A5079907326- HIV/AIDS Research and Interventions
- HIV Research and Treatment
- Adolescent Sexual and Reproductive Health
- HIV/AIDS drug development and treatment
- Global Maternal and Child Health
- Pneumocystis jirovecii pneumonia detection and treatment
- HIV, Drug Use, Sexual Risk
- HIV-related health complications and treatments
- HIV/AIDS Impact and Responses
- Poverty, Education, and Child Welfare
- Antibiotic Use and Resistance
- Viral-associated cancers and disorders
- Patient Satisfaction in Healthcare
- Lymphoma Diagnosis and Treatment
- SARS-CoV-2 and COVID-19 Research
- Medication Adherence and Compliance
- Tuberculosis Research and Epidemiology
- Healthcare Operations and Scheduling Optimization
- Adolescent and Pediatric Healthcare
- Child and Adolescent Health
- Healthcare Policy and Management
- Sex work and related issues
- LGBTQ Health, Identity, and Policy
- Culture, Economy, and Development Studies
- Urinary Tract Infections Management
Stellenbosch University
2017-2025
Western Cape Department of Health
2019-2025
Kheth’Impilo
2015-2024
National Research Foundation
2018-2019
United Nations Development Programme
2018
Oxford Policy Management
2018
University of Oxford
2018
International HIV/AIDS Alliance
2018
Harvard University
2018
Harvard Global Health Institute
2018
There are conflicting reports of antiretroviral therapy (ART) effectiveness comparisons between primary healthcare (PHC) facilities and hospitals in low-income settings. This comparison has not been evaluated on a broad scale South Africa.A retrospective cohort study was conducted including ART-naïve adults from 59 four provinces Africa, enrolled 2004 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models logistic regression...
Introduction: A large increase in lay health care workers has occurred response to shortages of professional staff sub-Saharan African antiretroviral treatment (ART) programs. However, little effectiveness data the large-scale implementation these programs is available. We evaluated effect a community-based adherence-support (CBAS) program on ART outcomes across 57 South sites. Methods: CBAS provide adherence and psychosocial support for patients undertake home visits address household...
Background HIV‐positive children in low‐income settings face many challenges to adherence antiretroviral treatment (ART) and have increased mortality on compared developed countries. Adult ART programmes demonstrated benefit from community support improve outcomes; however, there are no empirical data the effectiveness of this intervention children. This study clinical, virological immunological outcomes between who received did not receive community‐based patient advocates (PAs) four South...
Multimonth dispensing (MMD) of antiretroviral treatment (ART) aims to reduce patient-related barriers access long-term and improve health system efficiency. However, randomized evidence its clinical effectiveness is lacking. We compared MMD within community ART refill groups (CARGs) vs. standard-of-care facility-based delivery in Zimbabwe.A three-arm, cluster-randomized, pragmatic noninferiority trial was performed. Thirty care facilities associated CARGs were allocated either collected...
Abstract The arrival of coronavirus disease 2019 (COVID-19) on the African continent resulted in a range lockdown measures that curtailed spread infection but caused economic hardship. countries now face difficult choices regarding easing lockdowns and sustaining effective public health control surveillance. Pandemic will require efficient community screening, testing, contact tracing; behavioral change interventions; adequate resources; well-supported, community-based teams trained,...
Background. South Africa (SA) has the highest burden of childhood HIV infection globally, and high rates adolescent youth pregnancy. Objective. To explore risks associated with pregnancy in young HIV-infected women, we compared mother-to-child transmission (MTCT) maternal infant health outcomes according to age categories. Methods. A cohort HIV-positive pregnant women their infants were followed up at three sentinel surveillance facilities Nelson Mandela Bay Metropolitan (NMBM) district,...
Lesotho adopted the test-and-treat approach for HIV treatment in June 2016, which increased antiretroviral (ART) clinic volume. We evaluated community-based vs. facility-based differentiated models of multimonth dispensing ART among stable HIV-infected adults Lesotho.Thirty facilities were randomized to 3 arms, facility 3-monthly (3MF) (control), community groups (3MC), and 6-monthly distribution points (6MCD). estimated risk differences (RDs) between arms using population-averaged...
Abstract Introduction Lesotho, the country with second‐highest HIV/AIDS prevalence (23.6%) in world, has made considerable progress towards achieving “95‐95‐95” UNAIDS targets, but recent success improving treatment access to all known HIV positive individuals severely strained existing healthcare infrastructure, financial and human resources. Lesotho also faces challenge of a largely rural population who incur significant time burden visit facilities. Using data from cluster‐randomized...
Adherence to antiretroviral treatment (ART) is a challenge in childhood, and children on ART have reduced virological suppression compared adults. This study evaluated the effect of community-based adherence support (CBAS) outcomes amongst receiving four South African provinces. Patient Advocates are lay CBAS workers who provide psychosocial for patients, undertaking home visits address household challenges affecting adherence. counselling children's carers regarding problems. A multicentre...
Abstract Introduction Adolescents and youth receiving antiretroviral treatment (ART) in sub‐Saharan Africa have high attrition inadequate ART outcomes, evaluations of interventions improving outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce developing countries. We measured effectiveness cost‐effectiveness community‐based support (CBS) provided by lay workers for South Africa. Methods A retrospective...
The World Health Organization (WHO) recommends a CD4 cell count before starting antiretroviral therapy (ART) to detect advanced HIV disease, and routine viral load (VL) testing following ART initiation treatment failure. Donor support for has declined prioritize access VL monitoring. We examined trends in among adults (≥15 years of age) Southern Africa.We analysed data from 14 programmes Lesotho, Malawi, Mozambique, South Africa, Zambia Zimbabwe 2005 2018. the frequency testing, percentage...
Background Advanced HIV disease (AHD) remains a persistent public health challenge. Data regarding the burden, characteristics and predictors of AHD is scarce specifically for rural settings sub-Saharan Africa. This study aimed to describe trends in annual CD4 count distribution characterise adult persons living with (PLWH) on ART who have KwaZulu-Natal, South Methods A retrospective cohort design was conducted among antiretroviral therapy (ART) patients aged 18 years older. We used...
Background Few studies describe temporal trends in pediatric antiretroviral treatment (ART) programs sub-Saharan Africa. Adult show deteriorating patient retention recent years. We baseline characteristics and outcomes amongst ART-naive children between 2004 2009 at 30 facilities 4 South African provinces. Methods Linear trend parameters annual enrolment cohorts was assessed. Corrected mortality estimates were calculated, correcting for deaths those lost to follow-up using...
Current World Health Organization (WHO) guidelines recommend early initiation of HIV positive patients on antiretroviral therapy (ART) irrespective their clinical or immunological status known as the test and start approach. Lesotho, like many other countries introduced this approach in 2016 a strategy to reach epidemic control. There will be rapidly growing number HIV-infected individuals initiating treatment leading practical challenges health systems such congestion, long waiting time for...
Differentiated service delivery (DSD) models for HIV treatment decrease health facility visit frequency and limit healthcare facility-based exposure to severe acute respiratory syndrome coronavirus 2. However, two important evidence gaps include understanding DSD effectiveness amongst clients commencing within 12 months of antiretroviral (ART) initiation receiving only single annual clinical consultations. To investigate these, we pooled data from cluster-randomized trials investigating...
Introduction Increasing numbers of patients are starting antiretroviral treatment (ART) at advanced age or reaching while on ART. We compared baseline characteristics and ART outcomes older adults (aged ≥55 years) vs. younger 25–54 in routine care settings South Africa. Methods A multicentre cohort study ART-naïve 89 public sector facilities was conducted. Mortality, loss to follow-up (LTFU), immunological virological until five years were using competing-risks regression, generalised...
Background. Long waiting times are a major source of dissatisfaction for patients attending public healthcare facilities in South Africa (SA). The National Department Health has identified this as one six priority areas improvement. system-strengthening (HSS) interventions to improve patient time being implemented health across SA part the ‘Ideal Clinic’ model. effect these on needs be assessed and evidence generated system Objectives. To determine Ideal Clinic HSS intervention Amajuba...
<h2>Summary</h2><h3>Background</h3> Estimates of incidence switching to second-line antiretroviral therapy (ART) among children with HIV are necessary inform the need for paediatric formulations. We aimed quantify cumulative ART in an international cohort collaboration. <h3>Methods</h3> In this collaboration study, we pooled individual patient-level data younger than 18 years who initiated (two or more nucleoside reverse-transcriptase inhibitors [NRTI] plus a non-NRTI [NNRTI] boosted...
Background. Long waiting times are a major source of dissatisfaction for patients attending public healthcare facilities in South Africa (SA). The National Department Health has identified this as one six priority areas improvement. system-strengthening (HSS) interventions to improve patient time being implemented health across SA part the 'Ideal Clinic' model. effect these on needs be assessed and evidence generated system Objectives. To determine Ideal Clinic HSS intervention Amajuba...
Retaining high levels of patients in care who are virally suppressed over long treatment periods has been an important challenge for antiretroviral (ART) programmes sub-Saharan Africa, the region having highest HIV burden globally. Clinic-linked community-based adherence support (CBAS) provide home-based and psychosocial ART patients. However, there is little evidence their longer-term impact. This study assessed effectiveness CBAS after eight years ART. workers lay healthcare personnel...
Background: Family clinics address the problems of HIV-infected children and their families. The aims were to document demographics caregivers attending Clinic for HIV at Tygerberg Academic Hospital (TAH) investigate factors affecting disease progression in children.
Background Young Southern African women have the highest HIV incidence globally. Pregnancy doubles risk of acquisition further, and maternal contributes significantly to paediatric burden. Little data on combination prevention interventions during pregnancy lactation are available. We measured amongst pregnant postpartum receiving a community-based intervention in high setting South Africa. Methods A cohort study that included HIV-uninfected was performed. Lay workers provided individualized...
Introduction: Antiretroviral treatment (ART) guidelines recommend life-long ART for all HIV-positive individuals. This study evaluated tuberculosis (TB) incidence on in a cohort of individuals starting regardless CD4 count programmatic setting at 3 clinics included the HPTN 071 (PopART) trial South Africa. Methods: A retrospective analysis aged ≥18 years ART, between January 2014 and November 2015, was conducted. Follow-up continued until 30 May 2016 or censored date (1) incident TB, (2)...