A5006424587- HIV/AIDS Research and Interventions
- HIV Research and Treatment
- HIV/AIDS drug development and treatment
- HIV-related health complications and treatments
- HIV, Drug Use, Sexual Risk
- Tuberculosis Research and Epidemiology
- Vaccine Coverage and Hesitancy
- Pneumocystis jirovecii pneumonia detection and treatment
- COVID-19 Impact on Reproduction
- HIV/AIDS Impact and Responses
- Adolescent Sexual and Reproductive Health
- Cervical Cancer and HPV Research
- Ethics in Clinical Research
- Intimate Partner and Family Violence
- Biomedical Ethics and Regulation
- Medication Adherence and Compliance
- Pneumonia and Respiratory Infections
- Sex work and related issues
- Biochemical and Molecular Research
- Health Systems, Economic Evaluations, Quality of Life
- Reproductive tract infections research
eThekwini Municipality
2018-2025
University of KwaZulu-Natal
2024
South African Medical Research Council
2014
The effect of the COVID-19 pandemic on HIV outcomes in low-income and middle-income countries is poorly described. We aimed to measure impact 2020 national lockdown testing treatment KwaZulu-Natal, South Africa, where 1·7 million people are living with HIV.In this interrupted time series analysis, we analysed anonymised programmatic data from 65 primary care clinics KwaZulu-Natal province, Africa. included for HIV, initiating antiretroviral therapy (ART), collecting ART at participating...
There are few data assessing the uptake of first-line dolutegravir among men and women living with HIV in low-income middle-income countries, subsequent clinical outcomes non-trial settings. We aimed to determine women, effect on routine care South Africa.
Background We aimed to determine antiretroviral therapy (ART) initiation timing and outcomes in people living with HIV (PLHIV) receiving tuberculosis treatment KwaZulu-Natal, South Africa. Methods performed a retrospective cohort analysis of routinely collected de-identified data from 62 clinics including PLHIV not already ART aged ≥16 years, starting between October 2016-November 2019. Multivariable Poisson regression models robust standard errors evaluated associations (after treatment)...
Introduction We investigated the impact of increasing CD4 count eligibility for antiretroviral therapy (ART) initiation on advanced HIV disease (AHD) and tuberculosis (TB) prevalence incidence among people living with (PLHIV) in South Africa. Methods conducted an interrupted time series analysis de-identified data PLHIV aged ≥15 years initiating ART between April 2012 February 2020 at 65 primary healthcare clinics KwaZulu-Natal, Outcomes included monthly proportions new initiators presenting...
The integrase strand transfer inhibitor, dolutegravir (DTG), is widely used in first- and second-line antiretroviral therapy (ART) regimens South Africa. We describe an adult with virological failure on tenofovir/lamivudine/dolutegravir (TLD2) rapid emergence of DTG resistance within 3 months, while receiving rifapentine-based tuberculosis preventive therapy.
Many clinics in Southern Africa have long waiting times. The implementation of point-of-care (POC) tests to accelerate diagnosis and improve clinical management resource-limited settings may or worsen clinic flow objective this study was describe with special emphasis on the impact POC testing at a large urban public healthcare Durban, South Africa. We used time motion methods directly observe patients practitioners. created patient maps recorded individual consultation times for seeking...
There is an urgent need for more efficient models of differentiated antiretroviral therapy (ART) delivery people living with HIV (PLHIV), the World Health Organization calling evidence to guide whether annual ART prescriptions and consultations (12M scripts) should be recommended in global guidelines. We assessed association between 12M scripts (allowed temporarily during COVID-19 pandemic) versus standard 6-month (6M clinical outcomes.
BackgroundDolutegravir (DTG) is recommended for second-line antiretroviral therapy (ART) after virological failure on first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens in people living with HIV low-income and middle-income countries. We compared the effectiveness of DTG versus previously ritonavir-boosted lopinavir (LPV/r) regimen treatment South Africa.MethodsIn this retrospective observational cohort study, we used routinely collected, de-identified data from...
Data are required regarding the feasibility of conducting a randomized trial point-of-care viral load (VL) testing to guide management HIV viremia and provide estimates effect potential future design.Two public South African clinics during dolutegravir-based antiretroviral therapy (ART) rollout.We adults receiving first-line ART, with recent VL ≥1000 copies/mL, in 1:1 ratio receive Xpert HIV-1 versus standard-of-care laboratory after 12 weeks. Feasibility outcomes included proportions...
Abstract Introduction Novel point‐of‐care assays which measure urine tenofovir (TFV) concentrations may have a role in improving adherence monitoring for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). However, further studies of their diagnostic accuracy, and whether results are associated viraemia drug resistance, needed to guide use, particularly the context global dolutegravir rollout. Methods We conducted cross‐sectional evaluation among PLHIV first‐line ART...
All people living with HIV should receive antiretroviral therapy (ART), but those CD4 counts >500 cells/mm3 at ART initiation ("early initiators") may be less motivated to adhere treatment, compared <200 ("late initiators"). We performed a cross-sectional analysis among HIV-positive adults who had viral load taken 6 months after first-line in South African public clinic. Retrospective drug resistance testing was on all samples >1,000 copies/mL. used Poisson regression models robust variance...
Abstract Introduction The World Health Organisation recommends to Treat All people with HIV, irrespective of CD4 count. However, counts >500 cells/µL may be asymptomatic and therefore less motivated adhere antiretroviral therapy (ART). We aimed assess whether initiated had worse treatment outcomes compared those at lower counts. Methods performed a retrospective cohort study among non‐pregnant adults initiating ART eight public clinics in South Africa between September 2016, when was...
Substantial improvements in viral suppression among people living with HIV (PLHIV) are needed to end the epidemic, requiring extensive scale-up of low-cost monitoring services. Point-of-care (POC) tests for antiretroviral therapy (ART) adherence and load (VL) may be efficient effective tools real-time clinical decision making. We aim evaluate effects a combined intervention POC ART VL testing compared standard-of-care on adherence, retention at 6 18 months post-ART initiation...
To determine whether the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program in South Africa's differentiated ART delivery model affects clinical outcomes, we assessed viral load (VL) suppression retention care between patients participating those receiving clinic-based standard of care.
During the COVID-19 pandemic, South African Centralized Chronic Medicines Dispensing and Distribution (CCMDD) programme, adapted to include extended 12-month antiretroviral therapy (ART) prescriptions, 3-months ART refills earlier eligibility criteria at 6-months after initiation. We aimed explore experiences of healthcare workers (HCWs) in implementing these adaptations, understand overall impact on CCMDD. conducted semi-structured in-depth interviews with HCWs eThekwini District clinics,...
Introduction Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory clinic systems often delay the detection management of viraemia, which can lead morbidity, drug resistance transmission. Point-of-care could overcome these challenges. We aim assess whether it is feasible conduct a randomised trial point-of-care manage viraemia. Methods analysis will an open-label, single-site, individually...
Background: We aimed to evaluate the analytic performance of 3 rapid HIV viral load assays: novel Xpert HIV-1 VL XC (Xpert XC), VL), and m-PIMA HIV-1/2 (m-PIMA). Setting: Two South African clinics. Methods: conducted a prospective diagnostic accuracy study. Site-laboratory technicians nurses used XC, VL, test plasma samples from people with receiving antiretroviral therapy. compared results Roche cobas reference assay. determined detect viraemia at World Health Organization (WHO) failure...
Abstract Introduction Evidence is needed to guide the inclusion of broader groups people living with HIV (PLHIV) in differentiated service delivery (DSD) programmes. We assessed treatment outcomes among PLHIV on second‐line regimens a community antiretroviral therapy (ART) programme, compared those who remained at clinics. Methods Using data from 61 public clinics, we did retrospective cohort study receiving ART following rollout Centralized Chronic Medicines Dispensing and Distribution...
We examined the impact of past-year intimate partner violence (IPV) on HIV outcomes among women living with (WLHIV) in Durban, South Africa. assessed IPV using WHO Violence Against Women Questionnaire. conducted logistic regression to assess associations between demographic variables and at baseline, baseline longitudinal outcomes. Among 235 WLHIV, 17% reported emotional, physical, or sexual IPV. At HIV-disclosure was associated 4.35-fold odds (95% CI 1.17-16.10) after controlling for...
Abstract Introduction We investigated the impact of increasing CD4 count eligibility for antiretroviral-therapy (ART) initiation on advanced HIV and tuberculosis (TB) prevalence incidence among people living with (PLHIV) in South Africa. Methods conducted an interrupted time series analysis de-identified data PLHIV aged ≥15 initiating ART between April-2012 February-2020 at 65 primary healthcare clinics KwaZulu-Natal, Outcomes included monthly proportions new initiators presenting (CD4...
The Southern African Journal of HIV Medicine is focused on HIV/AIDS treatment, prevention and related topics relevant to clinical public health practice. purpose the journal disseminate original research results support high-level learning Medicine. It publishes articles, editorials, case reports/case series, reviews state-of-the-art practice correspondence.
ABSTRACT Introduction Novel point-of-care assays which measure urine tenofovir (TFV) concentrations may have a role in improving adherence monitoring for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). However, further studies of their diagnostic accuracy, and whether results are associated viraemia drug resistance, needed to guide use, particularly the context global dolutegravir rollout. Methods We conducted cross-sectional evaluation among PLHIV first-line ART...
We aimed to compare clinical outcomes after viremia between dolutegravir vs efavirenz-based first-line antiretroviral therapy (ART) as evidence is lacking outside trials in resource-limited settings. conducted a retrospective cohort analysis with routine data from 59 South African clinics. included people HIV aged ≥15 years receiving tenofovir disoproxil fumarate, lamivudine, (TLD) or emtricitabine, efavirenz (TEE) and first (≥50 copies/mL) June November 2020. used multivariable modified...