MSF will be at SA AIDS in Durban, KwaZulu-Natal (11-14 June). Our staff will be presenting key data from our HIV/TB projects in Western Cape and KwaZulu-Natal, on topics ranging from TB coinfection, PrEP and reaching 90-90-90.
Eshowe, KwaZulu Natal: Reaching 90-94-95
MSF will release important findings from its second Epicentre survey from our long-term HIV/TB project run in partnership with the KwaZulu Natal Department of Health in Eshowe, KwaZulu-Natal. The results confirm that the area has achieved the UNAIDS-endorsed treatment target of 90-90-90 with a result of 90-94-95. This area has one of the highest HIV rates in South Africa with 1 in 4 people living with HIV. This achievement is the result of local health partnerships, civil society, traditional leaders and medical practitioners working together to implement multi-pronged prevention, testing, counseling and treatment programmes.
Read the abstract: Significant decrease in the proportion of HIV-positive virally unsuppressed over the last 5 years in Mbongolwane and Eshowe sub-district, KwaZulu-Natal, South Africa
Watch our 2-minute explainer video: ‘Eshowe HIV project reaches 90-94-95’
Watch our ‘Bending the Curves’ video series (2016) which outline the five key interventions used by MSF in Eshowe to reach these results.
Khayelitsha: Piloting six-month ART supplies for patients
The MSF adherence club model in Khayelitsha has proven effective in keeping people living with HIV on treatment. The clubs meet every two months at a local clinic to receive their ARVs and participate in adherence support. A recent MSF study has shown that stretching out the time between clubs to twice a year (every 6 months) in non-inferior to the current standard. Changing to 6 month refills could be a more attractive option for overburdened health systems and allows for greater patient independence.
Read the abstract: Retention and viral load outcomes from a cluster randomized trial comparing extending adherence club ART refill dispensing intervals from 2 to 6 monthly
Watch our 2-minute video: ‘Khayelitsha: 6 months’ supply of ARVs’
Read the poster.
Introducing Khetha, a youth focused digital HIV counseling app
MSF in partnership with Aviro Health will launch its new digital HIV counseling syllabus for youth, Khetha, at SAAIDS.
The online platform, which includes youth-friendly videos and virtual reality options, aims to reach young people through their phones and computers.
The open-source digital HIV counseling syllabus focuses on teaching young people about HIV testing and how to access health services if they test positive.
Visit www.khetha.avirohealth.com for more information
Khayelitsha: Welcoming people living with HIV back into care
MSF’s Welcome Back service, started in Khayelitsha in 2018 in partnership with the Western Cape Department of Health and University of Cape Town, identifies HIV patients who have disengaged from HIV care and helps to support their re-engagement and put them onto effective treatment. This pilot project has shown that keeping people living with HIV on treatment relies on health systems adapting to respond positively to people wanting to get back onto ARVs rather than ‘punishing’ them for disengagement, and assisting them when they do return, to remain in care.
Read the poster.
PrEP Divas programme addressing HIV prevention among young women
The provision of pre-exposure prophylaxis (PrEP) in South Africa has been targeted at young women, a population at high risk for contracting HIV. In Khayelitsha, MSF has an ongoing study which evaluates the feasibility of incorporating PrEP into sexual and reproductive health services delivered to women aged 18-25 years attending a youth-friendly clinic. Preliminary results have shown that despite being highly motivated to continue on PrEP, the young women in the study still faced challenges with incorporating study visits and daily pill-taking into their lives. In that way, providing oral PrEP along with additional support in the first month encouraged a reasonable number of women to persevere on PrEP.
Read the abstract: Retaining young women on oral Pre-exposure Prophylaxis in a youth-friendly clinic: mixed methods findings from a feasibility study in Khayelitsha, South Africa
Khayelitsha, Western Cape: Digital peer mentor HIV program promoting ART initiation
Young people typically don’t access health care services, but MSF’s experience in Khayelitsha has shown that youth-friendly services increase their engagement. MSF piloted a peer mentorship program which paired up a young members of ART Adherence Clubs with a young person newly diagnosed with HIV. Mentors and mentees interacted via their mobile phones, provided peer support and encouraged ART initiation.
The results showed greatly improved ART initiation among those who accepted a mentor, compared to those who declined one. The findings suggest that peer mentorship programmes can help with ART initiation among young people and also utilise youth from the clinic as engaged and competent mentors.
Read the abstract: Newly diagnosed HIV positive youth value peer mentorship via mobile phones, and it may increase engagement in clinic care, in Khayelitsha, South Africa: a mixed methods study
Advanced Disease in KwaZulu-Natal 2008-2018
Advanced HIV disease remains a persistent public health challenge, especially in high burden countries like South Africa. An MSF study analysed Advanced HIV Disease in the KwaZulu-Natal province over 10 years, the findings show that Advanced HIV disease is increasingly represented by patients who are ART-experienced with a history of care disengagement or likely virological failure.
The study recommends that focusing on encouraging men to use health services combined with intensified adherence support, would assist in keeping people on treatment and lower the rate of Advanced Disease.
Read the abstract: Advanced HIV disease in Kwazulu Natal, South Africa, 2008 – 2018
Read the poster.
Virological Failure and switch to second-line ART
Defining how to deal with virological failure among people living with HIV is important when considering when to switch to second-line ART. An MSF study into virological failure among people living with HIV showed that ART continuity and low CD4 counts were significantly associated with virological failure and should therefore be considered when making decisions about timing for the switch to second-line ART.