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March Research Presentations

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Emily Krogstad (left) and Monika Kamkuemah (right)  present their research at DTHF

At the Desmond Tutu HIV Foundation’s (DTHF) March research meeting, we had the pleasure of not one, but two presentations. The speakers were the University of Cape Town’s (UCT) Ms Monika Kamkuemah and the DTHF’s Dr Emily Krogstad.

HIV and Chronic Disease

Ms Kamkuemah presented her PhD proposal where she intends to examine HIV in adolescents alongside the epidemiology of other chronic diseases such as diabetes and asthma. South African adolescents have the highest rates of HIV in Sub-Saharan Africa (1), while diabetes is now the leading cause of death of women in South Africa (2). Lifestyle choices such as diet and exercise can contribute to the development of diabetes. Kamkuemah is interested in examining which risk behaviours are present in adolescents that contribute to the development of chronic diseases. Examples of these include activities such as tobacco use, diet and physical inactivity. This will lay the foundation for the development of prevention strategies.
Her study will be based initially in Cape Town but with an aim to expanding the catchment area.

HIV Prevention and Bioengineering

Dr Krogstad discussed her PhD research at the University of Washington where she designed, made and tested nanofibres that contained an HIV-prevention drug. The final aim was to create a fabric that could be inserted into high HIV-risk bodily areas (i.e. vaginally or rectally) and, by doing so, prevent the virus from establishing HIV infection during sex. The fabric would dissolve and deliver the drug to prevent HIV infection.

The advantage with these sorts of products over others such as an oral pill is that they act faster and apply the drug straight to the area at risk of infection. Additionally, there are often fewer side effects as the drug does not need to pass through other areas of the body to get to its target site.
The sheet itself is thin and feels very soft in texture. It is made using a process called electrospinning that produces extremely fine fibres that are as small as 100 nanometres in diameter. That is 1000 times smaller than a strand of human hair. This process gives the bioengineers a lot of control over the fibre’s properties: size, structure, shapes, geometries, and how long it takes to dissolve. This is advantageous because it can be used to control drug delivery time.
The group are still testing different formulations of drugs to best target both HIV and other sexually transmitted diseases, and even for use as a contraceptive sperm barrier. The possibilities for this nanofibre technology are vast;  the next stage will be designing a more desirable product that people will want to or feel more comfortable using.
We congratulate both our speakers on their excellent presentations and wish them the best of luck with their research.

References

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22 April: Earth Day & the March for Science

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Why is there a March for Science this Saturday? 22 April marks Earth Day and the anniversary of the birth of the modern environmental movement in 1970. This was the first time a voice was given to environmental consciousness and a call to action was made to support environmentally friendly and sustainable processes. In the face of climate change denialism and pending US budget cuts to the National Institute of Science, the 22 April has again been identified as a day to call for action!

Earth Day 2017 will host the global March for Science, where thousands are suspected to flock to the streets worldwide in support of science. While there are strong political elements associated with the march, people are joining the March for Science for many different reasons. Some are marching to raise awareness around Climate Change science; others are marching as a political statement in reaction to the US budget cuts to scientific research, and others will take part to promote a general awareness around the fundamental role of science in all sectors of society.

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The Desmond Tutu HIV Foundation support this march and encourages all our staff, collaborators and supports to take part. As a scientific research institution, we conduct and rely on rigorous and innovative research to advance against the HIV and Tuberculosis epidemics, and other public health emergencies (some of which, such as malaria,  are a direct response to global warming). We need to find improved treatment and prevention options for our communities. Many of our projects are funded by the National Institute of Health and related US organisations, and our research and ability to be a cutting-edge research centre stand to be affected by these proposed budget cuts.

Linda-Gail Bekker, Deputy Director of the Desmond Tutu HIV Centre, says, “At this time in the world, innovation and research is key to changing the trajectory of public health. It is the worst sin of all to ignore good science. Let’s find new innovations, apply the science we’ve got, and work to really make a different to the face of public health!”

For those in Cape Town, the event details for the March for Science are as follows:

Date: Saturday, 22 April 2017
Time: 10:20-12:30
Meeting Point: Observatory Swimming Pool, Willow Rd, Observatory, Cape Town. The march will process to Station Rd, down Station Rd to Main Rd, and over to the Cape Town Science Centre where speeches will be made.
How to prepare: bring signs and wear green or science-related clothing.

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GeneXpert well received by adolescents

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Andrea Mendelsohn (left) & Shabaana Osman | DTHF March 31st Research Meeting 2017
Andrea Mendelsohn (left) & Shabaana Osman | DTHF March 31st Research Meeting 2017

The final March research presentation was hosted by Andrea Mendelsohn and Shabaana Osman. Mendelsohn presented the first portion of an ongoing research trial in Masiphumelele. They have been testing the efficacy and response of an STI (sexually transmitted infection) check in adolescents using the GeneXpert machine. So far, the results have been positive.

The centre invited adolescents in the region of Masiphumelele for a general wellness check up. They also offered HIV and STI tests using the GeneXpert testing unit. This is a unit that takes a urine sample from each patient and in 90 minutes can identify if that patient has gonorrhoea or chlamydia.

Adolescents undergo many changes; friendship groups, a new desire for independence and new behaviours can put them at risk of catching STIs. Two candidates; chlamydia and gonorrhoea, inflame the pelvic region and make the tissue more susceptible to HIV infection. This is a big concern for South African adolescents, especially women who have a 13.9% rate of HIV. Compare this to adolescent men who by comparison have a 3.9% risk. This makes women especially vulnerable to gonorrhoea and chlamydia. These STIs are particularly easy to spread since 70-80% of cases show no symptoms, therefore adolescents aren’t compelled to seek treatment.

The results thus far showed that the STI check has the strong potential to be an essential service in the Masiphumelele region. Only 20% of the youths tested sought out clinical consultation due to symptoms of an STI. Yet nearly half of them reported actually having symptoms when asked from a checklist by the clinician. The rates of chlamydia and gonorrhoea in the group were nearly double the national average. This indicates that this service is probably needed in the Masiphumelele region. With a long term plan and widespread catchment area the testing service could create a meaningful difference in the STI levels in the region.

So far, the adolescents tested have had a positive experience with the GeneXpert testing unit. They found it easy to use, and in spite of the ninety minute wait for results, only four people didn’t come back later or the next day to find out their results. An excellent turn out, considering that adolescents are sometimes (unfairly) stereotyped as being unreliable. The feedback also indicated that the youths want this service.

Whilst the study is in its infancy (only a tenth of the desired test subjects have been tested), the results thus far show positive responses to the GeneXpert testing unit.

Thank you again for your engaging talk. We wish you the best of luck for the rest of this study and in your future research ventures.

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Medical Male Circumcision Uptake to Prevent HIV

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Street Ethiopia | Rod Waddington

The last research meeting of April was on the subject of medical male circumcision (MMC), hosted by Nathan Beijneveld. He presented research of the acceptability and uptake of MMC in two adolescent populations in South Africa. This is a study with MACHO (Males Actively Choosing Healthy Options). The study investigated the uptake and acceptability of MMC in two adolescent populations. Additionally, it examined sexual risk behaviour between circumcised and uncircumcised participants.

The WHO recommends circumcision as part of an HIV-prevention package in conjunction with other methods such as male and female condoms. (1) There are medical justifications for this procedure. The foreskin is a thin piece of skin which is susceptible to abrasions and HIV can get into the bloodstream more easily. Furthermore, the foreskin can trap bacteria and viruses. The human body naturally protects itself by having a higher density of immune cells in this region. However, HIV has found a way to bypass this protection mechanism by attaching itself to these cells.

The study looked at two cohorts of participants in two high HIV-infection risk areas: one in Cape Town and the other in Johannesburg. Each cohort was made up of 50 uncircumcised, adolescent males and their legal guardian. Each participant was asked about their knowledge of MMC and whether it can protect against HIV. The main difference between the cohorts was their cultural representations. The Cape Town group was mainly Xhosa men and the Johannesburg group was mostly Zulu.

Medical Male Circumcision to prevent HIV infographic | WHO (5)

The timing of circumcision in Xhosa men at the average age of 19. (2) Furthermore, more than half of these men have had sexual intercourse at the age of 18. (3) MMC is most effective at preventing HIV-infection when performed before sexual debut.

The alternative to MMC is Traditional male circumcision (TMC). TMC is a right of passage into manhood for many Sub Saharan African men. A practitioner, with no formal medical training, conducts the procedure outside of a medical setting.(4)

TMC has more known health complications than MMC such as infection, haemorrhage, and delayed wound healing. Additionally, sometimes the circumcision is incomplete and part of the foreskin remains which increases the risk of catching HIV.

Within the two cohorts, only one participant from the Cape Town study underwent TMC and nobody underwent MMC. Whereas in Johannesburg, one participant opted for TWC and over ten volunteered for MMC. There were concerns in both groups about the safety, expertise and pain of TWC, but there were differences in concerns around MMC. The Johannesburg group were barely concerned with MMC. In contrast, the Cape Town group were largely concerned that MMC went against their culture or religion and were concerned that they would ‘not be regarded as a man.’

The study concluded that Xhosa men were far less likely to volunteer for MMC, largely for cultural reasons. Beijneveld noted that this is a pilot study and that 100 participants are a small sample size and that their conclusions could change with further investigation.

We thank Beijneveld for his fascinating presentation and wish him the best of luck in his future career as a doctor.

 

Written by Caroline Reid

References

  1. http://www.who.int/hiv/topics/malecircumcision/fact_sheet/en/
  2. Maughan-Brown B, Venkataramani AS, Nattrass N, Seekings J, Whiteside AW. A Cut Above the Rest: traditional male circumcision and HIV risk among Xhosa men in Cape Town. J Acquir Immune Defic Syndr. 2011;58(5):499-505. doi:10.1097/QAI.0b013e31823584c1
  3. Shisana O. South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2005. Human Sciences Research Council. http://www.hsrc.ac.za/en/research-data/view/2093. Published 2005
  4. http://www.who.int/bulletin/volumes/88/12/09-072975/en/
  5. http://www.who.int/hiv/pub/malecircumcision/vmmc-infographic/en/ 

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Closing in on Airborne TB

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We were very fortunate to have Professor Robin Wood and Dr Keren Middelkoop, both from the Desmond Tutu HIV Foundation (DTHF), update us on the tuberculosis (TB) aerobiology project. The project aims to characterise how airborne TB infects people in different spaces. South Africa is one of the six countries globally with the highest rates of TB. The bacteria is responsible for the highest percentage of deaths among HIV-positive South Africans. Understanding how and where transmission occurs and improving the case finding process may help eradicate the bacteria.

The Latest in Aerosol Capture

Robin Wood and Keren Middelkoop May research meeting | Caroline Reid

Wood summarised the progress made in measuring individual airborne TB bacteria. For this latest research by DTHC, each patient spent a short amount of time in an air-controlled kiosk. Clean air is pumped in, breathed by the patient, and captured. The team then analyse the air to see how the composition of the air has changed. For example, the carbon dioxide (CO2) levels should be higher due to exhalation. Each participant had TB, yet the kiosk identified just over 40% of participants as having TB. This result is useful, but indicates that less infectious cases of TB will be missed.

Measuring airborne bacteria, like tuberculosis, is tricky because the number of bacteria in a large quantity of air might be very small. As a result, the team has been aiming to develop more sensitive gadgets that are less likely to miss organisms. The new device will allow the team to measure the exhaled breath directly, instead of collecting it in the kiosk. Wood believes this will improve the sensitivity of exhaled air measurements, as high airflow capture increases the chance of capturing individual TB bacterium and other organisms.

Airborne TB in Communal Spaces

Middelkoop presented a different component of the same project. She has been sampling air in communal spaces to see if TB is being transmitted. As Middelkoop explained, this is tricky and the project is currently in the ‘proof of concept’ stage. There is the potential to identify areas with a high risk of TB transmission and advise on how to reduce the risk. Air is sampled using a filter over a vacuum that traps small particles while letting air flow through. The team has completed over 70 air samples from TB clinic rooms as well as from empty, windy fields where the team doesn’t expect TB (as controls). The team has been able to identify TB form clinic spaces, even in the presence of measures to reduce TB transmission (such as opening doors and windows).

TB levels in the air are expected to be higher in places where levels of CO2 (rebreathed air) are high. CO2 levels increase increase when lots of people share a space that isn’t ventilated, because everyone rebreathes the same air. Eventually, the team wants to go to communal spaces (such as churches, schools, etc) and quickly and reliably identify the presence of TB. If that space has no TB, then no one needs to be tested for active TB disease. However, if TB is found, then everyone can be tested and, if identified to have TB disease, treated quickly before the bacteria spreads.

At the moment, active case finding of TB in communities is expensive and time-consuming, and therefore rarely done. If shown to be feasible, this method has the potential to increase the efficiency of screening and identify new cases before they infect more people.

 

We wish Wood and Middelkoop the best of luck as they continue their valuable project, and thank them for an engaging presentation.

 

Written by Caroline Reid

 

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Healthcare Providers Respond to Latest HIV Prevention Research

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New HIV prevention technologies are researched all the time at the Desmond Tutu HIV Foundation. Often, scientists are concerned with how the people using these products will respond to them. But, equally important, is the response from the healthcare workers prescribing them. Robina Momanyi, an IAVI fellow visiting the Desmond Tutu HIV Foundation from Kenya, enlightened us on how health care providers (HCPs) are responding to new advancements in HIV prevention technology.

Robina Momanyi at Desmond Tutu HIV Foundation | Caroline Reid

Currently, there are 35 million people living with HIV, and South Africa has a large burden; 6.3 million, of these cases. Clearly, there is still a need for preventative technology and getting HCPs on board with the newest prevention tools is essential to reducing this burden. These new technologies include the already rolled-out PrEP (Pre-Exposure Prophylaxis), as well as products not yet on the market: microbicides (a lubricant with a compound that prevents HIV infection) and vaginal rings (a short-term silicon ring inserted into the vagina that releases a drug to prevent HIV).

Momanyi conducted small focus groups and in-depth interviews with HCPs to discover how well they knew these new products and the possible barriers and facilitators to their roll-out.

Most of the HCPs did not know much about the new preventative technologies. This is useful to know when devising outreach strategies for these new products once they can be prescribed. However, the interviewees embraced the products and emphasised that they will prescribe them if research shows they prevent HIV.

A Vaginal Ring | International Partnership for Microbicides

The HCPs were enthusiastic about the recent HIV prevention drug: PrEP (Pre Exposure Prophylaxis), a once a day pill of HIV-negative people at risk of infection. They noted that there would need to be a careful strategy for its roll-out. The PrEP program needs a new distribution infrastructure: PrEP-takers need repeat prescriptions and require an HIV test every three months. This prevention method is extremely effective so it is essential that it is known in the community.

Ideally, a long-acting vaccine would be the HCPs preferred prevention method: a one-time injection puts less strain on healthcare providers and there is less hassle for users. It can be easy to forget to take a daily pill and not everyone has places they can put pills discreetly. A vaccine would also get rid of the need for secrecy for PrEP users who prefer to keep their medication-use private.

Overall, the HCPs had competing interests about the roll-out and sustainability of these new prevention technologies. They indicated that there was a need for an education plan about the products as their willingness to prescribe depended on what and how much they knew. They also mentioned that there is a need for sensitivity and consideration on how their clinic community viewed the need for HIV prevention when considering the new products.

HCPs had the opinion that more community education was needed on proper and consistent use of condoms as they are 99% effective, then to promote other prevention technology. However, they also observed that new technology with less user-adherence would be more successfully used by consumers, so they were interested in the promotion of prevention that did not require daily commitment.

The next step will be more discussion, empowering providers with training and guidelines when we think about roll out. Willing users aren’t the only obstacle, we also need willing providers.

We are grateful to Momanyi for her fascinating and thought-provoking research and wish her luck as she moves onto the next stages of her career.

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How can Circumcision Prevent HIV?

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Medical Male Circumcision (MMC) is currently recommended for men living in areas where HIV rates are high and prevention tools are scarce. Some men, understandably, are unwilling to undergo MMC. Nyaradzo Chigorimbo-Tsikiwa, with the Desmond Tutu HIV Centre and the Division of Immunology, is researching the cellular and molecular composition of the foreskin. The goal is to identify how HIV penetrates the foreskin tissue and maybe find a solution for these men who would prefer to remain uncircumcised.

Nyaradzo Chigorimbo-Tsikiwa for DTHF research meeting May 2017 | Caroline Reid

It has been shown that after a medical male circumcision (MMC), randomised clinical studies report a 60% risk reduction in HIV acquisition. Researchers are not certain why the removal of the foreskin leads to lower incidences of HIV but there are some theories. One suggests that it reduces the number of  HIV target cells (including Langerhans’ cells)  by removing the foreskin during MMC. Secondly,  HIV can’t penetrate normal healthy skin but if there are abrasions then they could provide a point of entry in uncircumcised men. In addition, the inner foreskin removed during MMC has been found by researchers to be susceptible to infection by the virus due to its physiology.

a) Flaccid penis and b) erect penis and locations where HIV can enter the body | C Dezutter-Dambuyant/SG McCoombe & RV Short, AIDS

Chigorimbo-Tsikiwa takes foreskin samples from circumcised men with and without asymptomatic STIs. Studying these tissues provided insight on how HIV can infect a man through his foreskin.

The foreskin has an inner part which is in direct contact with the penis before circumcision and the outer part which covers the head of the penis. Chigorimbo-Tsikiwa together with Professor Clive Gray and others have found some important differences between the inner and outer foreskin using proteomics (the study of proteins) and on a cellular level. The first difference was in the proteins that function as barriers. The second difference was that the outer layer of the foreskin has a thicker layer of keratin than the inner foreskin. Keratin is a protective protein found in skin that makes it impenetrable. An important difference they found was also in increased numbers of HIV target cells in men with asymptomatic STIs. These few extra cells could make all the difference to infection susceptibility.

Distribution of Immune Cells (Langerhans’ cells, green) in the Outer Foreskin under a protective layer of keratin (dark blue) | C Dezutter-Dambuyant/SG McCoombe & RV Short, AIDS

It is possible that MMC can prevent HIV because it removes inner foreskin tissue that is susceptible to the virus. This would explain why men who undergo MMC have lower rates of HIV.

The next step is to figure out which genes are involved in prevention. The final goal is to figure out which compounds will prevent HIV from interacting with these immune cells. Eventually, this could be incorporated into a product e.g. a microbicide gel that the man could apply to the penis for protection during intercourse.

We wish Chigorimbo-Tsikiwa the best of luck with the next stages of her research.

 

Written by Caroline Reid

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Heart disease and living with HIV

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HIV is no longer the death sentence it once was: antiretroviral therapy (ARTs) have become so sophisticated that HIV-infected people have a normal life expectancy. However, now that HIV is a manageable, chronic disease, there is a shift in the focus of HIV research.  Jason Baker, an associate professor of medicine at the University of Minnesota, has been researching one of the new, main causes of death in HIV-infected people: cardiovascular disease (CVD). He spoke about the latest research in CVD in HIV positive cohorts.

Nowadays, approximately one third of deaths in HIV-infected people are cancer-related, and another third are related to cardiovascular disease (CVD). These data reflect the causes of death of the general population, however, there is a possible increased risk for HIV-positive patients. Baker suggests that HIV infection itself, and possibly use of certain antiretroviral medications can eventually increase the risk of certain cardiovascular complications over a number of years. However, the rates in HIV-infected people compared to the general population is only a marginal increase. The cause of CVD is varied. However, systemic inflammation can increase risk of complications later. HIV could be a driver for inflammation; damaging cells that the body doesn’t fully recover from.

The SUN study, which Baker has worked on, looked at calcium in the coronary arteries in an HIV cohort. The findings suggest that monocytes, a type of white blood cell, may be activated by HIV and increase CVD risk. Baker suggests that there is a possibility that it is the damage from HIV that causes inflammation as opposed to ARTs.

However, inflammation may not be the only factor contributing to CVD among HIV patients: there is research that suggests that long periods on ARTs may increase CVD risk through metabolic changes. The START study, which Baker works on along with the Desmond Tutu HIV Centre, studied the effects of ART, as well as untreated HIV infection, for CVD risk and other complications. The study found that starting ARTs as soon as possible was extremely effective for reducing clinical risk overall; especially in the ageing population.  CVD events were rare overall in START, but Baker hopes to study this further with longer follow-up of patients enrolled in the study.   

South Africa is at forefront of antiretroviral therapy and therefore has an interest in the diseases that arise in people managing HIV as a chronic condition. The success of ARTs has reduced AIDS mortality and increased the prevalence of HIV in the population.  In addition, CVD in South Africa is influenced by high rates of hypertension.  How HIV and ART interact with this risk may lead to important differences in CVD risk among HIV+ patients in South Africa, such as a greater risk for heart failure for example.  Now, our concerns will start to shift to managing age-related HIV issues.

Different geographies will have different concerns regarding the cause and profile of cardiovascular disease in their community. There is a large population of tuberculosis infected people in South Africa, and TB is the largest cause of death amongst its HIV-infected population. This will be a special consideration for South Africa, however, inflammation is a prominent symptom of TB disease.

We thank Baker for his engaging presentation and wish him luck with his future research. 

 

Written by Caroline Reid

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PEPFAR: Oh what good you have done!

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In 1982, the first case of HIV was reported in South Africa. Thereafter the unerring march of AIDS and death ravaged our communities, filled our hospital beds and cemeteries and rendered families bereft of young breadwinners, parents and children.

Anti-HIV treatment, known as antiretroviral therapy was the miraculous epidemic game changer – but it was only available to the richer nations that could afford the drugs. In 2002, the vision of Africa that came sharply into view was one where millions of our young people were dying and where social, economic and political destabilisation was evident.

The Presidents Emergency Plan for AIDS Relief (or PEPFAR), implemented in 2003, was a brilliant, generous and greatly valued intervention that changed the potential course of history forever. Under PEPFAR, we have seen a miraculous change to the narrative surrounding the AIDS response in Africa. This has included increasing access to HIV treatment, reductions in new infections through biomedical and behavioural prevention interventions, and an overall strengthening of health systems.

PEPFAR works closely with the South African Government and the Global Fund to Fight AIDS, Malaria and Tuberculosis. In 2016 alone, this collaboration provided ARVs for more than 3.4 million people, HIV counselling and testing for 10.4 million people, care and support for 407 056 orphans and adolescents affected by HIV/IADS, and medication for 220 626 pregnant HIV positive women to prevent mother to child transmission. The Global Plan for prevention of mother to child transmission has moved us very close to the complete eradication of transmission of HIV from women to their offspring.

We are now poised to move into the second chapter of the narrative where we can hope to see the numbers of new infections recede; communities again becoming strong and resilient, and African countries taking ownership and setting new benchmarks of health and wellbeing being set on the continent. We have new, strong HIV prevention tools and we know now more than ever how to engineer effective and exciting interventions, which include a possible cure and a preventative vaccine.

But it remains a tenuous fragile time….we can turn the page and move forward to a good ending or disengage too soon, lose all the gains we have made to date and slide back to a situation far worse that we have ever imagined.

PEPFAR was started by US President George Bush, expanded by US President Barack Obama and currently funds anti-AIDS activities in more than 60 countries. These funds come from the American people, and we are ever grateful for the huge contribution and difference they have made. Unfortunately, the change of administration in 2016 has resulted in a proposed reduction in the PEPFAR funding to a 5th of its current value, and a reduction of the countries it is active in, to a mere 11. This sits alongside a reduction in funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The impact of this on the HIV/AIDS response in developing countries will be enormous.

The HIV epidemic is far from over. Sub-Saharan Africa retains the highest HIV burden in the world today. AIDS continues to stalk our young people and rob our communities. The time is now, the challenge remains, and the reward is bigger than before! We continue to need global effort and investment in getting this job done!

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Prudence Mabele: A Tribute

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Prudence Mabele: Tribute

Prudence Mabele: Tribute

We have lost a champion. Prudence Mabele will always be remembered for being the first black woman to openly state she is living with HIV. She became a courageous activist and was a founder member of the Treatment Action Campaign when the government of the day refused to allow the import of life-saving antiretroviral drugs. At that time Prudence also faced the hostility of her peers. Her calling was to be a healer and she followed the cultural practices of her heritage. In this she played a unique role bridging the gap between traditional healing while advocating Western science in dealing with HIV.

An advocate for justice and women’s rights, Prudence founded the Positive Women’s Network that has done outstanding work in promoting gender justice. Her strong leadership skills led her to play a critical role as deputy chair of the Civil Society Forum within the South African National AIDS Council. It was this body that formulated the National Strategic Plan in response to AIDS, TB and STIs (2017-2022). Prudence was an icon and inspiration to many but especially to those living with HIV. She touched the lives of many of us at the DTHF.   As we mourn her passing, we give thanks for her determination, courage and passion.

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Second Quarter Newsletter

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IAVI #YOUTHTALK Workshop 9th/10th May 2017

For the second year, the International AIDS Vaccine Initiative (IAVI) partnered with us to host an exciting and informative research workshop at the River Club Conference Centre. We were delighted to welcome IAVI representatives from Kenya, Rwanda, and Uganda and many other local organisations.

Research has shown that unless new HIV infections among adolescents are reduced we will never get the HIV epidemic under control.   Dr. Rebecca Marcus, a close friend of the DTHF now in London, gave an outstanding presentation on the development of the human brain from birth to adulthood with a focus on development in adolescence.    We learned why adolescence is a challenging period both for the individual and for those who are concerned for their welfare.

Rebecca Marcus
Rebecca Marcus                                           

Many other excellent presentations gave a wide perspective on the science and behavioral science of what it means to grow up in an HIV environment.    Interesting videos highlighted successes and challenges and the conference closed with some creative participatory sessions led by the young women ‘Ignitors’ from the DTHF Women of Worth project.    Ndumiso’s encouragement (persuasion) to tweet comments and selfies added to the buzz.

Take away points:

  • No decisions should be made about youth, decisions and discussions regarding youth should be made with
  • The primary consideration should always be – what is in the best interest of the child (a minor is a child under 18 years).

It was made clear by a number of presenters that the adolescents of today are very different to previous generations.   They communicate frequently via social media often in their own lingo, they want to be real – they are who they are, take them as they are.   Adolescents are comfortable in diversity and expect innovation.   Adolescents are eager to turn challenges into opportunities.

Comment from Linda–Gail:    “We have just concluded a MOST successful IAVI/DTHF Adolescent research workshop and I want to thank ALL who took part. The standard of talks and inputs were just wonderful ….the participation from the floor was excellent and the energy and enthusiasm just reverberated for 48 hours and I am sure will power us on for months to come.”

IAVI team from Kenya
IAVI team from Kenya

Plenty to talk about!
Plenty to talk about!


SA AIDS 2017 – Durban – Brian Kanyemba

Brian Kanyemba and Karen Donimguez
Brian Kanyemba and Karen Donimguez

The conference came at a very exciting moment where implementation research on PrEP, new prevention technologies such as Antibody Mediated Prevention Studies (AMP), injectable PrEP studies, as well as the anticipated RV702 Vaccine Study are on the South African radar and currently being conducted at DTHF/C. It will be exciting to see what will be available in our prevention tool boxes in the next few years.

I was a conference chair, Track 4: Ethics, Marginalization and the Protection of Human Rights. This track provided an opportunity for conference attendees to examine and share issues relating to marginalized groups such as sex workers, LGBTIQA, miners, farm workers and travelers, and their challenges and successes that relate to the AIDS epidemic. It offered the opportunity for marginalized communities to be centre stage and engage in discussions on how marginalization has affected the response to the epidemic and approaches to overcoming these challenges.

The conference provided novel approaches to create social acceptability of new prevention technologies post trial, not only for trial participants but also for those who will need them.

Karen Donimguez presented a paper: STI Prevalence Among MSM Recruited for Biomedical Studies in Cape Town from 2014-2016.
Brian Kanyemba presented a paper at the Adherence 2017 Conference in Miami: Predictors of adherence among Black Men who have Sex with Men.

 


 Key Populations Division

 Katherine, Amelia, Brian, Karen and Nondikho – at the SA AIDS conference

Katherine, Amelia, Brian, Karen, and Nondikho – at the SA AIDS conference

We have completed the Sibanye Multi Prevention Study and presented the positive results to stakeholders and participants.  We are working on the HPTN 075 Study, this is a feasibility study.  We have had the final study visits and the results and dissemination are expected at the end of the year. We are about to commence the first ever-injectable PrEP (HPTN 083) study.

Sadly Karen is leaving us to return to the US.  She has shared her passion, integrity, and expertise with us over four years.  We will miss her always-supporting role, we have become a family so feel the loss of an integral part of our team.

 

 

 


Zimele: Philippi Village –  Amy Wilmot

Tree planting at Philippi Village
Tree planting at Philippi Village

The Zimele team has pushed FULL steam ahead since January 2017 with recruitment and BROCCOLI bio-metric registration of participants.   It has not been an easy road but we are getting there.   As Colleen Herman, Clinical Operations Manager likes to say, ‘There are 3 stages that this project will go through: Storming, Norming, and Performing.  We were storming for the first few months, are reaching Norming, and ultimately will be Performing’’. Our goal is to help the young women of the Mitchells Plain & Klipfontein sub-district recognise their own potential and take responsibility for their lives, and we know that will happen.    In the past few months, the following events have taken place – just to name a few!

  • Heideveld CDC AYFS (Adolescent Youth Friendly Services) event.
  • AYFS workshop at Mitchell’s Plain District Hospital.
  • Celebrating Youth Day – Vuyiseka Community Hall, Philippi.
  • Morgenson Primary School Soul Buddyz Club at Red Cross.
  • Broccoli registration – Keeping Girls in School Team.
  • Women of Worth (WOW) tree planting ceremony initiating the project.
Gifts of sanitary pads
Gifts of sanitary pads

Our big challenge is recruitment and adherence.   Creativity and innovation are key words for the team and finding the right approach to engage with diverse groups in age and language.    Finance is also an issue.   This is the ‘real’ generation who want to touch, feel and know before making a commitment.

Recruiting
Recruiting

I want to acknowledge the perseverance and commitment of the fantastic Zimele Team.   This project was never going to be easy, to reach 20 000 young people is a mammoth task – but this team is amazing, every single member.   They are determined, and we are confident that we will achieve our goal.    #zimeleteamrocks

 

 

 

 


J52 Clinical Trials’ Unit – Drs Precious Garnett & Yashna Singh

A highlight at J52 this quarter has been exploring healing beyond the biomedical approach. Last year we started an adolescent support group for the young adults in our research studies who are perinatally HIV infected. We wanted to provide a safe space to help them explore their feelings, share their experiences, and support one another. The purpose was to enable them to cope with the burden of having to take medications every day for the rest of their lives. Many of them struggle with anger towards their parents and themselves, around this illness.

A challenge has been to bring parents on board when problems have been identified with individual adolescents and bring about harmony in the family, this is difficult bearing in mind they were perinatally infected with HIV and adolescents can be a challenge purely because they are adolescents.   We try innovative ways to discuss difficult topics with them, yet also allowing them to express themselves.

Yoga with Yashna
Yoga with Dr. Yashna Singh

We are exploring some fun interventions to facilitate emotional/ psychological healing and sense of self-worth.  Dr. Yashna Singh is also a yoga teacher and she facilitated a yoga session at the Scout Hall in Gugulethu.  This was fun for the adolescents and also our support staff,  Nontle Madinga and Nobafundi Dondolo their ‘research mamas’.   On the last day of the school term( 30 June 2017), we are planning a Music and Dance therapy session with an acclaimed musician who is giving his time and expertise free of charge – (big thanks for that).   A camp is also planned for the end of the year, although we do need more adolescents to make a bigger group in order to book this.

 

 


G.R.O. celebrates 1st Anniversary

The Gugulethu Research Office is one year old!    The staff operates out of a group of containers on land next to the Scout Hall adjacent to Hannan Crusaid Treatment Centre.   The site houses Prof Catherine Orrell’s  antiretroviral adherence community-based research.   Three adherence studies are currently under way – the META study, Add-ART and the Treatment Ambassador Team programme. The META (Measuring Early Treatment Adherence) team was delighted to move to the new premises as they have been working out of a single room at the JL Zwane Church.

Lihle Mvumbi with Drs Cathy Kalombo and Anna Cross
Lihle Mvumbi with Drs Cathy Kalombo and Anna Cross

We enjoy a close partnership with Provincial staff at Hannan Crusaid.    After a year of planning and red tape, we have finally managed to renovate their reception area.    Prior to the renovation, the patient folders were in a stackable shelving system that only one clerk could access at a time.   We have extended the filing area into the boardroom and put in an open shelving system.   This outcome has been easier access for staff and shorter waiting periods for patients.

The Province staff are very grateful for our help as Shahida Jacobs commented:

Thank you to all who have been involved in initiating and getting the renovations complete. The area looks good with enough space for folders and movement of staff.  We look forward to getting the folders in boxes (currently in kitchen, reception, and boardroom) back onto the shelves soon. Thank you once again to the DT team for your ongoing support .”

 

 


Girl Power – Laura Myers

Girl Power
Girl Power

As the Girl Power study moves into its final stage, participants at Crossroads 2 Community Health Clinic are starting to complete the empowerment programme.   Led by outstanding facilitators, the programme consisted of 12 creative sessions that focused on goal-setting, relationship communication, contraception, HIV prevention, gender-based violence, and employment and financial skills in order to help young women make good choices about their health, feel empowered in their relationships and confident to achieve their goals.  Participants have really enjoyed the final session, where they become ‘Queens for the day’ as they reflect on the journey they’ve been on during their year in Girl Power, take time to affirm each other, and finish feeling a greater sense of how to harness their own ‘girl power’ in the future.  Participants who attended the most sessions receive a certificate and a menstrual cup in recognition of their commitment.

 

 


DTHF Youth Centre:  Youth Day 16th June – Khanyiselo Silo

The theme for Youth Day 2017 was “ROAD TO WELLBEING”.  The Youth Centre organized soccer and netball tournaments and collaborated with six other organizations in the area, showcasing what each offer to youth.    There were talks on health followed by singing and dancing performances and, of course, prizes.   It was a most successful day of celebration and fun for the youth of Masi.

 

 

Musa Sokomane is an intern at the Youth Centre, “The Youth Day event was a very important event for me, I was able to have fun, learn how to lead my peers and this was made possible by the Youth Centre. I have learned so much and I now have an idea of the challenges our Youth face.

Sbulele Mpahlwa, Msawenkosi Sokomane and Anele Ngqokwe show off the gifts
Sbulele Mpahlwa, Msawenkosi Sokomane, and Anele Ngqokwe show off the gifts

The Youth Centre is blessed with supporters committed to improving the lives of youth in Masiphumelele and Ocean View. JP Skinner, a South African now living in Holland and his wife, Renate Vink are among these. They founded an NPO, Support Orphans in South Africa and have visited the Youth Centre a number of times – always laden with gifts of stationery, etc.

In 2014 with support from JP, Shayne Rookhuyzen rode his bike from Cairo to Cape Town, right to the Youth Centre where he received a thunderous drumming welcome – a distance of 11 000ks. He raised over R400 000 for three orphanages and the YC. JP and Renate’s generosity and caring continues and they have sent another generous donation of gift vouchers to purchase games and goodies for our youth. The shopping spree was linked to Youth Day – so there was much to celebrate on 16th June.   Thank you, JP and Renate we deeply appreciate your support and caring.

and…..

DTHF launched into CROWDFUNDING for the Women of Worth (WOW) project.    We want to enhance the benefits of the monthly modules of this programme; to do this we need more money.   Thanks to Amy Wilmot, who is always ready for a challenge, we embarked on a crowdfunding campaign through Thundafund – with a target of R100 000.

Our amazing supporters did us proud and we raised a total of R66 900.   Very special thanks to several major donors who gave particularly generously, and to DTHF staff who also contributed.

MySchool MyVillage MyPlanet

DTHF is a non-profit organisation.   We need to raise money in order to go the extra mile for our communities, and some projects are not funded by research grants and are dependent upon donations from the public.

YOU, your friends and family can help at no costSign up for a My Village card and shop at Woolworths and other stores linked to the system and with every purchase and swipe of your My Village card – that store will put money into our account.

In two months we have raised R348.88!    We have 38 card holders supporting the DTHF through My Village – thanks to each one of you!   Imagine how much more money we can raise if more of our friends and family participated.   You may not always shop at Woollies, but even occasional purchases will help.  Click on the link to get a form.


 

Employees of the quarter (April – June)
Employees of the quarter (April – June)

 Tracey Swinerd (nominated by Katherine Gill):

Tracey is the kind of person who gets on with things. There is work that needs to be done and she does it quickly and efficiently with zero drama. Tracey graciously stepped in to help the Masi finance team during a difficult period – this means lots of hours of extra work at night and over weekends but she cheerfully and efficiently rose to the challenge. You embrace the value of progress .

Thank you Tracey ! We honour you for your reliability and for helping us when we needed you.

Value – Progress

Asavela Sodinga (nominated by Prof Linda-Gail Bekker and Philip Smith):

I asked Phil to send this to me after he called out your excellent work at an Ops meeting – this is so that I can personally thank you for your role in the hand over and your professionalism in your duties.

Well done!  And a huge thank you –

warmest wishes

Linda-Gail

To Linda-Gail from Philip Smith:  As requested, just a note to draw your attention to Asavela and her above and beyond efforts ensuring that TT staff were supported, even though she had moved to her new project, and for ensuring a smooth transition-in for the new CNP leading the team.

It is just a delight when colleagues assist and go the extra mile for one another!

Values – Excellence and Passion

Phyllisity Smith (nominated by Christie Heiberg):

Murphy has done an amazing job of keeping everything together while there were tsunami waves of change around her.  She manages the blood room and the flow of the participants through the clinic as well as overseeing all the study procedures.  She is the go-to, the memory, the one with the answers.  And she does it all with grace, humility, friendliness, excellence and a precious smile.

Murphy has been working with a number of new staff members, showing them the ropes and passing on her extensive knowledge of everything about and everyone on our studies, with passion and genuine care.   Murphy, thank you for all you do, every single bit of it!

Value – Excellence

Philosophy Brave Bangira (nominated by Nehemiah Simango):

Brave is always up for new challenges and works very hard in the community to make sure all safe space members are updated about all events and the studies we are running. He is always in the office on time and leaves the office after he has done his ‘’do to list’’ for the day.

Value – Integrity, Respect, Excellence

Prashnathan Naidoo (nominated by Karen Brooks):

Prash really enjoys solving the users problems and has contributed immensely to IT’s success in becoming a division that is there to assist all projects in making sure their systems work. He has a good, easy going manner, has great integrity and solves problems very quickly. A true asset to our organisation!

Values – Passion, Respect, Excellence

Edgar October (nominated by Karen Dominquez and Christie Heiberg):

Edgar is amazing!  He has been so helpful in accommodating our extra driving requests and always does so with a smiling face.  No matter what, we can trust him to do what needs to be done, and know that it

will be done with excellence and passion!!!  We truly appreciate his willingness to assist us with our ever increasing demands.

Values – Excellence and Passion

Nicola Kelly (nominated by Nomakhaya April):

Nicola Kelly is a very innovative, responsible worker. She is a team builder and a leader that respects her juniors as much as her seniors. She is always willing to put in extra effort and hours to achieve her work goals without expecting any rewards.   She always encourages her employees to achieve the best and do the best. She sympathizes with staff on personal matters and always offers psychological support when needed.

I believe that she deserves to be recognized for her dedication to serve at DTHF and I appreciate her as my line manager.

Values – Innovation and respect

Amelia Cordelia Mfiki (nominated by Brave Bangira):

Amelia has been great since she joined the Key Population’s Division especially on recruitment strategies.   Some of the changes that she has made within the Foundation are as follows:

She has connected the Key Pops Division with all the stake holders around Cape Town by holding a community stakeholders meeting. The whole idea was for us to reach out to every part of the community and present the clinical trials studies that the GSH CTU is undertaking. The Key Population is now well known by everyone in the community not just the msm community. She also came up with the idea of having meetings with all the organisations that are working with msm. This will help in planning our community engagement events so our events do not clash since we are working in the same communities.

We never knew the purpose of the CAB since it was created but now since she is involved there has been a change. CAB members are now visible in the recruitment and retention activities. She is so focused and multitasking on everything that she does.  Also very good on communication, always available when she is needed even when she is working in the community you will never notice that she is not in the office. Lastly she is a good team leader.

She has restructured the CAB as well as strengthened the recruitment and retention strategies.

Value – Innovation

Angela Mpekula (nominated by Dr Baningi Mkhize):

Ms Mpekula joined the Emavundleni Research Centre as a Regulatory Assistant in November 2016. At the time the Regulatory Affairs Manager had just resigned and the permanent Regulatory Assistant was on maternity leave. Although she had never done any regulatory work in the past, she single-handedly managed the Regulatory Section with incredible efficiency.  She had all the necessary protocol submissions to the Ethics Committee and the Medicines Control Council done on time for most of the first few months of 2017. She works until late when she is chasing a target.  She is a great team player, has a pleasant personality and will go an extra mile to assist other staff members.

All the DTHF values resonate with Ms Mpekula, but the one that most resonates with her is PASSION.

Value – Passion

Laura Myers (nominated by Katherine Gill):

Laura has been nominated by Masi because of her PASSION and INNOVATION for communications. The team at Masi often feel quite isolated and far from the other Sites. Laura has made a big effort to include us in the Friday lunch time presentations. This spirit of inclusiveness and innovation and determination to reach as many of the teams as possible is appreciated.

Thanks Laura !

Values – Passion and Innovation

Angela Wood (nominated by Giuseppe Degouveia)

Angela goes above the call of duty by finding innovative ways to solve problems that have otherwise been insoluble by other staff members, e.g. CRS staff member travel subsistence and ticket had not been reimbursed three months post date of travel.   Angela got involved although not really her role and canvassed, chased, and physically tracked the issue surrounding the non-payment.   She solved the problem and put real time documents and processes in place to avoid this happening again.

Values – Passion and Innovation

Zanyiwe Mavubengwana (nominated by Keshani Naidoo):

Zanyiwe works as a community outreach worker, she also works in the youth centre in her spare time. She had identified that the young adolescents have issues with getting pads and had reached out to the community, staff, and on Facebook to initiate a pads drive.

She also has classes that she holds in the community for the growth of her community. She facilitates the daily functioning at the site and goes the extra mile at a drop of a hat.

Values: Passion: She has a passion to forward the lives of others

Innovation: She took the initiative to do a PAD campaign to make a change for young women.

Excellence: She is striving for excellence in all that she does

Progress: She is completing her matric so she can grow and develop

Respect: She has respect for those she works for and those around her

Integrity: She has integrity in her work.


Some colleagues are leaving us, we thank them for their contribution to our work:

Carmenita Braaf Tamrin Dyers Linda Mqikela Sadieka Najaar
Nthoesele Letoao Karen Dominguez Mandy Novis Gavin Manuels

We welcome the following colleagues to the DTHF family:

Anele Gqwetu Yonela Booi Nadia Ahmed Julie-Ann Coombs
Lauren Fynn Thando Wonxie Vuyokazi Matiwana Yonela Booi
Busisiwe Nomnga Nomthandazo Ngaziwa Phindiwe Yenana Ruth Gona
Angelina Lingani-Ngubu Tarrin Petersen Mfundo Habasisa  Nokwazi Tsawe
Ngcwalisa Jama Menna Duvyer Catherina van der Post Aletha van der Post
Robin Julies Nangamso Ngcuka Anelisiwe Ngcuka Candice Lee Beukes
Farhaanah Fortune Khayakazi Ddzebedzeze Prisca Vundhla Athini Golinah
Sabo Dlelengana Nonela Mdutyana Portia Klaas Prashanthan Naidoo
Siphesile Mlokoti Thandokazi Mhambi Yonela Galada

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KGIS Project Coordinator

Apply for the Adolescent Health Training Program

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The Desmond Tutu HIV Foundation invites staff of governmental & non-governmental organizations working at national, provincial & district levels to the Adolescent & Youth Health Policy Short-Course. The short course for health training takes place from the 11-15 September 2017 at The President Hotel in Cape Town, South Africa.

The short-course will involve a five-day residential taught portion including site visits and an assignment to be completed within three months after the end of the taught portion. Upon completion of both components, CPD points and a certificate of course completion will be issued. This short-course has been developed to support the implementation of the new Adolescent & Youth Health Policy 2017 policies.

The application deadline is 7th August 2017 – 00:00

APPLICATIONS OPEN TO:

-People managing the A&YHP
-Managers who have “adolescents” in their job description
-Senior staff in Regional Training Centers designing training programmes
-Researchers/academics

FEES

-The fee for the programme is 2,000 ZAR covering participation in the programme, materials and refreshments during the 5 days.
-It does not include travel costs or accommodation.

TO APPLY

The application form is in the link below and includes extra information on the course. Email a completed form to Adol.ShortCourse@hiv-research.org.za

Application Form

Adolescent Course Leaflet

FOR FURTHER INQUIRIES EMAIL: Adol.ShortCourse@hiv-research.org.za

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Dr Linda-Gail Bekker opens the International AIDS Society Conference

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The IAS2017 conference in Paris highlighted the achievements we have made internationally to eradicate AIDS but also emphasized that we need to roll up our sleeves and maintain momentum. Nearly 8000 researchers, advocates and policy makers demonstrated how the science that comes out of places like the Desmond Tutu HIV Foundation can be turned into policies.

Globally, 36.7 million people were living with HIV in 2016. 19.5 million of those people were accessing antiretroviral therapy (ART). (1) AIDS deaths are almost half what they were in 2005 thanks to the research, interventions and treatment over the years. However, with over 17 million HIV-positive people not accessing ARTs, there is still more to do.

Our Deputy Director and International AIDS Symposium President Linda-Gail Bekker opened IAS2017.

Dr Linda-Gail Bekker at IAS2017

 

Bekker commented during the speech that “New prevention options are helping us really move forward to reducing transmission,” and the latest prevention tools were generating a lot of buzz.

The HIV prevention pill, PreExposure Prophylaxis or PrEP, has been tested for the first time in adolescents in an African context and found to be safe over a twelve month program. These findings were presented by Katherine Gill, who researched this in the ‘PlusPills‘ study at DTHF, and show promise that with focused and funded intervention, the drug Truvada (PrEP) can prevent new HIV infections.

Katherine Gill presenting at IAS 2017 | Roger Peabody, AIDSmap

Additionally, the results from a short-term immunisation trial were well-received. The immunisation is achieved from a drip that contains an infusion of HIV antibodies. There is hope that this may lead to an infusion injection every two months instead of a daily HIV prevention pill. Additionally, there may also be a similar, injectable antiretroviral treatment that will be long-lasting and replace daily HIV suppression medication.

Representing DTHF with their research posters were Philip Smith and Millicent Atujuna

Funding was another matter on everyone’s mind. Bekker insisted in her opening speech that cuts to funding would push progress back and must be avoided. The battle is half won and we cannot afford to lose the headway that has been made.

“I think there is certainly room for optimism in our field. We have made great strides….but now is the time to really keep the eye on the target, redouble our efforts and join all our forces to move to a swift, efficient and compassionate point where HIV need no longer be considered a global public health threat.”

 

References

(1) IAS fact sheet.

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Community Sandwiches For Mandela Day

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“It is in your hands to make of the world a better place.” This quote by Nelson Mandela encapsulates the feeling of Mandela Day. Commemorating his birthday, everyone is encouraged to celebrate by taking some action against poverty and serving the public for 67 minutes in some way.

The Desmond Tutu HIV foundation took this message to heart, and what better way to the heart than the stomach? Employees donated loaves of bread, peanut butter and jam and made trays of sandwiches to go out with the rainbow-coloured Tutu Tester to be distributed in the communities.

For 67 minutes, one minute for each year Mandela’s public service, the DTHF staff made and distributed sandwiches. The Tutu Truck then could take trays into the community where they offer free healthcare, including HIV testing, STI checkups, counselling, family planning, blood pressure and much more. If people in the community were interested, they can pop in. Feeding others is a wonderful way to bring communities together.

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Reaching Cape Town Men and the World

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It was a delight to have a two-for-one research meeting with Ndumiso Madubela and Caroline Reid. Madubela discussed his PhD research outline looking at how men in high HIV burden communities engage with their local health services. Reid discussed her master’s research in science journalism and outlined the popular science journalism process.

Caroline Reid and Ndumiso Madubela | Laura Myers

Women bear a greater burden of HIV than men, but males are still a crucial audience to target when preventing the spread of HIV. Madubela introduced his PhD topic, which aims to analyse what barriers Capetonian men face when seeking sexual reproductive health services. The goal is to use this research to inform community interventions that may be implemented in future trials.

The motivation for this research came from the opinions of young men in the community who feel that health services are sometimes too daunting for males to engage with. Madubela’s project aims to engage around 500 men in high HIV burden areas where clinic visits from males are sub-optimal. He intends to identify what deters young men from seeking HIV testing and treatment, and how to improve levels of male attendance in clinics. These questions will be answered by using a range of methods, including focus groups, in-depth interviews and questionnaires. These community dialogues, which have already begun, question the men on topics such as health service use, knowledge of STIs and specifically HIV, and recent sexual encounters.

This slide shows the substantial differences in HIV prevalence between young women and men aged years and highlights the vulnerability of young women. Source: UNAIDS 2014.

The first community dialogue was a great success, with around sixty attendants from a variety of ages. The data gathered from this programme will help identify problems and steer the direction of future community dialogues, and eventually, successful intervention models.

 

Reid discussed her pilot study in the use of expert quotes in popular science journalism on the internet and identified ways that researchers can get their voices heard on the digital sphere. She commented that the internet has reinvented the way that journalists approach their art: with benefits such as increased resources and access to experts, but also with difficulties such as tighter deadlines. The research focus was on press releases on scientific research, which are identified as a popular source for news stories for journalists, and how the expert quotes in these press releases are used elsewhere.

Additionally, she had some tips for researchers on ways they can ensure their research results are seen: starting a personal blog or a blog collectively as a research group and to have some graphics for each paper coming out. These could be photographs of relevant images or easy-to-read graphs or infographics; these images are gems that may get your results noticed by journalists.

Tips for Articles Tips when Interviewing
  • Contact your Press Officer when your research paper is accepted by a journal
  • Include graphics/photos with your press release
  • Be available for interview a few weeks before your paper is published
  • Find reporters you trust
  • Start a blog – alone or with your department
  • Think before you speak
  • Answer questions within your comfort zone
  • Try summarising what you have done and why its important in three sentences
  • Don’t feel pressure to fill the silence – often reporters are quiet because they are jotting down notes

We thank both our speakers for their engaging presentations and wish them good luck for their future research endeavours!

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Researchers Present at IAS 2017

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The International AIDS Symposium (IAS) Conference 2017 was a wealth of cutting edge research and discussion on HIV and AIDS, and the representatives from the Desmond Tutu HIV Foundation (DTHF) were no exception.

 

Linda-Gail Bekker at IAS 2017 | IAS Steve Forrest Workers Photos

Opening the conference was our own Prof Linda-Gail Bekker, the IAS President and International Scientific Chair of IAS 2017. Bekker spoke about the need to maintain levels of funding to continue the fight against HIV, as now it is critical to keep up momentum for all the progress that has been made.

Much of that progress is ongoing at DTHF, with researchers looking at all areas of the disease, from virological to social. HIV is a complex virus to combat and the variety of the research presented is testament to the importance of funding.

 

Katherine Gill presenting at IAS 2017 | Roger Peabody, AIDSmap

Dr Katherine Gill presented the results of the Plus Pills study, where Prof Bekker was principal investigator. This study is an evaluation of how South African adolescents between 15-19 respond to a daily pill of PrEP (Truvada) as part of their HIV prevention toolbox. Around 150 Capetonian and Sowetan adolescents who were already sexually active and at risk of HIV infection signed up for the study.

 During the study, the number of STIs overall in the cohort decreased and there was one incident of HIV. However, this participant opted out of the study prior to diagnosis. It has been noted for studies of this nature worldwide that adolescents find it difficult to adhere to a daily dose of PrEP. This age range needs tailored adherence support with scheduled clinic visits, or a new method that requires less-frequent dosing.

 

A Vaginal Ring | International Partnership for Microbicides

Continuing the topic of HIV prevention was Lulu Nair, who presented the rationale for a PrEP and dapivirine vaginal  ring study among  young African women aged 16-21 years (The REACH study). The  vaginal ring releases an antiretroviral over a period of one month. Young women are especially vulnerable to HIV because of economic, social and behavioural factors which make behaviour dependent methods such as condom use difficult.   In addition, there is limited access to youth friendly health services were staff is non-judgmental with respect to adolescent sexual behaviour. While injectable prevention methods and a vaccine hold promise for the future, the REACH Study will investigate the safety and acceptability of the only 2 currently proven HIV prevention methods. It will also provide information on preference for PrEP or the vaginal ring when there is an option to choose.

 The REACH study will enrol 300 female participants and offer them a combination of the vaginal ring and PrEP. These data will be essential for future roll out of the preventative products, but also to find out if regulations should be expanded to include girls under 18 years old.
Lulu Nair at a panel at IAS 2017 | DTHF

Dr Millicent Atujuna presented her research on how family household structures can affect whether adolescents take the HIV-prevention drug, PrEP. Youth are a key population that are vulnerable to unique barriers when accessing HIV prevention tools, including prejudices at home. The study, that took place in Cape Town, South Africa, questions 50 participants who were HIV negative and sexually active to explore what sorts of familial support are available.

Three main types of family support structure were found: the close-knit family who actively support their children’s prevention choices, the loose-knit family who gave no support and the family that gave passive support. The majority of the adolescents had disclosed their PrEP usage to the family, but over a quarter had kept it a secret. Atujuna commented that “In general, we found support to be fundamental to PrEP use; however, family support empowered youth more than partner support, highlighting its important role in the adoption of HIV prevention behaviors.”  Youth from close-knit families had greater agency (ability to negotiate safe sex, more defined future aspirations and placed a higher value on remaining HIV free). Whereas youth from loose knit families demonstrated less ability to negotiate safe sex, although they tended to seek more partner support for product use. 

Millicent Atujuna at IAS 2017

Another project presented by Atujuna was the results from a prototype questionnaire for women about their PrEP-use. The process took a questionnaire and examined how participants understood the questions, how the translations between English and isiXhosa were understood and how to frame questions for good-quality data. In order to have reliable data to analyse, the team needs reliable questions; this paper ensures that when the large-scale studies begin they will gather the best quality data.

 

Phillip Smith presents a poster ar IAS 2017 | DTHF

Also presenting a poster was Phillip Smith, whose research looked at the suitability of a web-based form where participants can watch a video and decide if they want to order an HIV test. The majority of South Africans who are HIV positive are unaware of it, which means they can’t actively seek treatment. HIV self-testing has been shown to be a feasible method to reach some of this population and increase access to care.

Of 200 participants who took the questionnaire, three quarters of them decided to order a home-based HIV test. The majority of the participants who used the delivery service felt it was a more positive experience than going to a clinic and it was rated 4.7 out of 5. 

 

Another poster of research was displayed by Rebecca Marcus, who has been researching the impact of offering HIV testing and other healthcare services at the DTHF Youth Centre. Adolescents are a key population for new HIV infections and statistically are less likely to seek healthcare in a clinical setting. Young women incur around 2000 new HIV infections a week (2) and 25% of young women have had a pregnancy by 19 (1). There is clearly a need to target this age group which is why the Youth Centre began offering adolescent-focused health services.

Katherine Gill, Giuseppe De Gouveia, Rebecca Marcas, Phillip Smith (Left to right) at IAS 2017 | DTHF

When comparing the number of adolescents using the Youth Centre health clinic to the City of Cape Town clinic, the Youth Centre had a higher number of adolescents using their services. Not only does this imply that youth are more likely to use services if they are geared towards them, but they are also more likely to test for HIV, particularly in young men. This is why adolescent-friendly services, like the Youth Centre, are necessary for the prevention and treatment of HIV. The next stage of this research will be to discover the factors around why adolescents are reluctant to test for HIV with an aim to creating youth-friendly spaces elsewhere.

 

We want to offer our congratulations to all the presenters, as well as the many many other researchers who worked for these incredible results. There is so much that happens at DTHF that it is difficult to cram it all into one conference!

References

1. Shisana et al South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. In. Cape Town; 2014

2. G Mchunu et al. Adolescent pregnancy and associated factors in South African Youth.

The post Researchers Present at IAS 2017 appeared first on Desmond Tutu HIV Foundation.

Why do Some Children Struggle to Adhere to HIV Treatment?

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This week, we were fortunate to have a visit from Sabine Van Elsland from the Desmond and Leah Tutu Legacy Foundation and VU University, who spoke about her research involving HIV positive children and how they respond to HIV treatment. Getting antiretroviral therapy (ART) to youths is one challenge, however, that is only the first challenge to overcome. An HIV positive person has to take daily medication to suppress the virus; Van Elsland’s research has studied why children succeed or fail in adhering to their ART regimen.

Sabine Van Elsland | Caroline Reid

HIV positive South Africans make up nearly a fifth of the global HIV population. With this burden, there is a high emphasis on successful treatment including access to treatment as well as adherence to treatment. Adherence to the daily ART regimen suppresses the virus. Good ART adherence is essential to reduce transmission and eradicating the virus.

Van Elsland’s research followed just under 200 children and their respective guardians in intervals of thirty days over the course of 1 full year, with a 6 month follow-up period. The mean age of the patients was eight years and around two thirds had an undetectable viral load. Based on pill count, 20-54% of the children were adherent to their treatment.

High levels of adherence were found for families where the disease had a prominent effect on life (school functioning affected, complications and high WHO clinical staging). In addition, children with a high quality of life, from well-functioning households and families with a better socio-economic status were more likely to adhere to treatment, including access to amenities such as a TV, a fridge or a bicycle.

Low levels of adherence were found in families with difficult family relationships, caregivers who experience difficulties administering medication and families who did not disclose the HIV status to the child. Important were the differences found in determinants of adherence between boys and girls and in particular the differences between adherence behavior (based on pill counts) and reported adherence (self-report). These data are useful indicators for future research into how to ensure successful adherence.

Analysing when adherence was successful is as important as when it is unsuccessful. Patients who did not have perfect adherence had a variety of reasons: mix-ups when different caregivers were responsible for the child, side-effects, the taste, running out of pills and simply forgetting.

Ultimately, the goal is to find ways of connecting healthcare systems with community based care (including faith networks and other structures in these communities). This way, support can be sustained for children taking ARTs outside of a clinical setting.

We thank Van Elsland for her fascinating and insightful presentation. We wish her the best of luck with her future research endeavours.

 

Written by Caroline Reid

The post Why do Some Children Struggle to Adhere to HIV Treatment? appeared first on Desmond Tutu HIV Foundation.

More Prevention Action Needed for MSM – The Sibanye Study

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Men who have sex with men (MSM) are a population at high risk of HIV infection. In order to end HIV, we need targeted prevention strategies for this key population and the Sibanye study has been researching just that.

The Sibanye study recorded the uptake of a package of HIV prevention tools in MSM in sites around South Africa over the course of a year. The offered tools and services included HIV testing, counselling, condom and lubricant choices, treatment for STIs, PrEP, PEP and more. The project finished in 2016 and whilst data analysis is ongoing, there are fascinating results coming out.

Karen Dominguez, from the Desmond Tutu HIV Foundation who worked on the Sibanye study, summarised that just under half the participants (male at birth but with any gender identity) had HIV, which is a very high figure. Additionally, around half of the HIV positive participants already knew their status but the rest were newly diagnosed. Additionally, around half the candidates had a sexually transmitted infection (STI) although only a very small portion had any symptoms. Nine times more participants had an asymptomatic (symptomless) STI than participants who knew their status.

STIs are rampant in South Africa, especially STIs that have no symptoms. A different study of 600 rural women showed that 25% of them were diagnosed with an STI and in most of these cases there were no symptoms. These studies indicate a need for awareness campaigns and an increase in targeted treatment and prevention.

Whilst these data show that MSM are still a high-risk group for STIs, the cohort was also enthusiastic about prevention methods. Over the course of the study, over 90,000 condoms were distributed to participants. Flavoured condoms were preferred to plain, which was indicated in questionnaires and supported by condom uptake. Interest in PrEP was high, with most of the patients that began a course of PrEP adhering to the drug.

MSM are a key population at unbelievable risk of HIV and STIs, which these data confirm. The Sibanye study highlights that there is still need for targeted prevention and active care interventions. It also demonstrates that MSM are interested in using PrEP and targeting this key population for PrEP is feasible.

 

Linda Gail Bekker (left) and Karen Dominguez | Caroline Reid

This research meeting we were fortunate to have Karen Dominguez and Prof Linda-Gail Bekker speaking on their respective research projects. Dominguez spoke about the Sibanye study, which evaluated how men who have sex with men (MSM) respond to different HIV interventions. Bekker summarised the latest research around the HIV prevention drug, Pre Exposure Prophylaxis or PrEP, including busting common myths or misconceptions about the drug.

 

Written by Caroline Reid

 

The post More Prevention Action Needed for MSM – The Sibanye Study appeared first on Desmond Tutu HIV Foundation.

Busting Myths about PrEP

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 PrEP is an everyday pill that an HIV negative person can take to prevent getting HIV. Consistent use is essential for protection. Since PrEP is still a relatively new advancement in HIV prevention technology, there are still a lot of concerns and misconceptions around it. Fortunately, there has been a flurry of research in the drug and Prof Linda-Gail Bekker, COO of the Desmond Tutu HIV Foundation, aims to dispel some common myths and concerns around it.

Oral polio vaccination in Begoua | HDPTCAR
Oral polio vaccination in Begoua | HDPTCAR
  • PrEP while Pregnant, Lactating and Breastfeeding

HIV positive people can now live full lives, which includes having HIV negative children. There have been concerns about HIV transmission from mother to infant, however, the research is indicating that taking PrEP during all stages of mother to infant contact is safe.

PrEP is advised during conception when there is a high-risk of the mother becoming HIV-positive. Transmission can occur during pregnancy because not everyone tests regularly while pregnant and seroconversion (the period when the HIV antibodies develop and become detectable) takes time. PrEP protects the mother from HIV, and therefore also protects an unborn baby. Additionally, it is difficult for the compound in PrEP (tenofovir) to move into the breast milk and is safe to take while breastfeeding.

Desk calendar | Caroline Reid
  • Time to Protection

The controversy here is how long a patient should take PrEP before they are protected. Some parties believe everyone should wait 21 days, whereas other think a week is sufficient. These data arise from animal studies, and there are models that support the one-week waiting period, but nothing conclusive has been shown in humans yet.

How long does someone need to take PrEP for until they are ready for sexual intercourse? Bekker advised that everyone should wait 21 days, especially if they are trying to get pregnant. This gives the drug the maximum time required to give the highest possible protection. However, a week may be the maximum time some populations will wait; adolescents, for example.  in the case of populations who are less likely to wait (adolescents, for example).  

PREP4Love campaign
PREP4Love campaign
  • ‘Just’ a Medical Intervention?

PrEP is more than just a drug. It’s a sensual product that can bring intimacy back into the bedroom. Instead of a medical intervention, it should be marketed as a lifestyle intervention. It puts women who feel unable to negotiate condom-use back in charge of their sexual health, and it dulls the anxiety of contracting HIV in the bedroom.

The PrEP4Love campaign (below) is a social marketing campaign showing real couples catching desire in the bedroom, safe from the threat of transmitting HIV with the proper use of PrEP. It is campaigns like this that turn PrEP into a tool for intimacy.

Talk PreP Stop HIV | CDC Act Against AIDS
  • Risk Compensation

The tough questions need to be asked: will PrEP-users stop using condoms, putting themselves at risk of other STIs and unwanted pregnancy? Some statistics attribute PrEP use to an increase in STI transmission. However, STIs and condomless sex have existed since before PrEP existed. These studies are starting to closely analyse a problem that has existed for a long time.

PrEP should be considered part of an HIV prevention package. With consistent use, it protects against HIV, but it can’t protect against other STIs and it is not a contraceptive.

Desmond Tutu HIV Foundation | Tyler Golato
Desmond Tutu HIV Foundation | Tyler Golato
  • Cost

 

Bekker summarised that at the moment, a month’s worth of PrEP is predicted to cost R260. This figure doesn’t include HIV tests or doctors fees. This estimate, whilst based on data, is not a ‘real world’ study and is derived from PrEP trials. It is predicted to change as PrEP is rolled out in South Africa.

It must be emphasised that PrEP is not a solution for life: it is a prevention method that one takes when at highest risk of infection.

 

 

Linda Gail Bekker (left) and Karen Dominguez | Caroline Reid
Linda Gail Bekker (left) and Karen Dominguez | Caroline Reid

This research meeting we were fortunate to have Karen Dominguez and Prof Linda-Gail Bekker speaking on their respective research projects. Dominguez spoke about the Sibanye study, which evaluated how men who have sex with men (MSM) respond to different HIV interventions. Bekker summarised the latest research around the HIV prevention drug, Pre Exposure Prophylaxis or PrEP, including busting common myths or misconceptions about the drug.

 

 

Written by Caroline Reid

 

The post Busting Myths about PrEP appeared first on Desmond Tutu HIV Foundation.

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