Browsing by Author "Bor J"

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    Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia.
    (2018-Sep-01) Brennan AT; Bor J; Davies MA; Wandeler G; Prozesky H; Fatti G; Wood R; Stinson K; Tanser F; Bärnighausen T; Boulle A; Sikazwe I; Zanolini A; Fox MP; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Institute of Public Health, School of Medicine, Heidelberg University, Heidelberg, Germany.; The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Africa Health Research Institute, Durban, South Africa.; Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts.; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.; Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa.; Research Department of Infection and Population Health, University College London, London, United Kingdom.; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    Tenofovir is less toxic than other nucleoside reverse-transcriptase inhibitors used in antiretroviral therapy (ART) and may improve retention of human immunodeficiency virus (HIV)-infected patients on ART. We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir for first-line ART. We applied regression discontinuity in a prospective cohort study of 52,294 HIV-infected adults initiating first-line ART within 12 months (±12 months) of each guideline change. We compared outcomes in patients presenting just before and after the guideline changes using local linear regression and estimated intention-to-treat effects on initiation of tenofovir, retention in care, and other treatment outcomes at 24 months. We assessed complier causal effects among patients starting tenofovir. The new guidelines increased the percentages of patients initiating tenofovir in South Africa (risk difference (RD) = 81 percentage points, 95% confidence interval (CI): 73, 89) and Zambia (RD = 42 percentage points, 95% CI: 38, 45). With the guideline change, the percentage of single-drug substitutions decreased substantially in South Africa (RD = -15 percentage points, 95% CI: -18, -12). Starting tenofovir also reduced attrition in Zambia (intent-to-treat RD = -1.8% (95% CI: -3.5, -0.1); complier relative risk = 0.74) but not in South Africa (RD = -0.9% (95% CI: -5.9, 4.1); complier relative risk = 0.94). These results highlight the importance of reducing side effects for increasing retention in care, as well as the differences in population impact of policies with heterogeneous treatment effects implemented in different contexts.
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    The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa.
    (2025-May) Hontelez JAC; Goymann H; Berhane Y; Bhattacharjee P; Bor J; Chabata ST; Cowan F; Kimani J; Knox J; Lora WS; Lungu C; Manne-Goehler J; Mauti J; Moshabela M; Mpembeni RM; Wa Mwanza M; Ndung'u T; Omondi E; Phiri S; Siedner M; Tanser FC; de Vlas SJ; Bärnighausen TW; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.; African Population and Health Research Center (APHRC), Nairobi, Kenya.; Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.; Partners for Health and Development in Africa, Nairobi, Kenya.; Department of Global Health and Epidemiology, School of Public Health, Boston University, Boston, MA, USA.; Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.; HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.; School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi.; Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa.; Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Medicine, Harvard Medical School, Boston, MA, USA.; Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands.; Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.; Ragon Institute of Mass General Brigham, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA.; Partners in Hope, Lilongwe, Malawi.; University of Cape Town, Cape Town, South Africa.; South African Centre for Epidemiological Modelling and Analysis, Centre for Epidemic Response and Innovation, School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.; Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Dar es Salaam, Tanzania.; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.; Division of Infectious Diseases, Brigham and Women's Hospital, Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA.; Institute of Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada.; Public Health Group, Malawi Liverpool Wellcome Trust-Clinical Research Programme, Lilongwe, Malawi.; Division of Infection and Immunity, University College London, London, UK.; Institute of Mathematical Sciences, Strathmore University, Nairobi, Kenya.; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.; HIV Center for Clinical and Behavioral Studies, NewYork State Psychiatric Institute and Columbia University, New York, New York, USA.; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Germany.
    BACKGROUND: On January 24, 2025, the United States government issued an executive order to freeze all foreign aid programs, including The President's Emergency Plan for AIDS Relief (PEPFAR), for 90 days. A limited waiver option became available, but its implementation remains incomplete. We estimated the impact of these policy changes on HIV deaths and new infections in seven sub-Saharan African (SSA) countries-Ethiopia, Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe -, which together account for about half of all people living with HIV in SSA. METHODS: We used STDSIM, an established individual-based simulation model, and previously published quantifications for the seven countries. We predicted changes in HIV deaths and new infections over the period 2025-2030 for four scenarios: (1) FINDINGS: A 90-day funding freeze would result in 60 thousand [95% UI: 49-71 thousand] excess HIV deaths for the INTERPRETATION: The sudden cessation of PEPFAR funding likely results in tens of thousands of HIV deaths and new infections. These losses of life and health should compel the United States government to rapidly and fully re-instate one of the most successful health programs in history. FUNDING: None.