EVIDENCE FROM NEW OPERATIONS RESEARCH GUIDES HIV
PROGRAMME SCALE-UP IN RESOURCE-LIMITED SETTINGS
Health Systems Strengthening and Overlapping TB/HIV Epidemics
Among Major Issues Addressed
(22 July 2009 - Cape Town, South Africa) - Studies presented in the new operations research track at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention this week offered new evidence of how to increase the effectiveness and efficiency of HIV prevention and treatment scale-up, while demonstrating that HIV programmes are strengthening health systems in low-income countries.
Scientists, implementers, clinicians and community leaders participating in the meeting heard new data on such topics as when to initiate antiretroviral therapy (ART), how best to monitor patients, and ways to expand access to HIV testing. Research also addressed strategies for implementing adult male circumcision and prevention of mother-to-child transmission programmes.
"On-the-ground research presented this week provides compelling data to help guide treatment decisions, resource allocation and implementation policies," said IAS President Dr. Julio Montaner, who is IAS 2009 Chair and Director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada. "Scientific advances in HIV treatment and prevention are of little benefit unless we can apply them to saving the lives of those most affected."
"There is emerging operational evidence that HIV scale-up represents a unique opportunity to strengthen health systems," said IAS 2009 Local Co-Chair Dr. Hoosen (Jerry) Coovadia who is Chairman of Dira Sengwe and Scientific Director of the Doris Duke Medical Research Institute at the University of KwaZulu-Natal in Durban. "The AIDS response is a model of how programmes that provide care and treatment for a specific disease can in turn generate a health care infrastructure in communities struggling to address a wide range of public health needs."
Advances in Operations Research Addressing Convergent HIV and TB Epidemics
In his remarks, Dr. Gerald Friedland stated that recent operations research demonstrates the feasibility of practical strategies to address the converging epidemics of HIV and TB. Examples include studies demonstrating the effectiveness of integrating TB/HIV care and treatment, and others on the documentation of and strategies to reduce drug resistant TB. These studies have been carried out in urban and rural areas of South Africa's KwaZulu-Natal Province and elsewhere. According to Dr. Friedland, such efforts require strong commitment, willingness to innovate, and increased, focused and sustained resources in order to be successful. Eighty percent of the estimated 700,000 people co-infected with HIV and TB reside in sub-Saharan Africa, with 250,000 or 29% in South Africa alone. Dr. Friedland is Director of the AIDS Program at Yale New Haven Hospital and Professor of Medicine, and of Epidemiology and Public Health, at the Yale School of Medicine.
Antiretroviral Therapy in 2009: Successes and Challenges
Dr. Pedro Cahn, President and Co-Founder of Huésped Foundation in Argentina and Immediate Past-President of the International AIDS Society, discussed the remarkable impact of antiretroviral therapy (ART) on HIV-associated morbidity and mortality, as well as the resulting improvements in quality of life and life expectancy in developing and wealthy countries. He also addressed the need to expand HIV testing and the timely, safe initiation of ART, including avoiding toxic drugs such as d4T. Other public health challenges include the need for inexpensive monitoring and adherence support tools, simple, low-cost second- and third-line strategies, and training and retaining health care workers. Looking forward, he outlined the landscape for new drugs and new treatment strategies, as well as drugs currently in development.
Gender and Sexuality: Recent Data and its Implications for HIV Prevention, Treatment, Care and Support
According to Dr. Rachel Jewkes, HIV prevention research has paid insufficient attention to gender identities (masculinities and femininities) and as a result has failed to consider the meanings and social context underlying risky sexual practices. Dr. Jewkes is Director of the Medical Research Council's Gender and Health Research Unit in Pretoria, South Africa. Dr. Jewkes' ethnographic and epidemiological research on gender and sexuality includes the evaluation of Stepping Stones, an HIV prevention programme that aims to improve sexual health by using participatory learning approaches to improve knowledge, risk awareness and communication skills. The research shows reductions in new herpes simplex type 2 (HSV-2) infections and men's use of violence against women. According to Dr. Jewkes, the consideration of sexual practices within a broader context of gender identities may help explain why efforts to change isolated sexual behaviours (such as promoting consistent condom use) have met with resistance, and may also explain the relatively greater success of interventions that have sought to change gender norms.
Developments in Tuberculosis Vaccine Research
Dr. Jerald Sadoff, President and Chief Executive Officer of the Aeras Global TB Vaccine Foundation, reviewed current efforts to develop a TB vaccine to protect people living with HIV. With the current TB vaccine BCG unable to control the epidemic, a new vaccine regimen for infants, and latently infected adolescents and adults, especially those with HIV, is desperately needed. There are four TB vaccines being tested now, all in Africa. Two are recombinant proteins and two are non-replicating viral vectored vaccines. Initial trials in people living with HIV have demonstrated safety and immunogenecity for two of the candidates. Another is about to enter large-scale safety and proof of principle efficacy trials in adults with HIV, most of whom are latently infected with TB. The first efficacy trial of a TB vaccine in infants (Phase IIB) in over 80 years was also recently begun in South Africa. Additional adjuvanted proteins and new viral vectors will be entering the clinic in the next two years, adding to the increasingly broad pipeline of new TB vaccines.
Over 5,800 participants Attend Meeting
IAS 2009 conference organizers announced the participation of more than 5,800 participants from 123 countries. Over 2,400 scientific abstracts were submitted and more than 1,550 were accepted for presentation. Organizers thanked the 360 individuals, most from the Cape Town area, who volunteered to help make the conference a success.
Online Coverage of IAS 2009 at www.ias2009.org
The online Programme-at-a-Glance, available through the website, includes links to all abstracts, as well as webcasts, session slides and speeches. A webcast of the plenary session will be available shortly after its conclusion. Additional online programming is provided by the IAS 2009's two official online partners: Clinical Care Options and NAM. Reporters and others can also follow key developments on the IAS 2009 Live blog at www.ias2009live.blogspot.com or
on Twitter at http://twitter.com/IAS2009live.
About the Organizers
IAS 2009 is organized by the International AIDS Society (IAS) in partnership with Dira Sengwe, a not-for-profit organization based in Pretoria, South Africa. The IAS is the world's leading independent association of HIV professionals, with over 13,000 members in 188 countries working at all levels of the global response to HIV/AIDS. Dira Sengwe originated amongst a group of scientists and activists, who came together to help organize AIDS 2000 in order to bring attention to the plight of people living with HIV in Africa. Since 2003, Dira Sengwe has organized the South African AIDS Conference, one of the largest national AIDS conferences in the world.
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"Reproduced with permission - International AIDS Society"
International AIDS Society