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Study on ‘Test and Treat’ for Inmates Takes Flight

Inmates around the world are at higher risk for both TB and HIV. This week in Brandvlei correctional centre, TB/HIV Care will launch the local arm of a new Southern African study to help HIV positive inmates stay healthy.

In May 2016, the South African Government announced it will be adopting the World Health Organisation’s (WHO) new “test and treat” guidelines for HIV infected people, enabling immediate anti-retroviral (ARV) treatment upon HIV diagnosis. These guidelines will help place South Africa in the position to address at least one of the UNAIDS ’90-90-90′ treatment targets; that 90% of people who test HIV positive are initiated onto treatment. This policy was adopted after the seminal ‘START’ study showed that starting people on ARVs early helped to keep them healthy. If people stay adherent to treatment once started, their viral load drops and it also becomes much more difficult to transmit the virus.

The Department of Correctional Services, has been successful in screening high numbers of inmates for HIV, but treatment thus far has only been offered to inmates with CD4 counts of <500. The Treatment as Prevention (TasP) project supported by Evidence for HIV Prevention in Southern Africa (EHPSA) is designed to offer universal test and treat (UTT) as a feasibility pilot study within a correctional centre environment. EHPSA is funded by UK Aid from the Department for International Development (DFID) and Sweden and managed by Mott MacDonald. EHPSA so far has three research arms working with adolescents, prisoners and LGBTI communities. (http://www.ehpsa.org/).

The TasP study has three sites within Southern Africa; Lusaka, Johannesburg and Worcester with two local correctional facilities on board, Brandvlei and Worcester. TB/HIV Care Association (THCA) will be responsible for the Western Cape sites and THCA’s partners on this study, the Centre for Infectious Diseases Research in Zambia (CIDRZ) and the Aurum Institute will run the study from Lusaka and Johannesburg respectively. Although there have been significant delays in study initiation, ethics approval from the Department of Correctional Services (DCS) as well as the University of Witwatersrand has been granted for South African sites.

THCA will commence the study this week from an office set up at Brandvlei training centre. This will also provide a home base for the study team working at both Brandvlei and Worcester correctional facilities. The study team consists of Phunyezwa Langa (Professional Nurse Counsellor), Earl Titus (Data Monitor), Irene Mokwena and Mzi Fosi (Research Assistants) and three HAST counsellors, Angie Solomons, Vanessa Solomons and Juliana Baadjies. THCA are in the process of procuring additional staff members for the Worcester site. THCA believes in expanding staff skillsets and in this spirit, most of the study team have attended workshops and training courses aimed at providing additional training.

The specific study objectives are to (1) describe the continuum of THCA under TasP/UTT by using several key indicators; (2) identify health-system, socio-cultural and inmate barriers and/or facilitators of TasP/UTT to refine TasP implementation; (3) characterize the resources needed and steps taken to achieve a functioning TasP/UTT program within the correctional environment; and (4) identify key policy stakeholder concerns and questions to facilitate TasP/UTT scale-up within correctional facilities in Southern Africa.

To assist study teams recruiting inmates at the various sites, consent and case report forms (CRFs) have been designed to accurately record data for capturing on an electronic database. Currently, CIDRZ has started recruiting inmates onto the study and the THCA team is receiving training on the finalised CRFs and electronic database the will be used to garner data from consented inmates. The THCA study team has started a support group for inmates that are infected/affected by HIV/TB and they have meetings once a week. A novel way to reach more inmates about the study and the work that THCA is doing within correctional facilities, was to use the local radio station at Brandvlei. Angie and Vanessa were invited to give a brief introduction of TasP on air and subsequently THCA has been invited back to give health and wellness talks in scheduled regular slots.

Two THCA community mobilisers show that age is not a barrier to education

Deon Martin started as a community mobiliser with TB/HIV Care Association (THCA) in 2015 and is currently a driver for the False Bay and Dunoon medical male circumcision (MMC) teams.

Deon left school in grade 11, but says he was partly inspired to study for his matric when he started working for THCA and saw the potential for his future growth. At the age of 47, after attending night school, he completed six subjects in six months and graduated with his matric in August this year.

Deon said that when he received his results he was overwhelmed. This achievement has spurred him on to further his education and next year Deon plans to study for a degree in social science. He feels that a degree in social science, coupled with the experience that he has gained working at THCA will equip him with skills that he can apply to both his life and out in the field.

Deon describes himself as a community person who is driven and motivated. He loves his job and people in general and is passionate about helping those that are disadvantaged.

Anthea Scullard started working for THCA in 2015 and is currently a community mobiliser for the False Bay MMC team. When her husband passed away she was forced to return to the workplace.

Anthea soon realised that in order to progress she needed to empower herself and decided at the age of 53 to study for her matric. Once the decision was made she wasted no time in enrolling for six subjects at Westridge High School and attending night classes. She also hosted a study support group in her home.

Anthea says that going back to school was not always easy, but with the help of God and the prayers of her family and friends she obtained her matric in June this year. Anthea also recently obtained 100% for her learner’s licence test and her next goal is to obtain her driver’s licence.

Anthea describes herself as a strong person who loves helping other people. She would love to move into the field of education by training and inspiring other adults to empower themselves and achieve success.

Both these colleagues epitomise one of the core values of THCA; empowerment. They serve as examples that it is never too late to set and achieve personal goals in life.

We need to urgently expand access to PrEP

JOHN MUTSAMBI writes:

Despite having the biggest HIV epidemic in the world, South Africa continues to make remarkable progress in the fight against HIV and AIDS. The country has become a hub of HIV prevention research and it has the largest anti-retroviral therapy (ART) programme in the world. On 1 June, 2016, a national programme to provide oral pre-exposure prophylaxis – or PrEP – to sex workers was launched and TB/HIV Care’s eThekwini and Pietermaritzburg sites became two of the first 10 sites in the country to roll out this novel HIV prevention tool. But PrEP advocates are urging for a wider roll-out on the grounds of ethics, cost-effectiveness and to avoid unintentionally encouraging stigma.

At the recently-concluded 21st International AIDS Conference (AIDS 2016) a senior official from the South African National Department of Health (NDoH), complimented TB/HIV Care’s eThekwini site for its sterling work in rolling out PrEP, the pill which, if taken regularly by someone who is HIV negative, helps to prevent that person becoming infected with HIV. To date, this site has initiated a total of 47 clients on PrEP while its sister site in uMgungundlovu, Pietermaritzburg, which started the rollout two weeks later, has also initiated 18 on PrEP.

This pioneering work, makes South Africa a torch bearer in rolling out a programme that could become a model for other countries, particularly those in the sub-Saharan region that have been hard hit by the HIV epidemic.

As PrEP advocates working in collaboration with civil society we welcome this programme and convey special thanks to Dr Aaron Motsoaledi, South Africa’s Minister of Health, for helping to spearhead the push for PrEP implementation.

However, the staged implementation of this HIV prevention method has sparked questions about ethics. One community member said: “Why is the government prioritising sex workers as a key population in the implementation of PrEP when there are other key population groups such as men who have sex with men, people who inject drugs, people in sero-discordant relationships, truckers and prison inmates who are also at high risk of getting HIV?”

And a sex worker remarked: “Some community members call us ‘the drivers of the epidemic’. I think that providing PrEP to sex workers only will further strengthen this stigma.”

These are all voices with concerns that should be listened to. As PrEP advocates, we urge decision-makers in the NDoH to urgently consider expanding access to PrEP to other key population groups, including adolescent girls and young women. We know that this process will not be easy and we are prepared to work very closely with civil society to support the NDoH’s efforts.

As we wait for information from PrEP demonstration projects to inform our decisions about how best to roll out PrEP, we also feel that at this point, we should also learn as we go. Further delays in expanding access to PrEP will result in continued high rates of new infections that could be averted and the associated costs of illness and providing lifetime ARVs. South Africa cannot afford to wait any longer to provide PrEP to those who are vulnerable, no matter who they are.