HIV and TB Developments Highlighted in MEPI Symposium

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The University of KwaZulu-Natal Medical Educational Partnership Initiative (UKZN MEPI), in collaboration with University of Mozambique MEPI, held the MEPI Clinical HIV Symposium on “HIV and TB: latest developments for clinicians and researchers” in Durban recently.

Making presentations at the Symposium were three esteemed researchers and academics from the United States who have worked in collaboration with the University of Mozambique MEPI, along with UKZN MEPI staff.

Mr Sandy Pillay, Co-Principal Investigator of the MEPI grant, said the University has benefitted in numerous ways from MEPI funding through collaborations with other MEPI grant awardees across Sub-Saharan Africa. ‘We were able to access the expertise of awardees across Africa, with Zimbabwe, Mozambique and our US partners.’

Project Manager for MEPI and the ENTRÉE Project at UKZN, Mrs Nisha Nadasen-Reddy, explained that in the numerous programmes implemented at UKZN, the main objective was for MEPI to strengthen and enhance the health system’s effectiveness by helping to improve health service delivery. The Enhancing Training, Research and Education Strategy (ENTRÉE) introduced at UKZN is an initiative which has an undergraduate, postgraduate and faculty component to accelerate the educational programme.

‘Since MEPI is in the last year of a five-year programme, the focus is on the University curriculum,’ she said. With eight components to support regional research and increase training of staff and students, fourth-year Nursing students have been provided with Nurse Initiatied Management of Antiretroviral Treatment (NIMART) training. In addition, the Pharmacy Department used MEPI funding to update its pedagogy and promote e-learning. The flagship project of MEPI has been the decentralisation of learning sites in rural areas. ‘All these programmes have all been implemented to ensure that students emerge from their studies both well-trained and knowledgeable,’ said Nadesen-Reddy.

Guest speaker Dr Thomas Campbell from the Division of Infectious Diseases at the University of Colorado spoke on the topic of “Options for third-line ARV therapy in the Developing World”.

Third-line ARV therapy or regimens refers to a patient who has failure or intolerance to first line NNRTI-based therapy and second line PI-based therapy. Such regimens may contain new drugs or drug classes such as Darunavir, Tipranavir, Etravirine and Raltegravir.

‘When we treat HIV with ARV’s, our goal is to block HIV replication as this leads to the CD4 count decreasing. This can lead to drug resistance. A population of viruses exists in an infected patient and ARV drug resistance develops from incomplete inhibition of viral replication,’ said Campbell.

As part of the key concepts of treating patients with multi drug resistant HIV, Campbell suggested that when changing drug regimens, the new regimen should include two active drugs and one more partially active drug. ‘To prevent MDR HIV one has to have adherence counseling, monitor the HIV viral load to detect resistance early, Change regimen early in virologic failure, do resistance testing to help select new regimens. Use the most potent regimens first to prevent subsequent resistance and treatment failure.

Specialist Pediatrician, Dr Mohern Archary from the Department of Pediatrics at UKZN, presented an update on the International AIDS Conference 2014.

With 10 countries in the world accounting for 61% of HIV infection, South Africa has the highest rate of HIV in the world, at 18%, followed by Nigeria, India, Kenya and Mozambique. Archary pointed that ‘treatment and preventative measures need to be designated at these 10 countries to decrease HIV by 61%.’

Archary explained that HIV is the number one cause of death amongst adolescents in South Africa and that while 3rd line regimens are vastly more expensive that first line ARV’s, the major significance of the regimen can be used for drug sensitive Tuberculosis and drug resistant TB.

Dr Constance Benson from the Division of Infectious Diseases at the University of California spoke about recent advances in the diagnosis, prevention and treatment of TB.

With nine million new incidents of TB in 2012, a constant decline has been seen in new TB case incidence, prevalence and mortality, and Benson explained that there are numerous drugs and new medication in the pipeline to eradicate TB.

‘As part of the WHO Xpert policy recommendations for 2014, Xpert MTB/RIF may be used rather than the conventional microscopy and culture as the initial diagnostic test in all adults and children suspected of having TB,’ said Benson.

Xpert MTB/RIF may be used as a replacement test for usual practice, and conventional microscopy and culture and performance of DST for agents other than Rifampin are essential for monitoring therapy.

Benson also spoke about new drugs in development that have the potential to revolutionise TB treatment. ‘Treatment shortening is not yet achievable with current drugs and there are long-term toxicities of new agents that are ill defined. Drug interactions with ARV’s can be problematic and there is much more work to be done in evaluating new drugs for TB.’

Dr Robert Schooley, Head of the Division of Infectious Diseases at the University of California spoke about HIV eradication: “A case for ongoing research”.

‘HIV treatment has gotten cheaper over the years and global access has reduced mortality around the world. But as drugs have improved, so have treatment outcomes. As molecules become cheaper, we can have much less drug failure and more time and opportunities to do clinical trials to create something that can be easily and quickly available. Better drugs should be made cheaper than last generation drugs.’

Professor Douglas Wassenaar from the Discipline of Psychology at UKZN, presented on “Building Research Ethics Capacity at UKZN”.

Wassenaar discussed research ethics as being an important element of research systems, saying that ‘Research has to be evidence based and tailored to community themes and issues. They have to be received by a competent research ethics committee. Research ethics is done to protect the population on whom and what the work is being done on.’

In South Africa, all Research Ethics committees have to be registered with the National Health Research Ethics Committee (NHREC). The Ethics Committee in South Africa has to be competent with the South African Department of Health NHREC and the US OHRP. With about 35 research committees in South Africa, there are around 170 Africa.

Wassenaar also added that through the use of MEPI funding, free online modules in ethics are now available on the TRREE website for those who have an interest in research ethics and regulation. Certificates are awarded to those who complete the courses upon passing with 70%.

The Medical Education Partnership Initiative (MEPI) is a co-ordinated effort led by the Office of the U.S. Global AIDS Coordinator (OGAC) and supported by the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA).

-           Zakia Jeewa