High rates of patient attrition from care between HIV testing and antiretroviral therapy (ART) initiation have been documented in sub-Saharan Africa, contributing to persistently low CD4 cell counts at treatment initiation. One reason for this is that starting ART many countries a lengthy burdensome process, imposing long waits multiple clinic visits on patients. We estimated the effect uptake viral suppression an accelerated algorithm allowed treatment-eligible patients be dispensed their...

Abstract South Africa has a long history of community health workers (CHWs). It been journey that required balancing constrained resources and competing priorities. CHWs form bridge between communities healthcare service provision within facilities act as the cornerstone Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document CHW policy implementation landscape across six provinces in explore reasons for local adaptation models identify potential barriers...

Antenatal care (ANC) provides healthcare services to pregnant women in an attempt ensure, the best possible pregnancy outcome for and their babies. Healthcare providers' understanding of patient's behaviour reasons engagement response this insight can influence patient-provider interactions patient demand ANC early pregnancy. We examined providers into women's starting later than South African National Department Health's recommended 20 weeks gestation. also looked at impact late...

Background Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality life, especially after first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, employment status among adult patients in South Africa over three full years following initiation. Methodology/Principal Findings A cohort 855 pre-ART <6 months was enrolled...

Abstract Introduction It is common in urban African settings for postpartum women to temporarily return family distant settings. We sought explore mobility among peripartum HIV ‐positive understand the timing and motivation of travel, particularly vis‐à‐vis delivery, how it may affect healthcare access. Methods Using same measurements within three different studies, we examined long‐distance travel mother infant before after delivery diverse clinics greater Johannesburg, South Africa (n =...

Adolescents experience disproportionately high rates of poor ART outcomes compared to adults despite prolonged use antiretroviral therapy in Southern African treatment programs, presenting a significant challenge national attempts meet the UNAIDS 90-90-90 targets for 2020. This cohort study among adolescents aged 12–20 years accessing care at two urban public-sector clinics Johannesburg between September and November 2013 aimed identify factors potentially associated with attendance clinic...

Determine the cost and cost-effectiveness of single-visit (same-day) antiretroviral treatment (ART) initiation compared to standard care initiation.Cost-effectiveness analysis individually randomized (1 : 1) pragmatic trial initiation, which increased viral suppression at 10 months by 26% [relative risk (95% confidence interval) 1.26 (1.05-1.50)].Primary health clinic in Johannesburg, South Africa.HIV positive, adult, nonpregnant patients not yet on ART or known be eligible who presented 8...

Evaluate the effect of antiretroviral therapy (ART) on South African HIV patients' economic well being, as indicated by symptoms, normal activities, employment, and external support, during first 5 years treatment. Prospective cohort study 879 adult patients at public or nongovernmental clinics enrolled before ART initiation less than 6 months followed for 5.5 less. Patients were interviewed routine clinic visits. Outcomes estimated using population-averaged logistic regression reported...

Women initiating antiretroviral therapy during pregnancy are at high risk of dropping out HIV care after delivery. We assessed the acceptability and feasibility a financial incentive – one-time R50 (∼USD4) supermarket voucher for completing one postpartum visit ≤10 weeks delivery to improve retention. enrolled 100 pregnant, HIV-positive women primary health clinic in Johannesburg, South Africa. Participants were interviewed enrollment we reviewed files assess retention ≥14 postpartum. Median...

Between 2010-2013, South Africa implemented WHO 'Option A' for prevention of mother to child transmission (PMTCT), where all HIV-infected pregnant women (from 14 weeks gestation) received zidovudine (AZT) as ARV prophylaxis and initiated CD4 testing at their first antenatal care (ANC) visit. After returning a second visit collect results, with counts ≤ 350 were referred the ART clinic fast-tracked initiation on lifelong while continuing ANC every four weeks. Women >350 dispensed daily AZT...

Background Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity mothers cause developmental problems in children born to affected mothers. Objectives We set out measure prevalence PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) negative women, identify predictors major among these peri-urban clinic South Africa. Methods conducted...

We report the PAEDLINK randomized trial results on effect of motivational interviewing (MI) retention counseling adherence postpartum women to early infant diagnostic human immunodeficiency virus (HIV) testing schedule.HIV positive and their babies were enrolled 3 6 days after delivery at 4 midwife obstetric units in Gauteng province South Africa into (A) MI telephonic tracing, (B) biannual (C) standard care. Mother-baby pairs followed up for 18 months via medical records. The uptake child...

Effective prevention of mother-to-child transmission benefits from early presentation to antenatal care (ANC). It is, however, unclear whether a previous HIV diagnosis results in earlier initiation ANC. We estimated the probability ANC among women with HIV-positive compared those who first tested for during and explored determinants women. conducted an analysis cross-sectional survey 411 adult (>18 years) gave birth at midwife obstetrics units Gauteng between October 2016 May 2017....

Assessment of data quality is essential to successful monitoring & evaluation tuberculosis (TB) services. South Africa uses the Three Interlinked Electronic Register (TIER.Net) monitor TB diagnoses and treatment outcomes. We assessed routine programmatic as captured in TIER.Net.We reviewed 277 records from collected for adults who had started drug-sensitive (DS-) between 10/2018-12/2019 15 facilities across three African districts using sources approaches link these (i.e., two compared...

Despite the success of prevention mother to child transmission (PMTCT) program in South Africa, 30% HIV prevalence among women childbearing age requires PMTCT be maximally efficient sustain gains vertical transmission. We aimed determine immunologic and virologic status at entry into antenatal care (ANC) childbirth positive who conceived under CD4<500 cells/μl antiretroviral therapy (ART) eligibility threshold universal test treat (UTT) policies Gauteng province Africa.We conducted a...

Initiating and retaining pregnant women on antiretroviral therapy (ART) to prevent mother-to-child HIV transmission (PMTCT) remains a major challenge facing African programs, particularly during the critical final months prior delivery. In 2013, South Africa implemented its "Option B" PMTCT regimen (three-drug ART throughout pregnancy breastfeeding, regardless of maternal CD4 count) introduced once-daily fixed-dose combinations lifelong ART. Currently, uptake Option B possible impact...

Abstract Background Many Adolescents in Sub-Saharan Africa don’t access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the students’ preferences for how are delivered so that implementation strategies can reflect this. Methods A discrete choice experiment (DCE) was used elicit preferences. The DCE conducted 10 high schools situated neighbourhoods varying socio-economic status (SES) Gauteng (South Africa). Students aged ≥15...

As part of the Reengineering Primary Health Care initiative, South African National Department (NDoH) has committed to expanding access home-based care provided by community health workers. The NDOH also prioritised Community Workers (CHWs) in their agenda improve child development outcomes Africa. However, there is limited research on CHWs' experiences and knowledge early childhood development.

Background: The HIV epidemic in sub-Saharan Africa has a disproportionate gender impact, with women bearing the brunt of epidemic. South carries largest share global burden, similar trends seen for due to unequal socio-cultural and economic status. Objectives: This study aims understand 30–49 year-old women’s barriers facilitators accessing services order maximize health resource limited settings reach missing from care. Design: Employing convenience sampling strategy, we recruited,...

Abstract Background Tuberculosis (TB) is a major health concern in South Africa, where prior to COVID-19 it was associated with more deaths than any other infectious disease. The pandemic disrupted gains made the global response TB, having serious impact on most vulnerable. and TB are both severe respiratory infections, infection one place individuals at increased risk for negative outcomes other. Even after completing treatment, survivors remain economically vulnerable continue be...

Tuberculosis (TB) is a major health concern in South Africa, where prior to COVID-19 it was associated with more deaths than any other infectious disease. The pandemic disrupted gains made the global response TB, having serious impact on most vulnerable. and TB are both severe respiratory infections, infection one places individuals at increased risk for negative outcomes other. Even after completing treatment, survivors remain economically vulnerable continue be negatively affected by...

Abstract Background Many Adolescents in Sub-Saharan Africa do not access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the Learners’ preferences for how are delivered so that implementation strategies can reflect this. Methods A discrete choice experiment (DCE) was used elicit preferences. The DCE completed between 07/2018 09/2019 conducted 10 high schools situated neighbourhoods varying socio-economic status (SES) Gauteng...

Abstract Background: The implementation of Prevention Mother to Child Transmission (PMTCT) programmes at midwifes obstetric units (MOU) involves the confirmation HIV diagnosis during labour, early infant (EID), initiation/continuation antiretroviral therapy (ART) for mother and baby as appropriate counselling postpartum care. Objectives: aim this study was explore barriers facilitators completing steps in PMTCT cascade MOUs defined by healthcare providers recently women. Methods: We...