A5073412516- HIV/AIDS drug development and treatment
- HIV/AIDS Research and Interventions
- HIV Research and Treatment
- Pneumocystis jirovecii pneumonia detection and treatment
- Health Systems, Economic Evaluations, Quality of Life
- HIV-related health complications and treatments
- Pharmacovigilance and Adverse Drug Reactions
- Pharmaceutical Practices and Patient Outcomes
- Pregnancy and Medication Impact
- Healthcare cost, quality, practices
- HIV, Drug Use, Sexual Risk
- Tuberculosis Research and Epidemiology
- Anesthesia and Pain Management
- Pediatric Pain Management Techniques
- Adolescent Sexual and Reproductive Health
- Health Policy Implementation Science
- COVID-19 Clinical Research Studies
- Pharmaceutical studies and practices
- Fungal Plant Pathogen Control
- Infectious Encephalopathies and Encephalitis
- Drug-Induced Adverse Reactions
- Isotope Analysis in Ecology
- Healthcare Quality and Management
- Multiple Sclerosis Research Studies
- Polyomavirus and related diseases
University of Cape Town
2014-2024
Wellcome Centre for Infectious Diseases Research in Africa
2018-2023
South African Medical Research Council
2023
University of KwaZulu-Natal
2023
Cecilia Makiwane Hospital
2023
Walter Sisulu University
2023
Stellenbosch University
2023
Centre for the AIDS Programme of Research in South Africa
2023
Department of Health
2020-2021
Groote Schuur Hospital
2012-2018
Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined proportion adult admissions attributable to ADRs at 4 hospitals South Africa. characterized drugs implicated in, risk factors for, preventability ADR-related admissions. prospectively followed patients admitted hospitals' medical wards over sequential 30-day periods 2013 identified suspected with aid a trigger tool. A multidisciplinary...
Abstract Background While people with human immunodeficiency virus (PWH) start antiretroviral treatment (ART) regardless of CD4 count, measurement remains crucial for detecting advanced (HIV) disease and evaluating ART programs. We explored (proportion PWH a result available) prevalence <200 cells/µL (hereafter “CD4 <200”) at initiation within the International epidemiology Databases to Evaluate AIDS (IeDEA) global collaboration. Methods included participating programs who...
Abstract Introduction : Tenofovir has been associated with decline in kidney function, but patients low baseline improvements over time have reported. Additionally, the magnitude and trajectory of estimated glomerular filtration rate (eGFR) changes may differ according to how eGFR is calculated. We described time, incidence of, risk factors for, toxicity, a South African cohort. Methods included antiretroviral‐naïve ≥16 years old who started tenofovir‐containing antiretroviral therapy (ART)...
<h3>Objective:</h3> To compare the efficacy and toxicity of 4-aminopyridine 3,4-diaminopyridine in patients with multiple sclerosis. <h3>Design:</h3> Intervention study a before-after design randomized, double-blind, crossover design. <h3>Setting:</h3> University referral center. <h3>Patients:</h3> Twenty-four definite sclerosis who had been treated previous clinical trial 4-aminopyridine. <h3>Interventions:</h3> Nonresponders to treatment (14 patients) were 4-week, open-label doses up 1.0...
Isoniazid preventive therapy (IPT) is widely used to protect against tuberculosis (TB) in people living with human immunodeficiency virus (HIV). Data on the safety and efficacy of IPT pregnant women HIV (PWLHIV) are mixed. We an individual-level, population-wide health database examine associations between antenatal exposure adverse pregnancy outcomes, maternal TB, all-cause mortality, liver injury during through 12 months postpartum.We linked routine electronic data generated public sector...
Background WHO guidelines recommend abacavir in first-line antiretroviral treatment for children and neonates. However, there is no approved dose <3 months of age, data neonates are limited. Methods We included infants who initiated ART aged months, between 2006 2019, nine South African cohorts. In those received or zidovudine, we described discontinuation rates; 6- 12-month viral suppression (<400 copies/mL). compared <28 ≥28 days, weighing ≥3 kg. Results Overall 837/1643 (51%) 443...
World Health Organisation guidelines recommend nevirapine 2 mg/kg/d for HIV-exposed infants <2 kg, but 4-6 >2 kg. In 116 low birth weight infants, until 14 days, and 4 thereafter, was safe (1 mild possibly related rash) achieved target plasma concentrations. Concentrations decreased with treatment duration. Routine dose increase at days should be considered.
Abstract Purpose Severe skin reactions may complicate combination antiretroviral therapy (cART). Nevirapine is known to be associated with severe reactions, but there are conflicting data on risk factors in African patients. We reviewed cases of admitted a tertiary hospital Cape Town, South Africa. identified associations patients cART. Methods described reaction taking cART Groote Schuur Hospital Africa, between 2006 and 2012. included those who developed within 120 days initiation...
The high HIV prevalence in South Africa may potentially be shaping the local adverse drug reaction (ADR) burden. We aimed to describe and characteristics of serious ADRs at admission, during two African children's hospitals.We reviewed folders children admitted over sequential 30-day periods 2015 medical wards intensive care units each hospital. identified potential using a trigger tool developed for this study. A multidisciplinary team assessed ADR causality, type, seriousness,...
Abstract Introduction Dolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co‐infection, its use complicated by a drug–drug interaction rifampicin requiring an additional daily dose dolutegravir. This represents disadvantage over efavirenz, which does not have major rifampicin. We sought to describe clinic practices prescribing concomitant dolutegravir rifampicin, characterize virologic outcomes among patients co‐infection...
Abstract Introduction In recent years, the expansion of HIV treatment eligibility has resulted in an increase people with antiretroviral therapy (ART) experience prior to pregnancy but little is known about postpartum engagement care this population. We examined differences disengagement from after delivery by maternal ART history before conception. Methods analysed data living (aged 15–49) Khayelitsha, South Africa, ≥1 live birth between April 2013 and March 2019. described trends over time...
The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, order inform National Department Health guidelines. To date, has reviewed 14 potential treatments, made recommendations based on local context, feasibility, resource requirements equity. Here we describe...
Introduction There are a limited number of paediatric antiretroviral drug options. Characterising the long term safety and durability different antiretrovirals in children is important to optimise management HIV infected determine estimated need for alternative drugs regimens. We describe first-line therapy (ART) reasons discontinuations at two South African ART programmes, where lopinavir/ritonavir has been recommended <3 years old since 2004, abacavir replaced stavudine as preferred...
Some clinicians prescribe ivermectin for COVID-19 despite a lack of support from any credible South African professional body. They argue that when faced by clinical urgency, weak signals efficacy should trigger action if harm is unlikely. Several recent reviews found an apparent mortality benefit including studies at high risk bias and with active rather than placebo controls. If these are discounted, the pooled effect no longer statistically significant, evidence very weak. Relying on this...
Background. Tenofovir is part of the preferred first-line regimen for HIV-infected patients in South Africa (SA), but associated with kidney toxicity. SA antiretroviral therapy (ART) guidelines recommend creatinine monitoring at baseline (ART start) and 3, 6 12 months, substituting tenofovir zidovudine, stavudine or abacavir should clearance (CrCl) decrease to <50 mL/min. Objective. To assess clinician compliance prescribing guidelines. Methods. We described proportion adult on...
The outbreak of the COVID-19 pandemic posed challenges to practice evidence-informed decision-making. Soon after index case was identified in South Africa, first local clinical guidelines were developed, reliant on preliminary evidence. Quick decisions essential inform and procurement at a time exceptional global demand for medicine supply. This chapter describes how rapid review mechanism implemented enable development context-specific treatment prevention recommendations Africa. reflects...
Introduction Estimating the incidence of antiretroviral discontinuations due to adverse drug reactions (ADRs) is important inform treatment (ART) regimen recommendations, and guide prescribing monitoring policies. Routinely collected clinical data a useful source pharmacovigilance data. We estimated incidences first-line ADRs using routine data, compared them with enhanced by folder review, in two South African cohorts. Methods included patients 16 years older on ART. selected stratified...
Abstract Background In the absence of clinical trials, data on safety medicine exposures in pregnancy are dependent observational studies conducted after agent has been licensed for use. This requires an accurate history antenatal use to determine potential risks. Medication is commonly determined by self-report, clinician records, and electronic pharmacy data; different sources may be more informative types medication resources differ setting. We compared three methods (self-report, records...
Background: While recognized as a key HIV prevention strategy, preexposure prophylaxis (PrEP) availability and accessibility are not well documented globally. We aimed to describe PrEP drug registration status the of services across care sites participating in International epidemiology Databases Evaluate AIDS (IeDEA) research consortium. Methods: used country-level from Vaccine Advocacy Coalition data IeDEA surveys conducted 2014, 2017 2020 among clinics seven global regions. descriptive...
Introduction: Equitable access to essential psychotropic medicines at primary level is fundamental universal health coverage for mental health. It relies upon rational selection, affordable pricing, financial protection and consistent supply systems. Which are selected as impacts patient care the economic sustainability of system. Rational selection uses best available evidence efficacy, safety acceptability, requires assurance affordability, obtainability appropriate usage medicines. The...