Dr. Denise Evans [Principal Researcher - Epidemiology]

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Dr. Denise Evans

Dr. Evans Denise, is a Principal Researcher at the Health Economics and Epidemiology Research Office, a Division of the Wits Health Consortium at the University of the Witwatersrand. She is currently the Senior HIV/TB Research Advisor (Deputy Program Director) for HE2RO’s current five-year USAID award called EVIDENCE: Evaluations to Inform Decisions using Economics and Epidemiology. She was the principal investigator of NIH/CFAR/CNIHR and two NRF supported research studies in South Africa and more recently received funding from SA-MRC and Bill and Melinda Gates Foundation for an intervention study to improve early childhood development. Denise is the principal investigator for the socio-economic sub-study of TB Sequel (http://www.tbsequel.org/). She has over 100 publications (Google Scholar h-index of 22 and 3193 citations (https://scholar.google.co.za/citations?user=pqyI8X0AAAAJ&hl=en; ResearchGate score of 34.24) and frequently reviews manuscripts for both local and international journals in the HIV and TB field.  To date she has supervised 5 MMed, 6 MSc, 1 PhD and 1 post-doctoral student to completion and currently has 1 MSc and 2 PhD students. She holds a doctorate in Biomedical Technology from the University of Johannesburg, South Africa and has been with the Wits Health Consortium for over 9 years.

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 

  • MHealth to Improve Community Health Worker Performance

    As part of the reengineering of primary health care in South Africa, the National Department of Health (NDoH) has prioritized the development of Ward-Based Outreach Teams (WBOTs) comprised of one nurse (the Team Leader) and 4 – 10 community health workers (CHWs). Each WBOT serves the population of an average administrative ward (~2,000 households); team CHWs provide home-based care and connect patients to clinics through referrals. During the next few years, the Anova Health Institute (Anova) 

  • Evaluation of a Standardized Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB (STREAM): Economic Evaluation at Sizwe Tropical Diseases Hospital

    Despite the widespread availability of an efficacious and affordable regimen and strategy for managing drug-susceptible tuberculosis (TB), the emergence of multidrug resistant (MDR) TB remains a major challenge for global TB control efforts. In 2010, data from Bangladesh indicated that a nine-month regimen achieves outcomes comparable to those of the existing, 18-24 month, WHO-approved MDR-TB regimen. The primary objective of the STREAM trial is to assess whether the Bangladesh regimen is 

  • Analysis of Drug Resistant Tuberculosis Population and Outcomes in South Africa, using the Electronic Drug Resistant Tuberculosis Register (EDRWeb)

    The South African Electronic Drug Resistant Tuberculosis Register (EDRWeb) is a national reporting database. We propose a retrospective analysis of this de-identified, established database of routinely reported patient-level data to describe the population and outcomes of drug-resistant TB as recorded within the EDRweb in order to inform treatment guidelines and practice for South Africa. Operational implementation across a broad number of sites is likely to differ from cohorts at 

  • Linkages to Care for Patients Diagnosed with Drug-Resistant Tuberculosis within the City of Johannesburg

    Nationally, in the most recently reported cohort of patients (2011), only 56% of patients with laboratory-confirmed MDR-TB initiated 2nd line TB treatment. The National Strategic Plan for HIV, TB, and STIs 2012-2016 set an ambitious target of 100% initiation. Because of the complexity of the referral and linkage process and the fragmentation of the records amongst various registers, the proportion of patients completing each step (sample collection, diagnosis of resistance, reporting 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. 

  • 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, 

  • 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