HIVAN / WCRP Forums - The HIVAN / WCRP Forum has a new partner - the US Consulate. They have come on board to help sponsor more workshops, as well as enabling our members and colleagues to meet with some of their very interesting visitors. We had more than 14 Forums this year, including five Youth Peace Forums, and a special celebration for International Peace Day. Every forum has 60 to 90 people participating and the YPFs have over 1000 young people at theirs.
16 Days of Activism - WCRP and HIVAN joined with Diakonia and the KZN survivors of violence for a very successful 16 Days of Activism against Violence against Women. The E-campaign of “Ring the Bell! Stop the Violence!” also saw articles in the press, a march, a wonderful T Shirt campaign at the City Hall preceded by a beautiful service at Emmanuel Cathedral .

“Experiences in paediatric ART (antiretroviral treatment) in KwaZulu-Natal” was the subject of discussion at the April 2006 Journal Club meeting at the UKZN School of Medicine. First Dr Holly France gave an overview of the paediatric ART programme running at Ridge House, the antiretroviral (ARV) clinic attached to McCord Hospital. This was followed by a presentation from Dr Gurpreet Kindra on the Structured Treatment Interruption study that was carried out at King Edward IV Hospital.

McCord Hospital is a semi-private state subsidized hospital in Overport in Durban, KZN, and it has a large programme to provide antiretroviral (ARV) treatment to adults and children. In July 2004 the programme was initiated with PEPFAR funding. Dr Holly France, a paediatrician at the hospital, explained the procedure for children to access ARVs. Children are assessed clinically and undergo three training sessions before commencing on ART. If suffering from TB, the usual practice is that unless the child is very sick, ARV treatment is postponed for two months in order to give the TB medication time to work. After initiating ART, children are seen every two weeks for a short while and then appointments are scheduled monthly.

Of the first 151 children enrolled onto ARV treatment since July 2004, none have been lost to follow up. However, 13 children died in the first 5 months of receiving therapy, mainly from chronic gastroenteritis. The age range of children accessing ARVs was 4 months to 15 years (median age 5.7 years). 70% of children were in WHO stage 3 or 4 and 33% of all children had TB at baseline. The increase in CD4 count was noteworthy: at 6 months, children showed an average increase of 9% in their CD4 count and at 12 months, an average increase of 15.2% was evident. After the first year, 84% of 100 children (after a year only 100 children had been receiving ART for 12 months) had an undetectable viral load. While these results were encouraging, Dr France stated that what was disappointing was that only 8% of children had been disclosed to, that is, only 8% knew their own HIV-status.

Dr Gurpreet Kindra then spoke about the study at King Edward IV Hospital. 30 children, aged 2-11 years old, were started on Structured Treatment Interruption (STI) two years ago. These were all treatment naïve children. Weekly viral load and CD4 counts were done, and once viral remission was achieved, children were randomised into 2 arms - continuous or intermittent therapy. Children in the intermittent therapy arm (9 children were eligible out of the 15) stopped treatment when their viral loads because undetectable. They resumed therapy when the viral load went up 1 log. After 3 months if the viral load was undetectable, children went off ART again. Unfortunately the study had to be stopped because treatment interruption was being based only on CD4 count.

Results showed that viral rebounds occurred rapidly on structured treatment interruption, and that viral load in both groups (both children on continuous treatment and those in the STI group) decreased over time. But prolonged interruptions may lead to deterioration of the immune system, thereby negating the benefits of STI. In addition, Dr Kindra pointed out that CD4-driven treatment interruption is clearly inferior if the threshold is less than 250 cells/ul.

Note: This overview serves to inform readers about presentations given at the HIVAN/ECI HIV/AIDS Public Health Journal Club on the first or second Friday of every month, at the Nelson R Mandela School of Medicine. It should be read in conjunction with the PowerPoint presentation slides and/or MS Word documents provided.

To view the April 2006 Journal Club Presentation by Holly France, please click here

To view the April 2006 Journal Club Presentation by Gurpreet Kinda, please click here

Prof Steve Reid from the Centre for Rural Health, UKZN, spoke on “Human Resources for Health in Underserved Areas” at the Journal Club held at the Nelson R Mandela Medical School on 12 May. This was an unusual presentation as it was not specifically focused on HIV and AIDS, but it dealt with human resources in the public sector which constrains the sector’s ability to deliver health services, including those related to HIV. “Why focus on human resources?” one might ask. Prof Reid stated that this issue was important for access to healthcare, quality of healthcare, equity in terms of the availability of health care to the population, and the impact or effectiveness of the care provided.

The Centre for Rural Health did a study in northern KwaZulu-Natal and found a 46% vacancy rate for Professional Nurses, a 41% vacancy rate for Medical Officers, and a 55% vacancy rate for Senior Medical Officers and more senior health workers. Most posts were filled in relatively urban areas which meant that in rural areas, the vacancy rates were even higher. A conclusion drawn by this particular piece of research was that the Community Health Programme was failing to meet the health needs of people in the most underserved areas, where they were most required. For example, at Ekombe Hospital in Nkandla District of the KZN Midlands, there was only one medical officer and no community health workers, a dire situation in this already resource-constrained setting.

Prof Reid went on to talk about the main topic of the day’s presentation, which was a journal article from a study done in North Viet Nam (see reference given). The exploratory qualitative study was based on Herzberg’s theory of motivation in the workplace, which identifies job satisfiers and job dissatisfiers at the individual level, and at the organizational level it postulates on a worker’s motivation to accept or remain in a job and the motivation to improve one’s performance. Semi-structured interviews with 14 policy makers and managers, 24 health staff and 11 patients were carried out, as well as 8 group discussions with health workers. Results showed those issues that health workers felt were main motivating factors to remain in their jobs, and those issues that acted as dissatisfiers. Interestingly, dissatisfiers tended to be extrinsic factors, while satisfiers tended to be more instrinsic.

To read the Journal Club May 2006 Overview, please click here

To view the Journal Club May 2006 Presentation, please click here

HIVAN has a networking team dedicated to facilitating contact, communication and collaboration within and across the higher education, public, private, faith-based, non-government, and community-based sectors. HIVAN’s website, database, newsletters, reviews, and fora are all intended to enable and encourage these interactions. These fora are attended by community workers, volunteers and representatives from NGOs, FBOs, CBOs and government. They create a context for people and organisations to network and build contacts outside of the usual networks, raise knowledge levels and expose people to relevant and timely issues surrounding HIV and AIDS and creates dialogue between groups that don’t normally come in contact with each other. HIVAN’s networking fora are:

• The MRC KZN AIDS Forum
• Faith-Based Leaders and HIV/AIDS Researchers Forum
• Youth Fora
• Capacity-building Workshops
• Home-Based Care Workshops
• Contentious Issues Panel Discussion
• The HIVAN North and South Coast Communities Fora
• SHAPE
• The Public Health HIV/AIDS Journal Club Forum
• Internal HIVAN Forum

HIVAN partnered with the Enhancing Care Initiative (ECI) KZN and Department of Community Health at the Nelson R Mandela School of Medicine, UKZN to host this forum series.