Scientific Program Report

Track A Summaries

Pontiano Kaleebu
Lead Rapporteur

Sessions

Abstract driven sessions

• Co-infections and Emerging Pathogens
• Viral Diversity and Drug Resistance
• Transmission and Mucosal Immune responses
• Host and virus interaction in Transmission and disease
• Rapid Diagnosis and Point of Care

Symposium

• Advances in vaccines
• Reservoirs and Cure

Co-infections

• Co-infections: bacterial, malaria, ExtrapulmonaryTB
  – Better diagnosis, management and tests plus importance of studies of immunological interactions
  – Usefulness of Quantiferon TB Gold for diagnosis Extr Pul TB
  – GeneXpert not yet widely available

Viral Diversity and Drug resistance

• Group O less susceptible to new NNRTI drugs and integrase inhibitors
• Notable resistance to the new NNRTI (Etravirine and Rilpivirine) in those resistant to 1st line NNRTIs- Mali
• Caution on subtyping some CRFs are URF
• What are best methodology for genotyping Sanger vs next generation sequencing

Potential new approaches to therapy

• RNA Aptamer as possible entry inhibitory molecules
• Mutagenesis in the Gag matrix and Capsid leading to failure of virus assembly
• Oral beta Defensins- that inactivate HIV in oral epithelial cells

Developments in protective immune responses/ genetics

• Exposed seronegatives, role of recall NK cell responses, Type I and II interferon responses to TLR7/8 and TLR 7
• Long term non progressors, elite controllers and the association between HIV superinfection and disease progression
• Genetic variation in Vit D receptor and disease progression

Rapid diagnosis and Point of Care

• Development of rapid assays for specific DR mutations (Oligonucleatide Ligation assays), the multiplex based one detecting <5% minority populations
• Development of assays to monitor adherence (cathepsin zymography)
• Evaluation of CyFlow MiniPOC for CD4 enumeration

HIV Vaccines

Follow up on RV144 study that showed modest efficacy through enhancing the level and duration of the immune response

Broadly neutralizing antibodies
to effectively prevent infection by a broad range of the many HIV variants

 

New antigen approaches to induce
T-cells to destroy HIV-infected cells

Replicating vectors to deliver vaccines in a manner that stimulates
strong and sustained immunity

Overview

• Though few basic science abstracts, there was good science
• Young investigators

 

 

 

 

TRACK B

CLINICAL SCIENCE, TREATMENT AND CARE

Mohammed Lamorde MRCP, PhD
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala

The consequence of failure of our antiretroviral and PMTCT programme is too ghastly to contemplate…
His Excellency F Mogae ICASA 2013

First-line ART in Africa

PRESENTER	HIGHLIGHTS
Nwuba, CNigeria	Co-trimoxazole propophylaxis appeared to increase of retention of pre-ART patients with high CD4 counts
Sibanda, DZimbabwe	Nevirapine toxicity in line with manufacturer defined risk thresholds for CD4 counts
Speight, CMalawi	Treatment limiting toxicity for efavirenz was 2%
Mukonzo, JUganda	Pharmacokinetic -Pharmacogenetic model suggests lower dose of efavirenz for African patients
Adzavon, YSenegal	High prevalence of genotypic resistance  (20%)

 

Detecting and Treating Virologic Failure

PRESENTER	HIGHLIGHTS
Ouedrago, SBurkina Faso	Darunavir/Raltegravir regimen efficacious and well tolerated in small cohort with treatment failure
Bygrave, HZimbabwe and Malawi	Dried blood spots and pooled testing to scale up routine VL monitoring
Toni, TCote D’Ivoire	High prevalence of genotypic resistance among children on ART
Jed, SSouth Africa	Adherence to VL monitoring guidelines in SA
Chani, CNamibia	Adherence to VL monitoring guidelines in Namibia

 

Children and Adolescents

PRESENTER	HIGHLIGHTS
Idele, PUNICEF	Inequities  persist in  care and treatment for children in SSA
Costenaro, PUganda	Feasible implementation of isoniazid preventive therapy  for HIV-infected children
Kania DBurkina Faso	Excellent agreement between dried blood spots  and plasma for early diagnosis
Jesson JIeDEA West Africa	Malnutrition at ART initiation common (51%) and some children do not catch up after two years of ART
Brahmbatt, HUganda	Neurodevelopment impact of HIV and benefit of ART

 

HIV and Tuberculosis

PRESENTER	HIGHLIGHTS
Fall Niang , MSenegal	Xpert versus MGIT 960 for sensitivity to MTB
Sumitani, JSouth Africa	Suboptimal ART initiation rates among TB/HIV patients
Hausler, HSouth Africa	TB / HIV screening  within correctional facility
Enegala , JNigeria	Greater risk of TB/HIV patients  stopping care at facility
Mukonzo, JUganda	Model to describe sub-clinical liver function  changes

 

HIV and Co-morbidities

PRESENTER	HIGHLIGHTS
Mutisya, RKenya	Nutrition counseling versus food supplementation equally effective in improving nutritional status
Ymele, F,Cameroon	Post-op complications similar between HIV –  or HIV+ women with Caesarian Sections
Patassi, ATogo	9.65% prevalence of Hepatitis B in a setting without routine screening or access to tenofovir
Kania, DBurkina Faso	Combination of RDT plus DBS is possible for testing for HIV, Hep B and Hep C

 

Adherence and Retention in Care

PRESENTER	HIGHLIGHTS
Gonzalez- Perez, JUganda	Approximately half of patients retained in care after 10 years. Lowest retention among those aged 15-19 years.
Grimsrud A, South Africa	No difference in risk of default with  4 month drug supplies versus 2 month drug supplies
Maharaj, TSouth Africa	Fast-track for stable patients reduces patient waiting time
Jobanputra, KSwaziland	Older age, lower viral load, higher CD4 count associated with resupression following enhanced adherence counseling

 

 

 

 

Track D:

Social Science, human Rights and Political Science
34 Oral presentations and 241 Poster presentations

Track Chair: Dr. Emil Asamoah Odei Co-Chair: Prof. Relebohile Moletsane
Rapporteurs: Pierre Brouard, Sianne Abrahams, Stella Kyobula-Mukoza and Lucina Reddy

Challenges: Thematic Areas

 

Recommendations: Disability

• Disability lens reflects chronicity of HIV
• Policy implementation effective only with established financial structures

Sensitization of clinical staff

• Access to health care; education; rehabilitation for disabilities

Recommendations: Fertility and HIV www.hartcapetown.co.za (Affordable and holistic approach for HIV +ve couples wanting to reproduce)

Guided by policy and best practice “It’s not the HIV that’s killing me… my mother in law will say where is the baby?”: A qualitative study of couples facing HIV and infertility. (Cal Volks, 2012).

• Reproductive health fertility specialist to consult on draft guidelines with HIV specialists on this population
• Call is for more consistent policy and full funding (not partially subsided)
• Because partial funding discriminates against the right of HIV+ couples to reproduce

Review of international guidelines (Mmeje)
Informing policy decisions and client care

Recommendations: Technology for Behaviour Change

Policy Regulations: Emphasising protection of respondents in digital media (recognising future implications) “How informed is informed consent?”

Cellphone technology and other mechanisms for treatment adherence and encouragement (V. Nembaware)

Links biomedical and psychosocial
“Umhlobo Wami” (V. Nembaware)

Recommendations: Rights and Violations PLHIV

UNAIDS toolkit: Defines risk, harm, defences. “Disclosure as a defence” (seen as informed consent to limit risk)

Sensitization (Maseko)
Judiciary and police need education in HIV litigation (Anonyuo)

Recommendations: HIV Prevention

Prevention strategies which interact with social and cultural dynamics

Short term:
education, communication and sensitization strategies at multiple level (individual, community and systems)

Medium term:
further research to inform policy

Long term:
embedded into policy and programming

 

Possible Areas of Inquiry

• How do we remain reflective about the language of “Key Populations” to notexclude vulnerable individuals and groups that we may have lost sight of?
• Considering the emerging focus of cash as an incentive, for behaviour change – is there a distinction between good and bad transactionality?
• Fear of the loss or injury to manhood emerged as a significant barrier to VMMC programmes; how can social research help us understand the relationship between circumcision, masculinity and HIV prevention?
• If the focus is on health of marginal groups (SW, MSM and drug users) whose legal situation is precarious, and there are limited efforts to decriminalise their activities, are we really addressing the primary drivers of their vulnerability?
• Stigma is a structural driver of HIV – guidance is needed at a national level toovercome this. How can we formulate a national strategy in response to this?

 

 

 

 

Track E

Health Systems, Economics and Implementation Science

The track’s aim was to provide new insights into the status of health systems and its capacity and challenges to expanding treatment and prevention in resource-limited settings.

 

Rapporteurs and Presentations

Track Chairs:
Dr. Ntounga
Professor Reid

Rapporteurs

• Ms. Sianne Abrahams
• Ms. Stella Kyobula – Mukoza
• Mrs. Lucina Reddy

Presentations

• Number of Oral presentations = 40
• Number of posters = 173

Laboratories and Facilities

• Monitoring of laboratories to ensure effective delivery of services (Lugada, 2013) and (Kerschberger, 2012)
• SMLTA mentorship model applied in Zimbabwe (Simbi, 2013)
• Dalmeida (2013) suggested the promotion and scale up of Open Polyvalent Platforms should be considered for resource limited settings

 

Cost Effective Measures – Recommendations

• Haacker (2013) Analysis in 2010 indicates that one MMC results in about 0.2 HIV infections averted for males up to age of 20

Highlights the importance of targeting young males

• Kripke (2012) Review of the KwaZulu – Natal DOH programme implementation

Scale up of VMMC was suggested as cost effective prevention response coupled with condom promotion.

Cost Effective Measures – Recommendations

• Maselle (2013) Evaluation of Pharmacy Only Visits (POV) Programme in Uganda

Focus on enhancing POV to assist with task shifting

• El-Sadr (2013) Analysis of routine data of patients enrolled in care

By assessing eligibility for initiation of ART, patients can be placed faster on treatment as well as initiation of healthier patients on ART

HIV/AIDS, Inclusivity & Change Unit:
Curriculum Integration of HIV/AIDS Student Image; Julian Gasson ‘One Hundred Hollow Men’

Leadership Program Report

LEADERSHIP SESSIONS

1. African Leadership in the Post -2015 Era
2. Leadership for change: Global Plan towards the elimination of the new HIV infections by 2015 and keeping mothers alive
3. National ownership and accountability
4. The end of AIDS. Reality or Myth?
5. Declarations, Commitments and Promises
6. Leadership for an Integrated and sustainable response to diseases/ill health
7. Embracing change for an effective response to HIV
8. African women Leadership for the HIV response-myth or reality?
9. Youth Leadership: crossing cultures
10. Religion, sexuality and HIV
11. African Union Roadmap

 

The End of AIDS -As the world defines a new agenda in the Post 2015 Era :-

• What leadership does Africa need to exercise?
• What goals do Africans need to get behind?
• What strategic alliances need to be formed?

 

Glass half full

• Zero new infections, Zero discrimination, Zero AIDS related Deaths
• Dream
• Overly Ambitious Goal
• Now more than ever slowly but surely becoming a reality

 

Glass half Empty

• Far from reaching the end of AIDS
• More difficult situation than ever before
• Need to address
• The multiple social issues,
• Strengthen health systems,
• Sustainability,
• Ensure adequate funding of the HIV response Hold authorities accountable.

 

 

 

 

 

 

IF AIDS IS NOT A STAND ALONE

PRIORITY GOAL IN THE POST 2015

AGENDA THE END OF AIDS WILL STILL BE

A FAR CRY

WE ARE ALL IN THIS TOGETHER

THERE IS NO THEM ONLY US

 

SIYABONGA