Southern African HIV Clinicians Society's strategic imperatives

Dr Francesca Conradie President of the SAHCS

Non-profit membership organisation of HIV health care workers

Formed in 1997 by Prof Des Martin to help coordinate response to HIV/AIDS epidemic

Governed by an eight member elected Board of Directors

WHO ARE WE?

Society membership is inclusive of all health care workers in HIV: doctors, related professionals, nurses and 2012 greater focus on lay HCWs as well

Approximately 3 700 members 58% doctors; 50% public sector 50% private sector28% nurse; 5% pharmacist85% South African, remaining largely Southern African (Botswana and Namibia)37% reside in Gauteng; ~15% KZN, Western Cape and Eastern Cape each Paediatrics is the largest reported specialty

WHO DO WE SERVE?

To promote quality comprehensive, evidence-based HIV healthcare in Southern Africa

MISSION & OBJECTIVES

Objectives:To partner with governments to implement optimal HIV programmes and policies

To foster evidence-based HIV related education for healthcare workers

To produce evidence-based guidelines

To facilitate interactions amongst HIV healthcare workers to optimise patient care

To expand access to the activities of the Society

To advocate for the best possible HIV treatment, care and prevention

To improve TB diagnosis, care and prevention within the context of the HIV epidemic

MISSION & OBJECTIVES

Presented at the TB Conference 2012By Dr. Francesca Conradie

To provide high quality, evidence-based information and resources to HIV health care workers

“Voice of reason”

Focus more resources to nurses (e.g. HIV Nursing Matters, clinical tip, nurse training, developing capacity, supporting health systems strengthening, leadership hubs)

To develop regional foot-print

To run first clinical conference focusing on HIV medicine in Southern Africa

WHAT IS OUR MANDATE 2012?

Presented at the TB Conference 2012By Dr. Francesca Conradie

Southern African Journal of HIV Medicine

HIV Nursing Matters magazine

Clinical practice guidelines

Website: clinical case study programme & searchable provider directory

SMS clinical tips

Limited Bursaries and educational opportunities

Bi-annual clinical conference

CPD-accredited branch meetings & Leadership Hubs

PROGRAMMES & ACTIVITIES

NATIONAL HIV PREVALENCE TRENDS (1990 – 2010)

SANDOH. National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa. 2011

What has been achieved so far?

• Treatment • Prevention• Then Treatment as prevention?

Numbers• 1.8 million on antiretroviral therapy in public

sector• +/- 200 000 in private sector• Successful program• Reduction in mother to child transmission

3.5%• Increase in life expectancy

Prevention

• Generally not successful• Drivers of the epidemic different in different places,

ages etc• Behaviour difficult to change• Very high awareness of HIV in South Africa in general. • Voluntary medical male circumcision.

Prevalence by Gender

Treatment as prevention

• Pivotal study done, HPTN 052.• Discordant couple- one HIV+ and one HIV-• One arm was given antiretroviral therapy at a

high CD4+ and one arm at CD4+ of 250.

Total HIV-1 Transmission Events: 39

HPTN 052: HIV-1 Transmission

Immediate Arm4

Delayed Arm

35

p < 0.0001

Total HIV-1 Transmission Events: 39

HPTN 052: HIV-1 Transmission

Linked Transmissions: 28

Unlinked or TBD Transmissions: 11

p < 0.001

Immediate Arm: 1

Delayed Arm: 27

• 18/28 (64%) transmissions from infected participants with CD4 >350 cells/mm3

• 23/28 (82%) transmissions in sub-Saharan Africa

• 18/28 (64%) transmissions from female to male partners

Treatment as prevention

• Pre- exposure prophylaxis (PrEP)– Truvada– For both heterosexual and homosexual transmission. – Recently approved by the FDA

• Microbicide• - CAPRISA 004 (UKZN)

Public enemy No.1

• TB

Incidence in SA (https://extranet.who.int/sree/Reports?op=Replet&name=

%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=ZA&outtype=html

The easy answer.

The tough answers• Policy reasons• Diagnostics • Treatment • Research

Diagnostics

Diagnostics

HIV

Diagnostics

Time to diagnosis

Microscopy

• Acid fast bacteria visualized on a slide may represent M. tuberculosis or non-tuberculous mycobacteria

Gene Xpert MTB/RIF

• Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance

National Strategic Plan for HIV, TB and STIs

• Very ambitious document www.doh.gov.za/docs/stratdocs/2012/NSPsum.pdf• Know you epidemic• Getting to zero

What are the good things?

• Political Commitment• Dark Mbeki days are over• Minister Aaron Motsaeledi

What are the challenges?

• Changing /decrease in international funding• Uncertainty about PEPFAR, Global Fund• Disbanding of SANAC and the re-formation.• Poorly functioning health care system• Lack of accountability between provincial and

national authorities

Role of the SAHCS

• Brains trust– Training– Guideline development – Taking new research findings and turning them

into policy

• Advocacy– Keeping government on track