Over 200 health care workers, academics, and policy makers who participated in the "Realities of ART Roll-Out: Overcoming Challenges to Successful Programmatic Implementation Conference" workshop co-sponsored by the Medical Research Council of South Africa, the Department of Health of KZN and the Nelson Mandela School of Medicine and Harvard University. The workshop was held in Durban, South Africa from October 4th through 7th.
This event was timely and addressed some of the most critical needs facing ART treatment expansion in resource limited settings. The participants were asked to debate the following key challenges: 1) integration of HIV and TB care, 2) facilitating ART access in rural communities, 3) managing treatment complications and 4) increasing the provision of ART to children. This conference resulted in innovative strategies proposed by both local and international delegates to accomplish the goal of universal access to comprehensive HIV care and treatment for all.
Clinical CPD Session
"When to Switch Antiretroviral Therapy: A Case Based Review of Appropriate Regimen Changes Within a Limited Formulary" CPD Session Introduction: Moderator: Henry Sunpath, MBChB, McCord Hospital (Click to Watch) Case Study 1: Panelist: Dan Kuritzkes, MD, Harvard Medical School (Click to Watch) Case Study 2: Panelist: Rajesh Gandhi, MD, Harvard Medical School (Click to Watch) Case Study 3: Panelist: Francois Venter, MCBhB, University of Witwatersrand (Click to Watch) General Questions: Drug Resistance, Drug Toxicity, Switching Options (Click to Watch) Case Study 4: Panelist: Dan Kuritzkes, MD, Harvard Medical School (Click to Watch) Further Case Studies (Click here to watch)
Day 2 (Friday, October 6, 2006)
Reaching Rural Communities and Clinic Down Referral Strategies
Faced with the burden of the HIV epidemic, developing nations are looking for rapid treatment roll-out for infected individuals. There is a need for implementing effective interventions using both the existing resources but also seeking new resources. Health worker shortage is a major issue to scaling up antiretroviral therapy in rural areas. ART distribution through hospitals limits access for many people in South Africa . Greater proximity and accessibility of services in clinics has led to faster enrollment and better retention. Community based settings ease stigma and increase disclosure of HIV status. In addition, provision of ART has shown to have a positive effect on the quality of primary health care. Community buy-in and participation in health care delivery has also shown to benefit the general quality of health services. Significant increases in funding will be essential to improve nurse recruitment and retention. Strategies such as integration, task shifting, and decentralization have been utilized to help spread the workload. Panelist Presentation #1 : Victor Fredlund, MBChB, Mseleni Hospital (Click to Watch) (Powerpoint Slides) Panelist Presentation #2 : Terence Moodley , MBChB, CAPRISA, UKZN (Click to Watch) (Powerpoint Slides) Panelist Presentation #3 : Pierre Barker, MD, University of North Carolina (Click to Watch) (Powerpoint Slides) Panelist Presentation #4 : Mphu Ramatlapeng, MBChB, Clinton Foundation (Click to Watch) (Powerpoint Slides) Panelist Presentation #5 : Hermann Reuter, MBChB, Doctors Without Borders (Click to Watch) (Powerpoint Slides) Panelist Discussion/ Question and Answer Session (Click to watch)
Increasing Access to Pediatric HIV Care and Treatment
It is estimated that approximately 300,000 children are infected with the human immunodeficiency virus (HIV) in South Africa . Since postnatal transmission rates of HIV are high, more education and support services for women on prevention of mother-to-child transmission (PMTCT) will need to be established. One opportunity to address this issue would be to train nursing staff to inform pregnant women and mothers of young infants on PMTCT, infant feeding options, infant diagnosis, and treatment. Establishment and identification of appropriately staffed pediatric diagnosis facilities and family-oriented services at all ART facilities will allow for more infants to enter care through early diagnosis. In addition, a multidisciplinary approach will need to be developed to deal with the psychosocial issues affecting children who are dealing with disclosure of their HIV infection status or losing their parents to the virus. A Department of Health appointed expert advisory team will be needed for regular updating of guidelines to meet the changing requirements of the pediatric epidemic. Moderator Introduction : Mark Kline, MD, Baylor College of Medicine (Click to Watch) Panelist Presentation #1 : Tammy Meyers, MBChB, Baragwanath Hospital (Click to Watch) (Powerpoint Slides) Panelist Presentation #2 : Glenda Gray, MBChB, Baragwanath Hospital (Click to Watch) (Powerpoint Slides) Panelist Presentation #3 : Kimesh Naidoo, MBChB, Grey's Hospital (Click to Watch) (Powerpoint Slides) Panelist Presentation #4 : Tshi Neluheni, MBBCh, EGPAF SA (Click to Watch) (Powerpoint Slides) Panelist Discussion/ Question and Answer Session (Click to Watch)
Treatment Complications: Overcoming Management Challenges and Promoting Pharmacovigilance
The WHO defines pharmacovigilance as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem. The responsibility of pharmacovigilance regarding ARTs needs to be recognized and shared between patients, medical practitioners, regulators, manufacturers, and researchers. Health practitioners face a therapeutic challenge because every patient is unique. Therefore, practitioners need to be aware of the signals that are causing adverse effects, investigate for follow-up, report up the line, and communicate concerns or alerts. Policies need to be in place to promote pharmacovigilance with education and training, coordinate research functions and processes, and communicate with the local government and the national bodies. Management challenges can be overcome by adopting the down referral model to make programs sustainable and to more effectively use nurse practitioners to manage patients. With the current uncertainties surrounding clinical and CD4 criteria to identify treatment failure, viral load measurement would be the ideal tool to ease the up-referrals. Moderator Introduction : Sandra Lehrman, MD, National Institutes of Health (Click to Watch) Panelist Presentation #1 : Des Martin, MBChB, University of Pretoria (Click to Watch) (Powerpoint Slides) Panelist Presentation #2 : Mariam Cassimjee, KZN Pharmaceutical Services (Click to Watch) (Powerpoint Slides) Panelist Discussion/ Question and Answer Session (Click to Watch)
Small Group Feedback Session: Translating Challenges Into Research Priorities Moderator Introduction : Professor Gita Ramjee, Medical Research Council (Click to Watch) Rapporteur Presentation #1 : Bhargavi Rao (Click to Watch) Rapporteur Presentation #2 : Ouzama Nicholson (Click to Watch) Rapporteur Presentation #3 : Celicia Serenata (Click to Watch) Rapporteur Presentation #4 : Krista Dong (Click to Watch)
Day 3 (Saturday, October 7, 2006)
Integrating HIV/TB Treatment
Areas of sub-Saharan Africa with a high prevalence of HIV are experiencing the added burden of drug-resistant tuberculosis (TB). Lack of advanced laboratory capacity and public health infrastructure is responsible for the limited surveillance in South Africa . In order to address this issue there is a need for age-specific interventions in population TB control. TB and HIV are intimately linked and evidence suggests that treating both conditions simultaneously is beneficial but complex. Hence, measures need to be taken to screen for TB during voluntary counseling and testing (VCT) for HIV. In addition, TB diagnosis can be used as an entry to ART and can include ART and TB prescription integration. In order to have effective TB/HIV collaborations the following will be need to be established: comprehensiveness, continuity, competence, compassion, and cost effectiveness. In addition, policy changes need to be in place for TB staff training and awareness, TB transmission prevention, and patient confidentiality. Many models of HIV/TB collaboration are needed to fit the vast needs of each community, region, and country. Panelist Presentation #1 : Dr. Robin Wood, University of Cape Town (Click to Watch) (Powerpoint Slides) Panelist Presentation #2 : Chris Jack, MBChB, Specialist Physician, KZN (Click to Watch) (Powerpoint Slides) Moderator Presentation : Charles Wells, MD, US CDC (Click to Watch) (Powerpoint Slides) Panelist Discussion/ Question and Answer Session (Click to Watch)
Addressing Health Worker Care and Treatment
Successful rollout of ART is challenging in countries with a high prevalence of HIV/AIDS especially where there are deficits in human resources. Many HIV positive health care workers experience burnout, struggle with stigma, and inability to access early care and treatment. Hospitals need to provide convenient, confidential, and holistic care for health care workers who are HIV infected. Health departments and institutions need to collect information anonymously on HIV/AIDS prevalence, morbidity, and mortality among their staff. In addition, strategies to prevent TB need to be put in place (ventilation, UV lights, N-95 masks). Provision of HIV care and treatment for health care workers needs to be addressed if universal access to ART goal is to be met. Moderator Introduction : Helga Holst, MD, McCord Hospital (Click to Watch) Panelist Presentation #1 : Kerry Uebel, MBChB, McCord Hospital (Click to Watch) (Powerpoint Slides) Panelist Presentation #2 : Victor Fredlund, MBChB, Mseleni Hospital (Click to Watch) (Powerpoint Slides) Panelist Presentation #3 : Ava Avalos, MD, Tshedisa Institute, Botswana (Click to Watch) (Powerpoint Slides) Panelist Discussion/ Question and Answer Session (Click to Watch)
Small Group Feedback Session: Translating Challenges Into Research Priorities Rapporteur Presentation #1 : (Click to Watch) Rapporteur Presentation #2 :Celicia Serenata, MD (Click to Watch) Rapporteur Presentation #3 : Lisa Hirschhorn, MD (Click to Watch) Rapporteur Presentation #4 : Krista Dong, MD (Click to Watch)
