Developing new strategies to fight HIV/Aids

South Africa has the largest HIV epidemic in the world.

Estimates indicate that 5.6-million people in our country are living with HIV. It has also been shown that Aids is the biggest killer in South Africa, causing 30% of deaths. As South Africa’s largest pathology group, the National Health Laboratory Service (NHLS) has as its top priority the national department of health’s need to provide increased access to patient testing and treatment.

The NHLS’s national priorities programme (NPP) was established earlier this year for this purpose. With its 268 laboratories countrywide, serving about 85% of the population and employing world- renowned pathology researchers, the NHLS is in a position to develop strategies to support our country’s global aim of zero new HIV infections.

There has been a vast improvement of diagnostic services by the NHLS to support the efforts of better access to care of HIV-infected individuals, with 65 laboratories testing CD4 counts and 11 specialising in early infant diagnosis of HIV. Medical professionals refer to the CD4 count to decide when to begin treatment during HIV infection.

Viral load tests provide important information that is used in con- junction with the CD4 cell count to monitor the status of HIV disease, guide recommendations for therapy, and to predict the future course of HIV. Evidence shows that keeping the viral load levels as low as possible for as long as possible decreases the complications of HIV disease, slows the progression from HIV infection to AIDS, and prolongs life.

Approximately 1.3 million viral load tests were performed last year in 16 HIV molecular laboratories. The NHLS this year launched a study to investigate point-of-care (POC) testing. The study will determine the feasibility of POC testing for HIV/TB diagnosis, treatment initiation and monitoring.

POC testing is performed outside the laboratory, near the patient or at the patient’s bedside and results are immediately available to the doctor. The cost-saving benefits of POC testing include shorter hospitals stays and reduced transport costs for out-patients travelling back to get results.

The NPP will also develop training programmes for nurses to operate POC tests. This type of testing will be particularly useful in rural areas hampered by lack of laboratories, technical skills and poor integration of HIV and TB services.

The centre for HIV/STIs (sexually transmitted infections) within the NHLS conducts research primarily on the virology and immunology of HIV and also provides a key role in HIV drug-resistance surveillance for the national department of health. NHLS researchers are constantly conducting studies to identify gene or antibody candidates for vaccine development or other compounds to prevent HIV infection.

Research into how broadly neutralising antibodies develop in HIV-1-infected individuals is being conducted. This research will assist with guiding vaccine design and immunisation strategies. In addition, the role of other host immunological responses towards HIV is being investigated to assess how these control HIV infection.

The NHLS is currently spearheading various HIV surveillance programmes on behalf of the national department of health. These include programmes to evaluate the effectiveness of the national prevention of mother-to-child transmission programme and the annual antenatal HIV-1 prevalence survey.

These surveys provide relevant information about the HIV epidemic in South Africa, including the national prevalence of HIV in pregnant women, as well as the number of new HIV infections in South Africa over a given period.

This article originally appeared in the Mail & Guardian newspaper as an advertorial

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