HIV Treatment Outcomes and Guidelines

HIV Treatment Outcomes and Guidelines

South Africa’s national antiretroviral therapy (ART) treatment program, the largest in the world with roughly 2.4 million people on treatment, has made substantial impact on reducing morbidity and mortality for HIV-infected people. As the national program matures, it faces significant challenges in expanding access to harder to reach populations while also maintaining quality of care for those for whom HIV has become a manageable chronic disease, including treatment fatigue, resistance development, and ART side effects. As part of the South African government’s expanding commitment to the national ART programme, the Minister of Health announced the country’s commitment to bringing HIV/AIDS to an end by 2030, an ambitious goal which will require 90% of those tested and on treatment to be virally suppressed in the next 15 years. To achieve this goal and monitor progress towards milestones along the way, the National Strategic Plan calls for evidence-based approaches to monitoring the national response to HIV and highlights several key populations as a priority for improving treatment outcomes on ART. In line with this call, the team at HE2RO and Boston University have built up a body of work evaluating the outcomes achieved since the rollout of ART nationally in 2004 and its impact on priority population groups. This work has the potential to inform program management, policy-making, resource allocation, and modelling.

Programs

  1. Indlela: Behavioural Insights for Better Health
  2. Evaluations to Inform Decisions using Economics and Epidemiology (EVIDENCE)
  3. Innovations Research on AIDS (INROADS)
  4. NHLS National HIV Cohort

Projects

  • 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 

  • 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