Affordable management of HIV infection in the private sector

No Abstrac

Early and Late Direct Costs in a Southern African Antiretroviral Treatment Programme: A Retrospective Cohort Analysis

Gary Maartens and colleagues describe the direct heath care costs and identify the drivers of cost over time in an HIV managed care program in Southern Africa

Improving the evidence base of Markov models used to estimate the costs of scaling up antiretroviral programmes in resource-limited settings

<p>Abstract</p> <p>Background</p> <p>Despite concerns about affordability and sustainability, many models of the lifetime costs of antiretroviral therapy (ART) used in resource limited settings are based on data from small research cohorts, together with pragmatic assumptions about life-expectancy. This paper revisits these modelling assumptions in order to provide input to future attempts to model the lifetime costs and the costs of scaling up ART.</p> <p>Methods</p> <p>We analysed the determinants of costs and outcomes in patients receiving ART in line with standard World Health Organization (WHO) guidelines for resource poor settings in a private sector managed ART programme in South Africa. The cohort included over 5,000 patients with up to 4 years (median 19 months) on ART. Generalized linear and Cox proportional hazards regression models were used to establish cost and outcome determinants respectively.</p> <p>Results</p> <p>The key variables associated with changes in mean monthly costs were: being on the second line regimen; receiving ART from 4 months prior to 4 months post treatment initiation; having a recent or current CD4 count <50 cells/µL or 50-199 cells/µl; having mean ART adherence <75% as determined by monthly pharmacy refill data; and having a current or recent viral load >100,000 copies/mL. In terms of the likelihood of dying, the key variables were: baseline CD4 count<50 cells/µl (particularly during the first 4 months on treatment); current CD4 count <50 cells/µl and 50-199 cells/µl (particularly during later periods on treatment); and being on the second line regimen. Being poorly adherent and having an unsuppressed viral load was also associated with a higher likelihood of dying.</p> <p>Conclusions</p> <p>While there are many unknowns associated with modelling the resources needed to scale-up ART, our analysis has suggested a number of key variables which can be used to improve the state of the art of modelling ART. While the magnitude of the effects associated with these variables would be likely to differ in other settings, the variables influencing costs and survival are likely to be generalizable. This is of direct relevance to those concerned about assessing the long-term costs and sustainability of expanded access to ART.</p

Prevention of vertical transmission of human immunodeficiency type 1 virus in a managed care setting

The original publication is available at http://www.samj.org.zaPlease cite as follows: Regensberg, L., Pead, C., Mahumapelo, J. & Cotton, M. 2000. Prevention of vertical transmission of human immunodeficiency type 1 virus in a managed care setting. South African Medical Journal, 90(11):1093-1094.[No abstract available]Publisher’s versio

A report back on more than four years of HIV/AIDS disease management in southern Africa

No abstract available

Control of an amoebiasis outbreak in the Philippi area near Cape Town

CITATION: Whittaker, S. et al. 1994. Control of an amoebiasis outbreak in the Philippi area near Cape Town. South African Medical Journal, 84(7):389-393.The original publication is available at http://www.samj.org.zaPrevious studies in Durban have shown that serological investigations, in combination with iso-enzyme electrophoresis, are invaluable for monitoring the endemicity of pathogenic strains of Entamoeba histolytica. We therefore proposed that antibody profiles could be used to detect epidemic situations. An outbreak of amoebiasis in the normally non-endemic Philippi area near Cape Town provided an opportunity for testing this hypothesis. Seven of 9 patients presenting at a district hospital with invasive amoebiasis originated from a single farm in Philippi. Iso-enzyme electrophoresis and serological investigations were used to monitor the endemicity of amoebiasis on 16 of the 49 farms in this district. In an attempt to contain disease transmission all inhabitants on farms from which patients came (including those where cyst-passers were identified) and all seropositive subjects were treated. The antibody profiles proved invaluable for confirming that the farm from which the hospitalised patients originated was the central focus of the outbreak, and also identified subjects infected with pathogenic zymodemes of E. histolytica on the adjacent 4 farms. On all 5 of these farms, 62,5-100% of seropositive subjects were strongly positive. In contrast weak to negative serological responses occurred on the remaining 11 farms. In addition the success of treatment was indicated by a notable drop in strong seropositive responses on the affected 5 farms to 11,5% within 9 months. The infection pathways implied that the pathogenic strain of E. histolytica was introduced into this non-endemic area by a foreigner from an endemic area; this suggests that the pathogenicity of E. histolytica is an immutable stable feature.Publisher’s versio

Enrolment experience and the measurement of survival in a private sector HIV/AIDS disease management programme

No abstract available

The Matatiele Archaeology and Rock Art (MARA) Program Excavations: The Archaeology of Mafusing 1 Rock Shelter, Eastern Cape, South Africa

The rock shelter Mafusing 1 was excavated in 2011 as part of the Matatiele Archaeology and Rock Art or (MARA) research programme initiated in the same year. This programme endeavours to redress the much-neglected history of this region of South Africa, which until 1994 formed part of the wider ‘Transkei’ apartheid homeland. Derricourt’s 1977 Prehistoric Man in the Ciskei and Transkei constituted the last archaeological survey in this area. However, the coverage for the Matatiele region was limited, and relied largely on van Riet Lowe’s site list of the 1930s. Thus far, the MARA programme has documented more than 200 rock art sites in systematic survey and has excavated two shelters – Mafusing 1 (MAF 1) and Gladstone 1 (forthcoming). Here we present analyses of the excavated material from the MAF 1 site, which illustrates the archaeological component of the wider historical and heritage-related programme focus. Our main findings at MAF 1 to date include a continuous, well stratified cultural sequence dating from the middle Holocene up to 2400 cal. BP. Ages obtained from these deposits are suggestive of hunter-gatherer occupation pulses at MAF 1, with possible abandonment of the site over the course of two millennia in the middle Holocene. After a major roof collapse altered the morphology of the shelter, there was a significant change in the character of occupation at MAF 1, reflected in both the artefact assemblage composition and the construction of a rectilinear structure within the shelter sometime after 2400 cal. BP. The presence of a lithic artefact assemblage from this latter phase of occupation at MAF 1 confirms the continued use of the site by hunter-gatherers, while the presence of pottery and in particular the construction of a putative rectilinear dwelling and associated animal enclosure points to occupation of the shelter by agropastoralists. Rock art evidence shows distinct phases, the latter of which may point to religious practices involving rain-serpents and rainmaking possibly performed, in part, for an African farmer audience. This brings into focus a central aim of the MARA programme: to research the archaeology of contact between hunter-gatherer and agropastoralist groups