Lyn@ Community Implementers Forum at the Birchwood Hotel, Boksburg on 24/11/2010

The FPD and the Compass Project launched the Community Implementers’ Guide to TB and HIV Research at a series of events.  This guide was developed with funding from the Kingdom of the Netherlands and the AIDS Foundation of South Africa.CABSA is one of the group of partner organisations of COMPASS, which also includes Soul City, The AIDS Consortium, LifeLine and NACOSA. Download resource below.

As usual, my brief notes from the event is limited by my typing speed, and I apologise to the very interesting and competent presenters if I do not give accurate reflection of their thoughts.  I repeat some of the points I heard. The presentations are available here. and a news report on the meeting here.

The day was introduced by Janine Mitchell from Compass. I later asked Janine why this was an important process for their organisation: (This was my first attempt at a mini video interview!  Thanks Janine for being my "guinea pig" Next time I will eliminate some of the mistakes!)

The aim of the community implementers’ knowledge management process is to ensure that the knowledge from conferences and academic events reaches the community level and makes an impact. 

Janine highlighted the relevant dates for the SA AIDS Conference in 2011 and encouraged the involvement of the NGO community.

The first speaker of the day was Prof Geoff Setswe, Head of the School of Health Sciences, Monash University, South Africa.  As always, he managed to convey the complexities of some of the international research in a clear and concise way.

What is Research? Social and Behavioural Interventions to Prevent HIV/AIDS,

Prof Setswe started with a explanation of What is seen as research evidence?

Strategies for obtaining research evidence:

Prof Setswe emphasised that not all research is viewed equally. In order to show that Certain approaches are classified more highly, he provided the following “pyramid” indicating which types of research is regarded as more credible

H e also proposed the following levels to evaluate the value of research evidence:

Proposed levels of research evidence:

• 80+% - Best evidence
• 60-79% - Good
• 30-59% Promising evidence
• Less than 30% - Poor or No evidence

Biomedical HIV prevention

Behavioural HIV Prevention Interventions

1. Condom use-
   1. Male Condoms -UNAIDS,  90% effective if consistently and correctly                                                             
      
      1. Safe and relatively effective for family planning
      2.   Condom use self report in SA increasing significantly in all age groups, with young people 15-24 particularly encouraging (85% M, 73% F) report condom use at last sexual intercourse.
      3. However, in younger adults, MCP also increased.

2. Abstinence only and ABC interventions
   1. Abstinence only programmes

2. No randomised studies of ABC programmes.  Anecdotal reports or reports of isolated small programmes show some success

3. Behavioural interventions that were successful in increasing knowledge did note necessary change behaviour for young people:

3. Voluntary counselling and testing
   1. Changes behaviour for those who are positive, but not for those who test negative
4. MCP
   1. SADEC think-tank: MCP with low consistent condom use in the context of low male circum
   2. As yet not agreement that there is Cross sectional studies, no RCT or observational studies conclusive evidence that MCP are key drivers of the HIV epidemic in Southern Africa
5. Structural social HIV prevention intervention
   1. Stepping Stones

2. IMAGE Study – Microfinance for AIDS and Gender Equity

Summary

Good evidence

Promising evidence

-          Stepping Stones and IMAGE on drivers of HIV

Poor evidence

However, this does not mean that we should stop these interventions:“Behavioural HIV Prevention works!” Dr Helene Gayle

There should not be a fight between behavioural and biomedical prevention interventions – behavioural interventions need to be targeted!

Lyn’s Comment: I think as community implementers we should seriously consider the way we operate and the implication this has on the amount of research available.  Many of what is anecdotally described as good or successful programmes are not documented accurately and the necessary pre and post implementation evaluation is not done.

Dr Kerrigan McCarthy, TB Technical Advisor, Reproductive Health and HIV Research Unit (RHRU), spoke about Integration of TB and HIV,

TB is the top killer of young people in South Africa!

If we understand the way in which the HIV and TB epidemics are intertwined and the drivers of the epidemics, we can create appropriate interventions.

The dilemma with TB is that it can for significant periods be latent and asymptomatic. When we have weakening immune systems, such as with HIV, it can lead to activation of the latent disease, and to the disease becoming infectious.

There are high levels of undiagnosed TB in communities with high HIV prevalence. In a study by Robin Wood et al individuals with TB were typically undiagnosed and infected for a period of more than a year.

More than 80% of South Africans in the study had latent asymptomatic TB infection!

Don’t wait! We need Integrated HIV/TB services now!

To end a very interesting morning, Dr Janet Frohlich of CAPRISA highlighted a few key points on “Combination HIV Prevention –Need for a paradigm shift in Community Involvement.”

Key issues:

There is a shift to greater and truer participatory methods and acknowledgement of community significance

Key to research success is that it should be shaped and informed by critical community input.

Social mobilisation through community partnerships is critical to their support

The ethics of community consultation should be considered in the planning, implementation and dissemination of research.

Acknowledge communities as change agents and advocates in combined prevention strategies!

Gerard Payne from the AIDS Consortium facilitated the Dialogue session. Some of the points raised included:

Much to soon the interesting morning was over.  Well done, Compass!