ArticlePloS one2017
Changing the South African national antiretroviral therapy guidelines: The role of cost modelling.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case.PloS one · 2019Pooled it
- A Urine Tenofovir Point-of-Care Assay Facilitates Positive Antiretroviral Therapy Adherence Discussions Among People Living With HIV and Healthcare Providers-A Mixed-Methods Evaluation in Cape Town, South Africa.Journal of the International AIDS Society · 2026Trial
- Fast-track treatment initiation counselling in South Africa: A cost-outcomes analysis.PloS one · 2021Trial
- The impact of evolving maternal antiretroviral therapy guidelines on vertical transmission of HIV in the Western Cape, South Africa.PloS one · 2025Article
- Economic Evaluation of Free Prevention of Mother-to-Child Transmissions (PMTCT) Services to Non-South African Women Living in South Africa.Health services insights · 2025Article
- Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF's Welcome Service.Scientific reports · 2024Article
- Efficacy, safety, and tolerability of dolutegravir-based ART regimen in Durban, South Africa: a cohort study.BMC infectious diseases · 2024Article
- Gynaecologic and breast cancers in women living with HIV in South Africa: A record linkage study.International journal of cancer · 2024Article
- The epidemiology of laboratory-confirmed Hepatitis B Virus infection in the general population of South Africa, 2016-2018.The Pan African medical journal · 2024Article
- The Economic Burden of Chronic Diseases with Co-Occurring Depression and Alcohol Use Disorder for People in the Western Cape, South Africa.SSM. Mental health · 2023Article
- Perspectives of people living with HIV and health workers about a point-of-care adherence assay: a qualitative study on acceptability.AIDS care · 2023Article
- HIV Viral Load Testing in the South African Public Health Setting in the Context of Evolving ART Guidelines and Advances in Technology, 2013-2022.Diagnostics (Basel, Switzerland) · 2023Article
- Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.PLOS global public health · 2023Article
- Adult intussusception in the era of HIV/AIDS: A case report.Southern African journal of infectious diseases · 2023Article
- Patient-centred care: reality or rhetoric-patients' experiences at ARV clinics located in public hospitals in KwaZulu-Natal, South Africa.AIDS research and therapy · 2022Article
- Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models.The Lancet. Global health · 2022Article
- Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines.AIDS and behavior · 2022Article
- Assessment of facility-level antiretroviral treatment patient status utilizing a national-level laboratory cohort: Toward an understanding of system-level tracking and clinic switching in South Africa.Frontiers in public health · 2022Article
- Article
- Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making.Global health action · 2021Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundWe were tasked by the South African Department of Health to assess the cost implications to the largest ART programme in the world of adopting sets of ART guidelines issued by the World Health Organization between 2010 and 2016.
methodsUsing data from large South African ART clinics (n = 24,244 patients), projections of patients in need of ART, and cost data from bottom-up cost analyses, we constructed a population-level health-state transition model with 6-monthly transitions between health states depending on patients' age, CD4 cell count/ percentage, and, for adult first-line ART, time on treatment.
findingsFor each set of guidelines, the modelled increase in patient numbers as a result of prevalence and uptake was substantially more than the increase resulting from additional eligibility. Under each set of guidelines, the number of people on ART was projected to increase by 31-133% over the next seven years, and cost by 84-175%, while increased eligibility led to 1-26% more patients, and 1-17% higher cost. The projected increases in treatment cost due to the 2010 and the 2015 WHO guidelines could be offset in their entirety by the introduction of cost-saving measures such as opening the drug tenders for international competition and task-shifting. Under universal treatment, annual costs of the treatment programme will decrease for the first time from 2024 onwards.
conclusionsAnnual budgetary requirements for ART will continue to increase in South Africa until universal treatment is taken to full scale. Model results were instrumental in changing South African ART guidelines, more than tripling the population on treatment between 2009 and 2017, and reducing the per-patient cost of treatment by 64%.
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