Principal Researchers
Dr Mhairi Maskew [Principal Researcher - Epidemiology]
Mhairi Maskew, MBBCh, PhD, is a physician and epidemiologist. Mhairi has been involved in the management and analysis of large HIV treatment cohorts databases for the last 10 years. She joined the HE2RO team in 2010 and, as a Principal Researcher, currently provides leadership to projects involving big data linkages. Mhairi was previously based at Helen Joseph Hospital in Johannesburg, South Africa, as a clinician in the Themba Lethu clinic, one of South Africa’s largest antiretroviral treatment sites. During this time she also worked in the hospital’s Oncology unit where she developed an interest in HIV-related malignancies. She has since completed a PhD at the University of the Witwatersrand which explored the epidemiology of Kaposi Sarcoma and its etiologic virus, the Kaposi sarcoma Herpes-virus. Since then, Mhairi has been involved as local principal investigator on two randomised clinical trials investigating simplified clinical treatment algorithms for same-day ART treatment eligibility in South Africa. In addition, she was awarded a five-year R01 which resulted in the development of the first National HIV Cohort created from routinely collected laboratory data and some of the first national-level estimates of retention on ART robust to transfers, with a focus on adolescents. She was recently awarded a second R01 to further develop the lab-based National HIV Cohort to focus on pregnant women. Mhairi has mentored several Master’s level students and her work has been published in several international peer-reviewed journals including Lancet HIV, AIDS, JAIDS, Clinical Infectious Diseases and the International Journal of Epidemiology.
Projects
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Analysis of National Lab Database to evaluate the HIV treatment rollout in South Africa
By linking lab tests on detailed patient identifiers, a national, patient-level longitudinal cohort is being developed, which contains over 3 million ART initiators and over 23 million observations. This “NHLS Patient Cohort” will enable us to evaluate the national ART program using data that are nationally representative and robust to self-transfer across care settings. Through a partnership between Wits University in South Africa and Boston University in the U.S., this project will -
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 -
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 -
Non-Communicable Diseases
The past two decades have brought a number of serious threats to public health in South Africa. One of these is the growing burden of non-communicable, chronic diseases. These diseases are already responsible for a large share of premature adult mortality and morbidity, and the burden they impose on the public sector health care system and national health budget is likely to grow substantially in coming years. HE2RO and its partner, Boston University, are developing a body of work to quantify -
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 -
RapIT-NCD: Prevalence of NCD risks and conditions in patients on ART
South Africa, like many other middle income countries, faces very high rates of NCDs and NCD risks but there are virtually no studies looking at NDCs in ART patients and none that have considered the effect of NCDs and NCD risk factors on long term retention on ART. RapIT-NCD is estimating the prevalence of NCDs and NCD risk factors in patients who are stable on ART and examining associations between NCDs and ART outcomes, including mortality, loss to follow up, viral suppression and
Publications
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Frequent Mobility among Postpartum Women: Implications for HIV Treatment and Care
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Regimen durability in HIV-infected children and adolescents initiating first-line antiretroviral therapy in a large public sector HIV cohort in South Africa
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Tenofovir stock shortages have limited impact on clinic-and patient-level HIV treatment outcomes in public sector clinics in South Africa
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Changes in elevated cholesterol in the era of Tenofovir: risk factors, clinical management and outcomes
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The right combination – treatment outcomes among HIV-positive patients initiating first-line fixed-dose antiretroviral therapy in a public sector HIV clinic in Johannesburg, South Africa
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Cohort profile: the Right to Care Clinical HIV Cohort, South Africa
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Predicting the need for third-line antiretroviral therapy by identifying patients at high risk for failing second-line antiretroviral therapy in South Africa
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Initiating Antiretroviral Therapy at a Patient’s First Clinic Visit: The RapIT Study
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Effect of Pregnancy and the Postpartum Period on Adherence to Antiretroviral Therapy Among HIV-Infected Women Established on Treatment
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Effect of Pregnancy and the Postpartum Period on Adherence to Antiretroviral Therapy Among HIV-Infected Women Established on Treatment
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Comparison of Pharmacy-Based Measures of Adherence to Antiretroviral Therapy as Predictors of Virological Failure
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A predictive risk model for first line treatment failure in South Africa
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Delaying second line antiretroviral therapy after first line failiure in South Africa: Moderating effect of CD4 count
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Predictors and Outcomes of Incident High Cholesterol in Adults on ART in South Africa
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Kaposi’s Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era.
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Incidence rate of Kaposi Sarcoma in HIV-infected patients on antiretroviral therapy in Southern Africa: A prospective multicohort study
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Rapid antiretroviral therapy initiation reduces attrition between HIV testing and treatment in Africa
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The relation between efavirenz versus nevirapine and virologic failure in Johannesburg, South Africa
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Attrition through Multiple Stages of HIV Care in South Africa
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CD4 monitoring improves the sensitivity of a clinical algorithm developed to identify virological failure in HIV-positive patients on first-line antiretroviral therapy
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Does most early mortality in patients on ART occur in care or lost to follow-up? Evidence from the Themba Lethu Clinic, South Africa
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Impacts of disaggregating programmatic outcomes by documentation of citizenship in South Africa
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Disaggregating programmatic outcomes by documentation of citizenship in South Africa
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Cotrimoxazole use and immune system recovery among newly initiating HIV-infected patients in an urban outpatient HIV clinic in Johannesburg, South Africa
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Decrease in Single-drug Substitutions in the First 24-months on First-line Treatment amongst HIV-positive Children and Adolescents in South Africa
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24-month Treatment Outcomes Amongst HIV-Positive Children and Adolescent Patients Prescribed Stavudine vs. Abacavir
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Eight years experience with attrition and mortality on antiretroviral therapy in South Africa
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Long-term Virologic Response in a Cohort of HIV-infected Patients in South Africa
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Predictors of Time to Switch to Second Line ART after First Line Failure in Johannesburg, South Africa
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Risk Factors Associated with TB in Children Receiving ART in a South African Multicenter HIV Cohort
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Obesity or hypertension at ART initiation and outcomes amongst HIV patients in South Africa
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Predictors of incident hypertension in HIV-positive adults over 24 months on ART in South Africa
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Kaposi Sarcoma-Associated Herpes Virus and Response to Antiretroviral Therapy: A Prospective Study of HIV-Infected Adults
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The Relation Between Efavirenz. vs. Nevirapine and Virologic Failure in Johannesburg, South Africa
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Impact of nutritional supplementation on immune response, body mass index and bioimpedance in HIV-positive patients starting antiretroviral therapy (NuStART)
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Current CD4 Count, More than Baseline, Predicts Loss to Follow-up from HIV Care
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Treatment Response and Mortality among Patients Starting Antiretroviral Therapy with and without Kaposi Sarcoma: A Cohort Study
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Antiretroviral treatment outcomes after the introduction of tenofovir in the public-sector in South Africa
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Incidence and Risk Factors Associated with Tuberculosis in HIV-positive Children Receiving Antiretroviral Therapy in a Large South African Multicenter Cohort
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Decrease in Single Drug Substitutions in the First 12-months on First-line Treatment amongst HIV-positive Patients in Johannesburg, South Africa
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Incidence of Herpes Zoster among HIV-infected Patients on Antiretroviral Therapy in Johannesburg, South Africa – Who Should We Vaccinate?
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Viremia Copy-years as a Measure of Viral Load Burden and Associated Mortality Risk among Antiretroviral Therapy Patients in Johannesburg, South Africa
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The Effect of 30 vs. 40mg of Stavudine vs. Tenofovir on Treatment Outcomes amongst HIV-positive Patients in Johannesburg, South Africa
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Incident pulmonary tuberculosis on antiretroviral therapy: seven years of experience at the Themba Lethu Clinic in Johannesburg, South Africa
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CD4 criteria improves the sensitivity of a clinical algorithm developed to identify viral failure in HIV-positive patients on first-line antiretroviral therapy
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Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary health clinic in Johannesburg, South Africa
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Reduced loss to ART initiation among patients initiating cotrimoxazole prophylaxis therapy in Johannesburg, South Africa
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Initiation of ART at higher CD4 counts under South Africa’s revised antiretroviral therapy guidelines results in improved patient outcomes
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HIV treatment outcomes after seven years in a large public-sector HIV treatment program in Johannesburg, South Africa
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The Feasibility of Using Criteria to Identify Stable Patients on HAART at Themba Lethu Clinic
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Short-term impacts of a change in ART initiation threshold for patients co-infected with TB in Johannesburg, South Africa