme under Different Sets of Guidelines: The National ART Cost Model (NACM) and the Treatment as Prevention Cost Model (TasP Cost Model)

    On request of the South African Department of Health (NDoH), since 2009 HE2RO has used the detailled cost and outcomes data collected in other projects to develop mathematical models projecting the size of the treatment cohort under different scenarios of antiretroviral treatment (ART eligibility as well as the resulting costs). Our budget models, most notably the National ART Cost Model (NACM) and the Treatment as Prevention Cost Model (TasP Cost Model), have contributed to several sets of 

  • Impact of Nutritional Supplementation on Physical Development, Retention in Care and Adherence to ART in HIV-Positive Infants and Children

    The study aims to determine whether a nutritional supplement, FutureLife HIGH-ENERGY Smart food, given to caregivers/guardians to give to their HIV-positive infants and children for 6 months concurrently with antiretroviral therapy (ART) compared to standard of care results in improved growth and physical development as measured by an increase in height-for-age Z score (HAZ), weight-for-age Z score (WAZ) and mid-upper arm circumference (MUAC) at 6, 12 and 24 months. Secondary outcomes 

  • Remote Electronic Treatment Adherence Monitoring of Patients on Antiretroviral Therapy in South Africa: A Pilot Study

    Electronic patient adherence monitoring is a novel method for improving adherence to HIV treatment. This pilot study aimed to generate preliminary data for a larger trial. We determine the effectiveness and cost-effectiveness of using electronic patient adherence monitoring in patients at high risk of failing second-line antiretroviral therapy (ART) at Themba Lethu HIV clinic in Johannesburg, South Africa compared to the standard of care, which involves optimized adherence counseling. 

  • Rapid Initiation of Antiretroviral Treatment (RapIT) for Pregnant Women

    Alongside the primary RapIT study, we are enrolling pregnant women at a public clinic in Johannesburg in a prospective study of the impact of the guidelines on retention on ART for the duration of pregnancy. We are comparing our main outcome, adherence to ART until delivery, for these women to a retrospective comparison group who received PMTCT under earlier 

  • RapIT: Rapid Initiation of Antiretroviral Therapy to Promote Early HIV/AIDS Treatment in South Africa

    The RapIT study was a randomized strategy evaluation of the feasibility, effectiveness, and cost-effectiveness of rapid ART initiation using accelerated clinic procedures and point-of-care laboratory tests. Outpatient, non-pregnant, HIV-positive adults who came to two South African clinics for an HIV test or CD4 count, consented to study participation, and were eligible for ART under 2010 guidelines were randomized 1:1 to rapid ART initiation or to standard care. Those who were assigned to 

  • Retention and Attrition from HIV Care

    With the rapid expansion of access to antiretroviral therapy (ART) in sub-Saharan Africa, the number of HIV-positive people on treatment has increased dramatically. In South Africa, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients while continuing to expand access to new patients. With increased demand and limited capacity, many HIV-positive patients never access care, and many who do discontinue treatment. HE2RO staff, 

  • Southern African Treatment Programme Evaluation

    Understanding HIV epidemic in the wider Southern African region provides context and valuable insight for the National treatment programme. To this end, HE2RO contributes data to the International Epidemiologic Databases to Evaluate AIDS Southern Africa network. This collaboration collects key data and implements methodology to effectively analyse data from large generated datasets to address high priorty HIV/AIDS related questions that are not answerable by a single 

  • Linkage to National Databases to Enhance Programme Evaluation

    HIV care involves a web of local clinics and laboratories throughout South Africa. In the emergency phase of the epidemic, monitoring and evaluation took a backseat to HIV care. Currently HIV care takes place at over 3,000 local clinics throughout South Africa. Laboratory test from the labs and patient records from the clinics provide potentially useful sources of data for monitoring and evaluation of the National treatment programme currently and historically. Linkage of patient records to the 

  • Pregnant Women

    Treatment outcomes among pregnant women remain a critical indicator for monitoring and evaluation of the national treatment program over time. A long-standing collaboration with researchers from the University of North Carolina has enriched the analysis of longitudinal data on pregnant women by the researchers at 

  • Paediatric and Adolescent Populations

    Children and adolescents have been identified as priority populations with the greatest potential impact on the development of the HIV epidemic. HE2RO has used multiple sources of data to evaluate the outcomes of children and adolescents initiating ART at multiple clinics across Gauteng and Mpumalanga. We also utilize prospective cohorts to identify factors associated with treatment adherence and missed clinic visits among adolescents and plan to use national level laboratory data to produce 

  • Second and Third-Line Antiretroviral Regimens

    As South Africa continues its rapid expansion of access to first-line antiretroviral therapy (ART), more patients will need to be switched to second-line therapy as these first-line regimens fail. However, with little experience with second-line treatments in resource-limited settings, it is not clear how well patients will do on these medications if their first regimen fails. As the cost of second-line medications is much higher than first-line, it is critical to evaluate whether these 

  • First Line Regimen Durability and Adverse Events

    Understanding the implications of the side effect profile of individual antiretroviral drugs as well as the durability of drug regimens has considerable significance in settings where resources and drug options for HIV remain limited. HE2RO has explored these questions through longitudinal patient datasets with a particular interest in the effects of tenofovir upon introduction into the national programme. These analyses are ongoing as guidelines continue to evolve and current projects include 

  • Adult Treatment Outcomes and Opportunistic Infections

    As the HIV epidemic matured in South Africa and the national treatment programme reached 10 years since inception, the team at HE2RO has used longitudinal patient databases to evaluate treatment outcomes among adults initiating ART. We consider diverse factors that may influence the effect of ART and also the impact of changing national guidelines in an on-going 

Publications