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ELDIS HIV/AIDS Reporter on Making ART more accessible in sub-Saharan Africa (pdf, 200kb) Theme 2 publications
Current Theme 2 Research Generated by Evidence for Action Access to care and the roll-out of HIV treatment and care The issue of access to care and the roll-out of HIV treatment and care has continued to be a major area of work for Evidence for Action. MRC/UVRI together with the Uganda Ministry of Health (MoH) and Wakiso District Health Officers have completed data collection on the ART Rollout project (Wakiso project). This operational research project has been exploring how best ART services can be delivered through peripheral health centres and whether ART delivery can be integrated with HIV prevention activities. Analysis of the data has started, and results are expected soon. Initial analysis suggests that patients are happy that services are closer to their homes. This work has been funded by DFID and MRC.
MRC CTU, MRC/UVRI together with Imperial College, Joint Clinical Research Centre, Makerere University, University of Zimbabwe, Malawi MoH and African Dialogue on AIDS Care: Following the successful completion of the DART trial, and the positive results, these partners held a workshop to develop a proposal looking at the implementation of clinically driven monitoring in non-research primary health centres in sub-Saharan Africa. The workshop was funded by Evidence for Action, and an outline proposal has been submitted to DFID. Evidence for Action is a partner on this proposal, contributing expertise particularly in the areas of outcome indicators, policy analysis and communications.
NARI have been continuing to work on projects to understand the delivery, access and utilisation of HIV services in Goa and Belgaum. Data collection and data entry are now complete, and analysis is underway. This work is funded by Evidence for Action.
IHAA, LSHTM and ZAMBART have completed work on a study on home-based care for PLHIV in the era of ART. The study looked at how the role of home-based care has shifted since the introduction of free ART in Zambia. The study report has been completed, and policy and implementers’ briefs are being developed. Findings and recommendations from the study were communicated with various policy makers and implementers in Zambia and the UK. Capacity building for research was provided through ongoing training of the staff involved in this project at ZAMBART and Alliance Zambia.
Missed opportunities in Prevention of Mother to Child Transmission (PMTCT)
LSHTM, University of Nairobi and Elizabeth Glaser Paediatric AIDS Foundation have continued data collection on the Access to HIV Care for Women Testing HIV Positive in Maternity Services: Missed Opportunities Project. The aim of this Kenyan study is to document what proportion of women who test HIV positive in antenatal or delivery care access HIV care and, where indicated, treatment for themselves, and to explore the reasons for any “missed opportunities” that are observed. Initial findings suggest that there is a high patient drop-out between testing HIV positive in maternity services and accessing HIV-related services. Some initial findings were presented at the Countdown to 2015 conference co-organised by Evidence for Action. This work is funded by MRC/ESRC, Evidence for Action SIG, Parkes Foundation and the University of London CRF. LSHTM and the Tanzanian National Institute for Medical Research (NIMR) Mwanza Centre are working on the analysis of data from a similar study looking at the uptake of HIV care and treatment services among HIV-positive women identified through PMTCT programmes in Mwanza City, Tanzania. Initial findings were also presented at the Countdown to 2015 conference co-organised by Evidence for Action. This work is partially funded by an Evidence for Action SIG.
MRC/UVRI have continued work on a study of how the uptake of PMTCT services in rural areas can be improved. This was a pilot study to inform the design of a larger cohort study. Data collection is complete, and analysis is under way. Preliminary results were presented at the 5th Annual Conference of Makerere College of Health Sciences in September 2009. This work was funded through an Evidence for Action SIG.
Other Evidence for Action-related research in this thematic area included:• MRC/UVRI & MRC CTU: The ARROW trial is continuing. ARROW is an open-label, randomised controlled trial to evaluate different strategies for the management of ART in HIV-infected children in Africa in areas where resources are limited. MRC/UVRI are conducting the Ugandan component of this multi-centre trial, which is funded by the MRC.
• LSHTM: Results of a qualitative study exploring barriers to children accessing HIV care in South Africa, in which LSHTM are collaborating with the Aurum Institute, have been presented at the IAS conference in 2009. A journal article is in press with AIDS Care. The work is funded by the Aurum Institute, PEPFAR and LSHTM.
• Lighthouse are continuing operational research monitoring on effective referral of TB patients to ART initiation. The main outcome is the proportion of eligible TB patients starting ART. 2 abstracts are being presented at the International AIDS Conference in 2010, and results were presented at the Countdown to 2015 conference. This work is funded by CDC and NAC.
• NARI: Data analysis is in progress in a study in Pune, India, exploring the roles of family members as care givers for HIV-infected individuals. This work is being carried out by NARI and MAAS. It should help the health system plan the involvement of the community in supporting people living with HIV and their families, and elucidate how the health system can more effectively assist family members as they provide home-based care for their HIV-infected relatives.
• MRC/UVRI & MRC CTU: Work has been completed on the DART Trial, which was an open-label, randomised controlled trial to evaluate different strategies for the management of ART in HIV infected adults in Uganda and Zimbabwe. MRC/UVRI and MRC CTU worked on this trial with other partners. The findings showed that: 1. Treatment interruptions were not advisable; 2. Antiretroviral treatment can be delivered safely without laboratory monitoring in sub-Saharan Africa. Although mortality and/or new AIDS-defining events were slightly higher (28%) among those who were randomly allocated to the clinical monitoring arm than among those allocated to clinical + laboratory monitoring (22%), the absolute difference was small at only 1.7 events per 100 person years of follow-up, and clinical monitoring without laboratory monitoring was more cost-effective, with the difference of including lab monitoring costed at $9,016 per life-year gained. These results, combined with those of the Jinja trial (see last year’s report) are likely to have a major influence on the simplification of HAART delivery in high prevalence, low-income settings.
• LSHTM and Aurum Institute are working on an investigation into the clinic-level determinants of ART treatment outcomes in South Africa. The project involves analysing outcome data from the Aurum Institute’s ART multi-site HIV care programme. It will be funded by the Aurum Insitute and the AngloAmerican President’s Fund.
• LSHTM and the Aurum Institute are working on a qualitative study of the barriers to IPT implementation in South Africa. The results of this will contribute to policy on IPT roll out. The results will be submitted to AIDS.
• Lighthouse are continuing work on a pilot novel monitoring system for a community based ART support group. This system uses tokens to validate home visits made by community volunteers to ART patients. The system is designed to empower patients to ‘claim’ services offered through the programme. The token system is now up and running and data collection is ongoing. This work is funded by PACT, Malawi.
• Lighthouse, together with the University of Heidelberg, have completed a study on the risk of virological failure and drug resistance in ART patients from the Back to Care Programme at Lighthouse, Lilongwe, Malawi. One of the study objectives was to assess the biological relevance of different patterns of ART treatment interruptions reported by patients who are identified in the active ‘defaulter tracing’ programme at Lighthouse. It also measured viral load levels and patterns of resistance in HIV patients with documented treatment interruptions. The results of this study have been disseminated in Malawi by policy brief, and were presented at the International AIDS Conference in July 2010. This work was funded by Hector Foundation and Lighthouse. |
