The International AIDS Symposium (IAS) Conference 2017 was a wealth of cutting edge research and discussion on HIV and AIDS, and the representatives from the Desmond Tutu HIV Foundation (DTHF) were no exception.
Linda-Gail Bekker at IAS 2017 | IAS Steve Forrest Workers Photos
Opening the conference was our own Prof Linda-Gail Bekker, the IAS President and International Scientific Chair of IAS 2017. Bekker spoke about the need to maintain levels of funding to continue the fight against HIV, as now it is critical to keep up momentum for all the progress that has been made.
Much of that progress is ongoing at DTHF, with researchers looking at all areas of the disease, from virological to social. HIV is a complex virus to combat and the variety of the research presented is testament to the importance of funding.
Katherine Gill presenting at IAS 2017 | Roger Peabody, AIDSmap
Dr Katherine Gill presented the results of the Plus Pills study, where Prof Bekker was principal investigator. This study is an evaluation of how South African adolescents between 15-19 respond to a daily pill of PrEP (Truvada) as part of their HIV prevention toolbox. Around 150 Capetonian and Sowetan adolescents who were already sexually active and at risk of HIV infection signed up for the study.
During the study, the number of STIs overall in the cohort decreased and there was one incident of HIV. However, this participant opted out of the study prior to diagnosis. It has been noted for studies of this nature worldwide that adolescents find it difficult to adhere to a daily dose of PrEP. This age range needs tailored adherence support with scheduled clinic visits, or a new method that requires less-frequent dosing.
A Vaginal Ring | International Partnership for Microbicides
Continuing the topic of HIV prevention was Lulu Nair, who presented the rationale for a PrEP and dapivirine vaginal ring study among young African women aged 16-21 years (The REACH study). The vaginal ring releases an antiretroviral over a period of one month. Young women are especially vulnerable to HIV because of economic, social and behavioural factors which make behaviour dependent methods such as condom use difficult. In addition, there is limited access to youth friendly health services were staff is non-judgmental with respect to adolescent sexual behaviour. While injectable prevention methods and a vaccine hold promise for the future, the REACH Study will investigate the safety and acceptability of the only 2 currently proven HIV prevention methods. It will also provide information on preference for PrEP or the vaginal ring when there is an option to choose.
The REACH study will enrol 300 female participants and offer them a combination of the vaginal ring and PrEP. These data will be essential for future roll out of the preventative products, but also to find out if regulations should be expanded to include girls under 18 years old.
Lulu Nair at a panel at IAS 2017 | DTHF
Dr Millicent Atujuna presented her research on how family household structures can affect whether adolescents take the HIV-prevention drug, PrEP. Youth are a key population that are vulnerable to unique barriers when accessing HIV prevention tools, including prejudices at home. The study, that took place in Cape Town, South Africa, questions 50 participants who were HIV negative and sexually active to explore what sorts of familial support are available.
Three main types of family support structure were found: the close-knit family who actively support their children’s prevention choices, the loose-knit family who gave no support and the family that gave passive support. The majority of the adolescents had disclosed their PrEP usage to the family, but over a quarter had kept it a secret. Atujuna commented that “In general, we found support to be fundamental to PrEP use; however, family support empowered youth more than partner support, highlighting its important role in the adoption of HIV prevention behaviors.” Youth from close-knit families had greater agency (ability to negotiate safe sex, more defined future aspirations and placed a higher value on remaining HIV free). Whereas youth from loose knit families demonstrated less ability to negotiate safe sex, although they tended to seek more partner support for product use.
Millicent Atujuna at IAS 2017
Another project presented by Atujuna was the results from a prototype questionnaire for women about their PrEP-use. The process took a questionnaire and examined how participants understood the questions, how the translations between English and isiXhosa were understood and how to frame questions for good-quality data. In order to have reliable data to analyse, the team needs reliable questions; this paper ensures that when the large-scale studies begin they will gather the best quality data.
Phillip Smith presents a poster ar IAS 2017 | DTHF
Also presenting a poster was Phillip Smith, whose research looked at the suitability of a web-based form where participants can watch a video and decide if they want to order an HIV test. The majority of South Africans who are HIV positive are unaware of it, which means they can’t actively seek treatment. HIV self-testing has been shown to be a feasible method to reach some of this population and increase access to care.
Of 200 participants who took the questionnaire, three quarters of them decided to order a home-based HIV test. The majority of the participants who used the delivery service felt it was a more positive experience than going to a clinic and it was rated 4.7 out of 5.
Another poster of research was displayed by Rebecca Marcus, who has been researching the impact of offering HIV testing and other healthcare services at the DTHF Youth Centre. Adolescents are a key population for new HIV infections and statistically are less likely to seek healthcare in a clinical setting. Young women incur around 2000 new HIV infections a week (2) and 25% of young women have had a pregnancy by 19 (1). There is clearly a need to target this age group which is why the Youth Centre began offering adolescent-focused health services.
Katherine Gill, Giuseppe De Gouveia, Rebecca Marcas, Phillip Smith (Left to right) at IAS 2017 | DTHF
When comparing the number of adolescents using the Youth Centre health clinic to the City of Cape Town clinic, the Youth Centre had a higher number of adolescents using their services. Not only does this imply that youth are more likely to use services if they are geared towards them, but they are also more likely to test for HIV, particularly in young men. This is why adolescent-friendly services, like the Youth Centre, are necessary for the prevention and treatment of HIV. The next stage of this research will be to discover the factors around why adolescents are reluctant to test for HIV with an aim to creating youth-friendly spaces elsewhere.
We want to offer our congratulations to all the presenters, as well as the many many other researchers who worked for these incredible results. There is so much that happens at DTHF that it is difficult to cram it all into one conference!
Article courtesy of The Desmond Tutu HIV Foundation
1. Shisana et al South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. In. Cape Town; 2014
2. G Mchunu et al. Adolescent pregnancy and associated factors in South African Youth.