To improve the quality of care in district hospitals in Lesotho
This involves developing several vignette and simulation exercises divided by three disease areas that are (i) maternal and newborn health/obstetric and neonatal care (with simulation); and (ii) communicable diseases (TB and AIDS) and (iii) emergency care. After the first year of the programme's inception, it was expanded to all hospitals in Lesotho.
Lesotho Perinatal Death Review
Strengthening and scaling up the current system of perinatal death reviews and response
To develop an operational plan for strengthening and building district systems for both maternal and newborn death reviews, assessments and response at facility, community, district, and national levels.
PMTCT Cohort monitoring
Improving Paediatric HIV case-based surveillance at District level in South Africa
The PMTCT (prevention of mother to child transmission) programme has made huge strides in reducing mother to child transmission in utero and during delivery. However, the largest proportion of transmission now occurs during the first six months of the breastfeeding period. During this time, women may experience pronounced challenges to adherence and retention in care, which in turn impact negatively on viral suppression. Achieving complete elimination of MTCT will, therefore, require innovative strategies to achieve and maintain maternal viral suppression in the period after birth, while at the same time, promoting and protecting breastfeeding as a major child survival strategy. Preventing MTCT in the breastfeeding period depends largely on having the relevant maternal information available at the infant’s point of care, but to date, monitoring systems have not been able to track viral suppression rates in breastfeeding women, nor have they been able to understand the outcomes of these mothers and their HIV-exposed or infected infants. The PMTCT Cohort Monitoring project is an innovation that aims to make clinically relevant information about the MIP available to the clinician. By linking the mother and infant pair (MIP) at birth, and strengthening routine monitoring and follow-up systems through linking laboratory results and other relevant databases, the cohort monitoring project aims to improve the quality and coordination of care provided to the MIP, and track their outcomes over time. The project will initially be implemented in the Tshwane District.
The UP Research Centre has been instrumental in the development of the new national HIV guidelines: the Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) 2019, the 2019 Abridged ART Guideline, and the Consolidated ART Guideline (the latter is still under development). These guidelines reflect on new evidence, both scientific and operational, to ensure that SA’s ART and PMTCT programmes remain relevant, practical, and evidence-based. The PMTCT guideline includes a strong focus on maternal viral suppression, preventing MTCT during the breastfeeding period, and care integration for the mother-infant-pair. The 2019 Abridged ART guideline centers around the use of dolutegravir-containing regimens to achieve viral suppression and retention in care for adults, adolescents and children on ART, as well as the need for integration of ART and family planning services. The new construct and approach to the guidelines intend to create a practical and user-friendly tool to equip health care workers to provide the essential care needed for PLHIV in SA to have a long and healthy life.
More than 20 years ago the effective treatment for HIV became available, and the lifespan of HIV-infected adults in high-resource settings is approaching that of uninfected individuals. However, if therapy is interrupted, the virus generally rebounds in the blood to pretreatment levels due to the presence of viruses that persist and reactivate from the “HIV Reservoirs”. Curative therapies suitable for the millions of infected individuals have been sought, including strategies using therapeutic vaccines, chemotherapies paired with stem-cell transplant, chimeric antigen receptor cells, gene therapies, cytokines and antiretroviral therapy during acute infection. While many of these have reduced the HIV reservoirs and in two cases may have cured HIV infection, a better understanding of the mechanisms that allow persistence of the reservoir are needed to develop an effective, safe and economical cure. The HIV reservoirs of perinatally infected children are primarily established early in infection when their immune system is tolerogenic to foster a healthy gestation, postnatal colonization with commensal bacteria and tolerance of foods.
This study proposes to examine four mechanisms that could contribute to sustaining the HIV reservoirs and compare the contribution of each in children versus adults. Through studies of specimens collected prospectively from South African children known to have acquired HIV perinatally, their mothers and uninfected paediatric controls, parameters will be measured of each of these mechanisms to gain insight into the roles of these mechanisms in sustaining the infectious HIV reservoir. The knowledge gained regarding the relative contribution of these four mechanisms in children vs. adults should point to mechanisms most relevant to children and assist with developing interventions tailored to the unique mechanisms identified in children.
- Department of Health and Human Services; National Institutes of Health (Grant number: 1R01HD094719-01)