ENCORE: Monitoring and evaluating treatment in South Africa with National Health Laboratory Service Data

South Africa has the largest population of HIV infected people in the world and the largest population of people on antiretroviral therapy (ART).  Both the South African Government (SAG) and international donors have invested billions of ZAR annually in the country’s HIV care and treatment program.  The implementation of a comprehensive monitoring and evaluation (M&E) program lagged behind the implementation of intervention rollout.  As a consequence, we lack important strategic information concerning the overall effectiveness of the treatment management programme that could be used to refine treatment strategies and direct scarce resources where they are most needed. We constructed a National HIV Cohort from the complete laboratory records of South Africa’s HIV treatment program, covering over 4000 facilities. Integrating this cohort with treatment monitoring data, we are working with HE2RO to evaluate the national impact of Universal Testing and Treatment and identifying where in the UTT care cascade patients are lost to follow-up, in order to guide the next phase of South Africa’s HIV response.


Boston University investigators Jacob Bor, William Macleod, Matt Fox, Alana Brennan
Partner investigators NHLS, HE2RO
Countries South Africa
Project period 2020-2025
Funder NIH
Project website https://reporter.nih.gov/search/VYZv8ZPqD0y0HlPgok1azw/project-details/10164720#description
Contacts Jacob Bor

Publications and other documents

Bor J, Gage A, Onoya D, Maskew M, Tripodis Y, Fox MP, Puren A, Carmona S, Mlisana K, MacLeod W. Variation in HIV care and treatment outcomes by facility in South Africa, 2011-2015: A cohort study. PLoS Med. 2021 Mar 31;18(3):e1003479. doi: 10.1371/journal.pmed.1003479. PMID: 33789340; PMCID: PMC8012100.

Fox MP, Brennan AT, Nattey C, Macleod W, Harlow A, Mlisana K, Maskew M, Carmona S, Bor J. Delays in repeat HIV viral load testing for those with elevated viral loads: a national perspective from South Africa. Journal of the International AIDS Society 2020, 23:e25542.

Harlow AF, Bor J, Brennan AT, Maskew M, MacLeod W, Carmona S, Mlisana K, Fox MP. Impact of viral load monitoring on retention and viral suppression: a regression discontinuity analysis of South Africa’s national laboratory cohort. Am J Epidemiol 2020; published ahead of print.Delays in repeat HIV viral load testing for those with elevated viral loads: a national perspective from South Africa

Fox MP, Bor J, Brennan AT, Macleod WB, et al. Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa. PLoS Medicine 2018; 15 (6): e1002589.

Carmona S, Bor J, Nattey C, Maughan-Brown B, Maskew M, Fox MP, et al. Persistent high burden of advanced HIV disease among patients seeking care in South Africa’s national HIV program: data from a nationwide laboratory cohortClinical Infectious Diseases 66 (suppl 2): S111-S117.

Maskew M, Bor J, Hendrickson C, Macleod W, Bärnighausen T, Pillay D, et al. Imputing HIV treatment start dates from routine laboratory data in South Africa: a validation study. BMC health services research 2017; 17 (1): 41.