Boston University Affiliates
Dr. Lawrence Long [Research Assistant Professor]

Lawrence Long (MCom, PhD) is a health economist and public health policy researcher. He is a Research Assistant Professor at the Boston University School of Public Health and holds a joint appointment at the University of Witwatersrand (Johannesburg, South Africa). He has more than 12 years of experience conducting applied research on the economic impact of HIV, tuberculosis and associated conditions within South Africa and sub-Saharan Africa. Lawrence did his undergraduate degree in business science with a specialization in economics and finance and then went on to focus on economics and its application to public health in his graduate studies.
Projects
-
AMBIT: Alternative Models of ART Delivery – Optimizing the Benefits
AMBIT is a 2.5-year research and evaluation project in sub-Saharan Africa supported by the Bill & Melinda Gates Foundation and implemented by the Boston University School of Public Health in the U.S., the Health Economics and Epidemiology Research Office (HE2RO) in South Africa, and other local partners. The project, launched in September 2018, will include data synthesis, data collection, data analysis, and modeling activities aimed at generating information for near- and long-term -
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 -
Assessing the Impact of Integration of HIV and TB Services into Primary Health Services in the Public Sector in South Africa: An Evaluation of Resource Utilisation at Facility Level
Early in the HIV epidemic, in South Africa and other low income countries, HIV and TB services were provided in vertical programs as a result of disease-specific funding or approaches to service provision. Provision of separate services for specific health problems or specialisation usually means that patients need to visit separate and specialised clinics for their different health problems or needs, and can result in “missed opportunities” for service provision, fragmented and -
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 -
A Cost Description of HIV Counselling and Testing (HCT) Models in South Africa
South Africa’s National Strategic Plan for 2011-2016 (NSP) aims to see a halving of HIV incidence over this period, and a realisation of 80% HIV treatment coverage, or 3 million patients on antiretroviral therapy (ART). The realisation of these goals relies on increased and equitable access to and uptake of HIV Counselling and Testing (HCT). Achieving sustained high levels of HCT in turn requires accurate cost data from which budgeting decisions can be extrapolated. Although a number of -
An Evaluation of an Automated Dispensing System for Pharmaceutical Services
In both developed and developing countries, pharmaceutical management is a critical issue due to escalating health care costs and increased pressure to improve access to services. The past few decades have seen the role of pharmacy staff expanding. For example, in many resource limited settings burdened by HIV, the complexity of HIV-related medication, the increased life span of HIV-positive patients that comes with antiretrovirals, and the comorbidity of HIV/AIDS with other diseases has -
An Evaluation of the Acceptability and Feasibility of Booked Appointments in a Large HIV Clinic in Johannesburg, South Africa
In many resource-limited settings, health care delivery systems face constraints due to increasing need for health expenditure and the large proportion of the population reliant on the public sector. In South Africa, the existing service delivery structure faces additional challenges related to the growing number of HIV-infected South Africans initiating antiretroviral therapy. Long queues, long wait times, and overcrowding are often characteristic of South Africa’s public health care -
Analysing the Impact and Cost of Scaling up Xpert MTB/RIF Technology for TB Diagnosis: The National TB Cost Model (NTCM)
In the South African context, smear microscopy and other conventional TB diagnostic technologies that have been used for decades, are no longer reliable, because many HIV-positive tuberculosis patients are smear-negative, and the long time to diagnosis means that many patients die without having started TB treatment. In December 2010 the GeneXpert System using the Xpert MTB/RIF assay received a strong recommendation from the World Health Organization as the initial test in individuals with HIV -
Rewards for TB Contact Screening (RECON)
Because of the high risk of both TB and HIV among the household contacts of TB patients and the importance of early case detection for both diseases and especially for DR-TB, improving TB case finding is a high priority. Recent studies have shown that having healthcare workers make multiple visits to the homes of TB patients in order to screen household contacts is a logistically challenging and resource- intensive strategy, and it is not routinely undertaken in most public sector settings in -
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 -
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 -
Investigating the Feasibility of Implementation of Multi-Disciplinary Point-of-Care Testing in an HIV Treatment Clinic Using a Randomised Controlled Trial
A major challenge to successful implementation of both antiretroviral and anti-tuberculosis therapy in low-resource settings remains the ability to diagnose and monitor the progress of both infections, a process that is hampered by lack of laboratory infrastructure, technical skill and poor integration of HIV and TB services. Recent technological innovations in the Point of Care (POC) testing arena promises to alleviate the problem by providing access to on-site laboratory tests with the future -
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 -
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
Publications
-
Regimen durability in HIV-infected children and adolescents initiating first-line antiretroviral therapy in a large public sector HIV cohort in South Africa
-
Tenofovir stock shortages have limited impact on clinic-and patient-level HIV treatment outcomes in public sector clinics in South Africa
-
Changes in elevated cholesterol in the era of Tenofovir: risk factors, clinical management and outcomes
-
Timing of pregnancy, postpartum risk of virology failure and loss to follow up among HIV-positive women
-
Cohort profile: the Right to Care Clinical HIV Cohort, South Africa
-
Predicting the need for third-line antiretroviral therapy by identifying patients at high risk for failing second-line antiretroviral therapy in South Africa
-
Pharmacy Automation for HIV Treatment: An Evaluation of Costs
-
The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South Africa
-
A predictive risk model for first line treatment failure in South Africa
-
Delaying second line antiretroviral therapy after first line failiure in South Africa: Moderating effect of CD4 count
-
Predictors and Outcomes of Incident High Cholesterol in Adults on ART in South Africa
-
Delays, interruptions, and losses from prevention of mother-to-child transmission of HIV services during antenatal care in Johannesburg, South Africa: a cohort analysis
-
Rapid antiretroviral therapy initiation reduces attrition between HIV testing and treatment in Africa
-
The relation between efavirenz versus nevirapine and virologic failure in Johannesburg, South Africa
-
Attrition through Multiple Stages of HIV Care in South Africa
-
Does most early mortality in patients on ART occur in care or lost to follow-up? Evidence from the Themba Lethu Clinic, South Africa
-
Impacts of disaggregating programmatic outcomes by documentation of citizenship in South Africa
-
Disaggregating programmatic outcomes by documentation of citizenship in South Africa
-
Cotrimoxazole use and immune system recovery among newly initiating HIV-infected patients in an urban outpatient HIV clinic in Johannesburg, South Africa
-
Decrease in Single-drug Substitutions in the First 24-months on First-line Treatment amongst HIV-positive Children and Adolescents in South Africa
-
24-month Treatment Outcomes Amongst HIV-Positive Children and Adolescent Patients Prescribed Stavudine vs. Abacavir
-
Long-term outcomes of over one thousand patients on second-line antiretroviral therapy in South Africa
-
Eight years experience with attrition and mortality on antiretroviral therapy in South Africa
-
Long-term Virologic Response in a Cohort of HIV-infected Patients in South Africa
-
Predictors of Time to Switch to Second Line ART after First Line Failure in Johannesburg, South Africa
-
Risk Factors Associated with TB in Children Receiving ART in a South African Multicenter HIV Cohort
-
Obesity or hypertension at ART initiation and outcomes amongst HIV patients in South Africa
-
Predictors of incident hypertension in HIV-positive adults over 24 months on ART in South Africa
-
Missing Visits, Missing Opportunities: Losses From Care During PMTCT At Primary Health Care Clinics In Johannesburg, South Africa
-
Changing the South African HIV and TB guidelines: The role of cost modelling
-
Loss to Initiation and Linkage to Care
-
Costs of inpatient treatment for multi-drug resistant TB in South Africa
-
How Much Does It Cost?
-
The Health Economics and Epidemiology Research Office (HE2RO): An overview of research methods and results
-
HE2RO’S Overview of Research 2012-2013
-
Costs and cost models of point of care technology
-
The Relation Between Efavirenz. vs. Nevirapine and Virologic Failure in Johannesburg, South Africa
-
Current CD4 Count, More than Baseline, Predicts Loss to Follow-up from HIV Care
-
Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough
-
Diagnosing Xpert MTB/RIF negative TB suspects: Impact and cost of an alternative algorithm
-
What To Do with Xpert Negatives? The Cost of Alternative Diagnostic Algorithms for TB Suspects Who Are Xpert MTB Negative in a High HIV/MDR-TB Burden Setting
-
HIV-related Burden on South African Hospitals in the Era of Large-scale Access to Antiretroviral Therapy
-
Short-term impacts of a change in ART initiation threshold for patients co-infected with TB in Johannesburg, South Africa
-
What to do with Xpert negatives? The cost of alternative diagnostic algorithms for TB suspects who are Xpert MTB negative in a high HIV/MDR-TB burden setting
Tools
-
The Healthcare Cost and Outcomes Model
The Healthcare Cost and Outcomes Model (HCOM) provides a simple tool for analysts and decision-makers to determine the cost-effectiveness of a healthcare intervention in which resources are consumed to produce certain healthcare outcomes.