Professor Sydney Rosen [Division Head, Co-Founder]

T: +1 (617) 358 2251  
Professor Sydney Rosen

Sydney Rosen, M.P.A., is a Research Professor in the Department of Global Health at the Boston University School of Public Health and a Co-Director of the Health Economics and Epidemiology Research Office (HE2RO) of the University of the Witwatersrand in Johannesburg, South Africa. Her research addresses the economic consequences of the HIV/AIDS epidemic, and in particular the outcomes, costs, cost-effectiveness, and benefits of HIV treatment interventions and models of service delivery. She is also involved in research on tuberculosis, hepatitis C, and noncommunicable diseases. She is the principal investigator of multiple USAID-, NIH-, and foundation-supported studies and evaluations in South Africa, with other research underway in Zambia, Malawi, and elsewhere. She is also the author of policy and review papers on the business response to AIDS, the rationing of antiretroviral therapy (ART), the retention of patients in HIV/AIDS care and treatment programs, and same-day ART initiation. Professor Rosen’s technical training is in policy analysis and applied economics. She holds a BA magna cum laude from Harvard University and an MPA from the Kennedy School of Government at Harvard

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 

  • 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 

  • 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 

  • 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 

  • 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 

  • The Costs and Outcomes of Paediatric Tuberculosis Treatment at Primary Health Clinics in Johannesburg, South Africa

    In South Africa, little up-to-date information is available about the costs of providing TB treatment to any population, and no information was found on the costs of providing TB treatment to a paediatric population. Despite the significant burden from paediatric TB, analysis of patient characteristics, contacts, and method of diagnosis is limited. The proposed study aims to begin to fill the information gap by generating descriptive analysis of the cost-outcomes of paediatric treatment for TB 

  • The Costs and Outcomes of Tuberculosis Treatment at Primary Health Care Clinics in an Urban Township, South Africa

    The actual implementation of DOTS across South Africa varies widely. Implementation of DOTS may differ between the intensive phase of treatment (first 2-3 months, with daily injections for the retreatment regimen and a 4-drug fixed combination pill for both first-line regimens) and the continuation phase of treatment (consisting of a daily, 2-drug fixed combination pill). In either phase, the treatment supervisor may be a nurse or counselor at a healthcare facility, a lay healthworker from the 

  • Adverse Events of Treatment in a Decentralized Drug-Resistant Tuberculosis Clinic in Johannesburg, South Africa

    The overall aim of this study is to review adverse events of decentralized, ambulatory drug-resistant TB (DR-TB) among a high proportion of rifampicin monoresistant TB patients at an outpatient specialized clinic in Johannesburg, South Africa. The study is a retrospective study and differs in two significant ways from previous studies of DR-TB in South Africa.  Firstly, a large proportion of the patients receiving decentralized care have rifampicin mono-resistant TB. All the previous studies 

  • Costs and Outcomes Analysis of Decentralized, Deinstitutionalized Drug-Resistant Tuberculosis Management at a Johannesburg Hospital

    The overall aim of this medical record review observational cohort study is to analyse the cost and outcomes of decentralized, deinstitutionalized drug-resistant TB (DR-TB) management at an outpatient specialized clinic in Johannesburg. In August 2011, the South African National Department of Health adopted guidelines regarding MDR-TB treatment, “Decentralised Management of Multidrug-Resistant Tuberculosis: A Policy Framework for South Africa.” These guidelines recommend that acid fast 

  • 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 

  • 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, 

  • 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

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.