A5031952967- HIV/AIDS Research and Interventions
- HIV/AIDS Impact and Responses
- HIV, Drug Use, Sexual Risk
- Adolescent Sexual and Reproductive Health
- HIV Research and Treatment
- Global Maternal and Child Health
- HIV/AIDS drug development and treatment
- COVID-19 Clinical Research Studies
- COVID-19 epidemiological studies
- Tuberculosis Research and Epidemiology
- SARS-CoV-2 and COVID-19 Research
- Health Systems, Economic Evaluations, Quality of Life
- Poverty, Education, and Child Welfare
- COVID-19 and healthcare impacts
- Vaccine Coverage and Hesitancy
- Pneumonia and Respiratory Infections
- Sex work and related issues
- Pneumocystis jirovecii pneumonia detection and treatment
- Global Public Health Policies and Epidemiology
- Healthcare Systems and Reforms
- Genital Health and Disease
- Intensive Care Unit Cognitive Disorders
- Female Genital Mutilation/Cutting Issues
- Chronic Disease Management Strategies
- Adolescent and Pediatric Healthcare
Boston University
2016-2025
University of the Witwatersrand
2016-2025
Africa Health Research Institute
2021-2024
Stellenbosch University
2022-2024
National Research Foundation
2023-2024
South African College of Applied Psychology
2024
Center for Global Health
2012-2023
National Treasury
2022
University of Cape Town
2022
Africa University
2022
New WHO guidelines recommend ART initiation for HIV-positive persons with CD4 cell counts ≤500 cells/µL, a higher threshold than was previously recommended. Country decision makers must consider whether to further expand eligibility accordingly.We used multiple independent mathematical models in four settings-South Africa, Zambia, India, and Vietnam-to evaluate the potential health impact, costs, cost-effectiveness of different adult criteria under scenarios current expanded treatment...
Objective We estimated the incremental cost and impact on diagnosis treatment uptake of national rollout Xpert MTB/RIF technology (Xpert) for pulmonary TB above current guidelines years 2011 to 2016 in South Africa. Methods parameterised a population-level decision model with data from national-level databases (n = 199,511) implementation studies. The follows cohorts suspects under diagnostic or an algorithm that includes Xpert. Assumptions include number suspects, symptom prevalence 5.5%,...
Background: Recent studies have shown HIV incidence declines at a population level in several African countries. However, these not directly quantified the extent to which are attributable different programs. Methods: We calibrated mathematical model of South epidemic age- and sex-specific data from antenatal surveys, household death registration, using Bayesian approach. The was also parameterized on self-reported condom use, voluntary medical male circumcision (VMMC), testing,...
Abstract A new SARS-CoV-2 variant of concern, Omicron (B.1.1.529), has been identified based on genomic sequencing and epidemiological data in South Africa. Presumptive cases Africa have grown extremely rapidly, despite high prior exposure moderate vaccination coverage. The available evidence suggests that spread is at least part due to evasion this immune protection, though may also exhibit higher intrinsic transmissibility. Using detailed laboratory from Africa, we estimate the constraints...
BackgroundApproaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead lower HIV incidence, but their cost-effectiveness is unknown. We aimed evaluate conditions under which cost-effective.MethodsWe applied a mathematical model of transmission simulate 3000 setting-scenarios reflecting range epidemiological characteristics communities in sub-Saharan Africa. The prevalence viral load...
Voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition by 60%. Programmes to provide VMMCs for prevention have been introduced in sub-Saharan African countries with high burden. Traditional is also a long-standing coming-of-age ritual, but practices vary considerably across populations. Accurate estimates coverage age, type, and time at subnational levels are required planning delivering meet targets evaluating their impacts on incidence.
Katharina Kranzer and colleagues investigate the operational characteristics of an active tuberculosis case-finding service linked to a mobile HIV testing unit that operates in underserviced areas Cape Town, South Africa.
Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting cost such scale-up in comparison benefits from reduced mortality. We review available literature modelled estimates providing ART different populations around world, suggest alternative methods characterising when modelling several decades into future. In past economic analyses provision, costs were often assumed vary by disease...
While momentum for increasing treatment thresholds is growing, if patients cannot be retained in HIV care from the time of testing positive through long-term adherence to antiretroviral therapy (ART), such strategies may fall short expected gains. estimates retention on ART exist, few cohorts have data care.We explored attrition (loss or death) at Themba Lethu clinic, Johannesburg, South Africa 3 distinct enrolled testing, pre-ART initiation, and initiation.Between March 2010 August 2012 we...
Background We were tasked by the South African Department of Health to assess cost implications largest ART programme in world adopting sets guidelines issued World Organization between 2010 and 2016. Methods Using data from large clinics (n = 24,244 patients), projections patients need ART, bottom-up analyses, we constructed a population-level health-state transition model with 6-monthly transitions health states depending on patients' age, CD4 cell count/ percentage, and, for adult...
BackgroundThe goal of virtual elimination horizontal and mother-to-child HIV transmission in South Africa (SA) has been proposed, but there have few systematic investigations which interventions are likely to be most critical reducing incidence.ObjectiveThis study aims evaluate SA's potential achieve targets identify will achieving incidence reductions.DesignA mathematical model was developed simulate the population-level impact different SA. Probability distributions were specified...
Abstract Although many African countries have achieved high levels of HIV diagnosis, funding constraints necessitated greater focus on more efficient testing approaches. We compared the impact and cost-effectiveness several potential new strategies in South Africa, assessed prospects achieving UNAIDS target 95% HIV-positive adults diagnosed by 2030. developed a mathematical model to evaluate home-based testing, mobile assisted partner notification, schools workplaces, female sex workers...
Abstract Background Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)–related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown. Methods We projected unit (ICU) needs capacity from August 2020 January 2021 using South African National COVID-19 Epi Model. assessed of (1) administration dexamethasone ventilated patients nonventilated patients, (2) alone both (3) only, (4) all relative...
Coronavirus disease 2019 (COVID-19) has had a devastating impact globally, with severe health and economic consequences. To prepare systems to deal the pandemic, epidemiological cost projection models are required inform budgets efficient allocation of resources. This study estimates daily inpatient care costs COVID-19 in South Africa, an important input into evaluation models.We adopted micro-costing approach, which involved identification, measurement valuation resources used clinical...
In response to the global pandemic of COVID-19, countries around world began imposing stay-at-home orders, restrictions on transport, and closures businesses in early 2020. South Africa implemented a strict lockdown March 2020 before its first COVID-19 wave started, gradually lifted between May September 2020, then re-imposed December second wave. There is concern that COVID-19-related morbidity mortality, fear transmission, government responses may have led reduction antiretroviral...
BackgroundAfter successful intensive interventions to rapidly increase HIV awareness, coverage of antiretroviral therapy (ART), and viral suppression, programmes in eastern southern Africa are considering scaling back some interventions, such as widespread general population testing. We aimed model whether testing South could result a resurgence the epidemic or substantial slowing declines incidence, resulting increased long-term ART.MethodsIn this modelling study, we used Thembisa 4.5 (a...
Abstract Objective The World Health Organization recommends using Xpert MTB/RIF for diagnosis of pulmonary tuberculosis (PTB), but there is little evidence on the optimal placement instruments in public health systems. We used recent South African data to compare cost placing at points TB treatment (all primary clinics and hospitals) with sub‐district laboratories. Methods estimated Xpert’s cost/test a clinic pilot phase national roll‐out smear microscopy laboratories; expected future...
The ever-growing HIV treatment programs in sub-Saharan Africa (SSA) present local policy makers with complex decision dilemmas, as international guidelines emphasize the need for expanded access to antiretroviral therapy (ART), yet funding has flatlined.• We argue that current evidence base prioritizing ART scale-up strategies results recommendations are theoretically optimal but practically infeasible implement.• Cost-effectiveness analyses (CEAs) of scaling up SSA should be made more...
Background The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular middle-income countries such as South Africa. recent African HIV Investment Case produced an alternative threshold prevention and treatment interventions estimates life years saved the committed budget. Methods We analysed optimal mix over baseline current programme under budget 2016–2018. calculated incremental ratio (ICER)...