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SATuRN: Newsle-er
Southern Africa Treatment and Resistance Network
Foreword: The concept behind the newsle-er is that anyone with 15 minutes to spare can learn about the work of SATuRN. The newsle-er is presented as a PDF document with links to complete arCcles at the bioafrica.net website. The newsle-er is best viewed on your computer screen as the web links give access to open access documents. In this first issue of our newsle-er we have included interesCng news, blogs, reports, tweets, publicaCons and training informaCon produced by our network. We hope you enjoy it and find it informaCve. We welcome any feedback about content or format.
Highlights: News: Transmi5ed Drug Resistance Rate Remains Below 5% in South Africa Blog: Shortage of doctors in rural South Africa? PublicaCon: EvaluaCon of tuberculosis diagnosCcs: establishing an evidence base around the public health impact Upcoming Event: 1st Nurses & Health Care Workers HIV & TB Drug Resistance Workshop Produced by: Tulio de Oliveira, Richard Lessells, Lungani Ndwandwe, Justen Manasa, Cloete van Vuuren & Chris Seebregts
Vol. 1, Num. 1 Jan-‐ Mar 2012
News: Transmi5ed Drug Resistance Rate Remains Below 5% in South Africa
by Mark Mascolini – Analysis of South Africans with newly diagnosed, untreated HIV infecCon
indicates low levels of transmi-ed anCretroviral-‐resistant HIV across the country through 2010 and no evidence of transmi-ed drug-‐resistant HIV in rural KwaZulu Natal.
This analysis of transmi-ed drug resistance rates in South Africa involved several methods: (1) a literature review, (2) analysis of 72 sequences from newly diagnosed people in rural KwaZulu-‐Natal idenCfied in the Africa Centre's 2010 HIV surveillance round, and (3) publicly available data on transmi-ed drug resistance from Genbank. Links: h-p://www.bioafrica.net/news.php?id=22 , h-p:// www.iasociety.org/Default.aspx?pageId=5&elementId=14379
Among 1618 viral samples collected in 10 datasets from 2000 through 2010 across South Africa, the rate of transmi-ed drug resistance peaked at 6.67% (95% confidence interval 3.09% to 13.79%) in 2002. In subsequent years, the rate of transmi-ed drug resistance always lay below 5%, the World Health OrganizaCon cutoff for low-‐level transmi-ed resistance. 'In Southern Africa as an2retroviral therapy access and treatment programs grow,' the authors cauCon, 'it is cri2cal to maintain surveillance among recent seroconverters, treatment-‐naive and treated popula2ons.' They add that 'programs, covering well-‐defined geographic areas and popula2ons, minimize the biases inherent in transmiAed drug resistance surveillance and provide guidance in implemen2ng risk reduc2on and secondary preven2on to maintain the effec2veness of first-‐line treatment.' Reference: Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira T. Primary drug resistance in South Africa -‐ data from 10 years of surveys AIDS Res Hum Retroviruses, Epub ahead of print: (2012). Open access publicaCon: h-p://www.bioafrica.net/publicaCons.php?pubid=41
News: Highly Specialized Team to Tackle HIV Drug Resistance Problem in Southern Africa DURBAN, SOUTH AFRICA, 24-‐26 FEB 2012 -‐ A small, highly specialized mulCdisciplinary team of doctors and staCsCcians from South Africa, Botswana, the USA and the UK meet in Durban this weekend with the express purpose of pooling their resources, knowledge and experCse in an a-empt to improve understanding the problem of HIV drug resistance in southern Africa.
Resistance to HIV drug treatment threatens to undermine the success of South Africa's ARV (AnCretroviral) campaign and should thus be handled with the utmost urgency. To this end, collaboraCon is essenCal; this meeCng is a response to this need. The meeCng is coordinated by SATuRN (Southern African Treatment and Resistance Network), a non-‐profit network devoted to developing innovaCve means of collaboraCng and sharing data in response to anC-‐ HIV and TB treatment in southern Africa. Links: h-p://www.bioafrica.net/news.php?id=21 , h-p://www.ukzn.ac.za/news.aspx?id=445 2
SATuRN Newsle-er, vol. 1, number 1, March 2012
Blog: Shortage of doctors in rural South Africa?
Over the past two decades Africa has experienced a sharp increase in the mortality rate due to dreadful diseases that have plagued the conCnent, such as hepaCCs B, tuberculosis (TB), HIV/AIDS, and malaria, to name a few, some curable but most of which are incurable. This spread of diseases is heavily felt in this third world conCnent (Africa) and unfortunately a conCnent where there are fewer solid structures in place to control the spread. South Africa is a prime example of how burdensome this increase has been. Adding fuel to the fire in South Africa is the lack of human resource in the health care system, parCcularly doctors, with or without field experience. South Africa alone has a significant gap in raCo of doctors to paCents of 77: 100 000. This lack of or inadequacy is exacerbated in rural hospitals and rural clinics. Link: h-p://www.bioafrica.net/blogs.php?id=11
Fairly speaking, this shortage does not only apply to doctors, but also to all healthcare professionals in general (doctors, nurses, etc) 'nurses are forced to take on expanded roles without receiving appropriate training or supervision, and pa2ents oEen not get seen by a doctor in circumstances where that level of exper2se is required', says Dr. Lessells. The vicCm in this whole shortage scenario is not the paCent, as one would feel but the whole health care system. The high burden also puts a strain on doctors who are present which can lead to ‘burn out’ thus perpetuaCng a vicious cycle where doctors do not want to stay and thus the shortage conCnues and puts strain on the next group of doctors. 'This causes high aAri2on rates, the inability to aAract and retain staff in the public sector, which results in chronic understaffing' added Dr. Cloete van Vuuren, a physician and an HIV specialist working at the University of the Free State. According to Dr. van Vuuren, the implicaCon of this to the paCent is long queues and waiCng Cmes. by Lungani Ndwandwe & Tulio de Oliveira 3
SATuRN Newsle-er, vol. 1, number 1, March 2012
More follow-‐up data on phase 2 trial of bedaquiline (TMC-‐207) Author: Richard Lessells -‐ 2012-‐03-‐15 “Bedaquiline (TMC-‐207), a diarylquinolone, is an anC-‐TB drug based on a novel mode of acCon (inhibiCon of ATP synthase). IniCal results from a phase 2 randomised, double blind, placebo-‐controlled trial were reported in the New England Journal of Medicine in 2009. A new arCcle published ahead of print in AnCmicrobial Agents and Chemotherapy provides longer term follow-‐up data on efficacy and safety up to 104 weeks.” Link: h-p://www.bioafrica.net/blogs.php?id=10
Poetry: Toward A SATuRN Hope Author: Joshua Machao -‐ 2012-‐03-‐14 “SATuRN With her circles of concern Stands firm despite fires that burn Whether you are home-‐schooled or college Let us all recognize and pay homage To her rings of infinite knowledge
Drug resistance in Mycobacterium tuberculosis: do sputum specimens tell us everything? Author: Richard Lessells -‐ 2012-‐03-‐14 “The diagnosis of drug resistance in pulmonary TB generally relies on performing suscepCbility tests either directly on sputum specimens or on the isolate grown in sputum culture. An interesCng arCcle in Clinical InfecCous Diseases addresses the quesCon of whether the suscepCbility pa-ern in sputum tells the whole story.” Link: h-p://www.bioafrica.net/blogs.php?id=9
Social Worker perspecCve: Adolescents on anCretroviral (ARV) therapy -‐ a VideoBlog Authors: Pre5y Nkosi, Nokuthula Skhosana, Lungani Ndwandwe and Tulio de Oliveira “AnC-‐retroviral therapy (ART) social workers from Africa Centre for Health and PopulaCon Studies work with adolescents as part of the Hlabisa HIV and Care Treatment Program. At the end of 2011 they organized many acCviCes, including a four day workshop during the school holidays. targeted at adolescents, aged 12+ on ART, most of whom were failing ART.” Link: h-p://www.bioafrica.net/blogs.php?id=6
‘Totally drug-‐resistant' tuberculosis in India: should we be worried? Author: Richard Lessells -‐ 2012-‐01-‐23 "A recently published report of tuberculosis strains resistant to all tested first-‐ and second-‐line anC-‐TB drugs in Mumbai has garnered much a-enCon in the media. What has actually been reported: Is this a new form of TB? What is the significance for global TB control?" Link: h-p://www.bioafrica.net/blogs.php?id=2
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SATuRN Newsle-er, vol. 1, number 1, March 2012
Blogs: our work and other related topics of interest
We need the new tools to fight the new challenges We must adapt or die The gauntlet truth has never been more apparent We must change Aver all Our enemy changes shells every so oven Mutates into a mulCplicity of variants” Link: h-p://www.bioafrica.net/blogs.php?id=8
Twi5er: SATuRN Microblog We use twi-er to interact with our community. We have a growing number of followers and we are also following informaCon with many interesCng organizaCons. Please follow us at: h-ps://twi-er.com/#!/drug_resistance h-p://www.bioafrica.net/15minutes.php
Report: Transmi5ed Drug Resistance data now more accessible through HIVDB GIS Tool
A new interacCve Geographic InformaCon System (GIS) displaying studies of HIV-‐1 Drug Resistance in ARV-‐Naive
populaCons has just been added to the ever-‐expanding HIV drug resistance monitoring tools developed by Stanford HIVDB group and their collaborators (Rhee et al. CROI 2012). The system uses published data to create snapshots of HIV transmi-ed drug resistance (TDR) levels across the globe. The data currently used is available through Genbank and include data from more than 51 publicaCons in Africa. Authors: Justen Manasa, Gillian Hunt, Tulio de Oliveira Link: h-p://www.bioafrica.net/report.php?id=11
A Report of the Center for Global Development's Drug Resistance Working Group Links: h-p://www.bioafrica.net/report.php?id=10 , h-p://www.cgdev.org/content/publicaCons/detail/1424207
In an increasingly interconnected world, problems with drug resistance have moved from the paCent's bedside to threaten global public health… The conclusions of the Center for Global Development’s Drug Resistance Working Group make clear the need for urgent acCon to address this growing crisis. 5
SATuRN Newsle-er, vol. 1, number 1, March 2012
Disclaimer: The SATuRN consorCum wishes to express its graCtude to the following funders for their generous support for the producCon of this report: European Commission (EC), Centers for Disease Control and PrevenCon (CDC funding for SoPH/UWC and CAPRISA), President's Emergency Plan for AIDS Relief (PEPFAR), InternaConal Development Research Centre (IDRC), Council for ScienCfic and Industrial Research (CSIR) Swiss / South Africa iniCaCve and the Wellcome Trust. The SATuRN newsle-er is published as open access under a CreaCve Commons ShareAlike 3.0 Unported (CC BY-‐SA 3.0) license (h-p://creaCvecommons.org/licenses/by-‐sa/3.0/) and is available in printed format as well as electronically as PDF, Web-‐format, etc. The contents of this report and the opinions expressed herein are solely the responsibility of the authors and do not necessarily represent the official views or policies of any of the funders.
Featured open access publicaCons
Primary drug resistance in South Africa -‐ data from 10 years of surveys. Manasa J, Katzenstein D, Cassol S, Newell ML, de Oliveira T, AIDS Res Hum Retroviruses 2012 Mar 12 [Epub ahead of print] EvaluaCon of tuberculosis diagnosCcs: establishing an evidence base around the public health impact. Lessells RJ, Cooke GS, Newell ML, Godfrey-‐Fausse- P, J Infect Dis 2011; 204: S1187-‐95 InternaConal spread of mulCdrug-‐resistant tuberculosis from Tugela Ferry, South Africa. Cooke GS, Beaton RK, Lessells RJ, John L, Ashworth S, Kon OM, Williams OM, Supply P, Moodley P, Pym AS, Emerg Infect Dis 2011; 17: 2035-‐2037
Upcoming Events
May 2012 Aug 2012 Nov 2012
1st Nurses and Health Care Workers HIV & TB Drug Resistance Workshop, Africa Centre for Health and PopulaCon Studies, Somkhele, South Africa, 17 May 2012. 17th InternaConal BioInformaCcs Workshop on Virus EvoluCon and Molecular Epidemiology University of Belgrade, Faculty of Medicine, Belgrade, Serbia, 27 -‐ 31 August 2012 7th Southern African HIV / TB Drug Resistance & Clinical Management Workshop, Cape Town, South Africa, 28-‐29 November 2012
SATuRN Newsle-er, vol. 1, number 1, March 2012
For more informaCon on how to parCcipate in SATuRN acCviCes please contact:
Dr. Tulio de Oliveira, Africa Centre for Health and PopulaCon Studies, UKZN, South Africa. Tel : +27 35 550 7500, Fax: +27 35 550 7565, e-‐mail : [email protected] Prof. Chris Seebregts, South African Medical Research Council, South Africa. Tel: +27 21 938 0318, Fax: +27 86 683 2449, E-‐mail: [email protected]
Funded by:
