Background: Primary Health Care in South Africa is being re-engineered to create a model of integrated care across different levels of the health care system. From hospitals to clinics, in the community and in the home, health care will focus more on prevention, health promotion, and advocacy for healthy lifestyles and well-being, in addition to clinical services. We provide a best-practice model of integrating community health workers (CHWs) trained as generalists into a multi-level health system in the Oliver Tambo district of the rural Eastern Cape.
Methods: Based at Zithulele Hospital, a health care network between the hospital, 8 clinics, and 50 CHWs has been created. The functions of each tier of care are different and complementary. This article describes the recruitment, training, supervision, monitoring, and outcomes of CHWs who deliver maternal, child health, nutrition, and general care through home visits.
Results: CHWs, especially in rural settings, can find and refer new TB/HIV cases, ill children, and at-risk pregnant women; rehabilitate malnourished children at home; support TB and HIV treatment adherence; treat diarrhoea, worm infestation, and skin problems; and distribute vitamin A. CHWs provide follow-up after clinic and hospital care, support families to apply health information, problem-solve the health and social challenges of daily living, and assist in accessing social grants. Case examples of how this model functions are provided.
Conclusion: This generalist CHW home intervention is a potential model for the re-engineering of the primary health care system in South Africa.
L.A. Trans* Health Summit: Creating Comprehensive Services for the Trans* Community
This is a free one-day event designed for consumers, community members, and providers who are interested in initiating or improving services for the trans* community.
Download the flyer here. (32)
Join us as we explore the health and HIV needs of trans* communities, discuss strategies for providing comprehensive and culturally competent care services for the trans* community, learn more about HIV biomedical interventions and their potential impact on the trans* community, and discuss how to navigate the health and
HIV care system to support trans* health.
This event will take place on June 30, 2015, 8:30am-4:00pm (registration starts at 8am), at St. Anne’s Maternity Home, Foundation Conference Room,
located at 155 N. Occidental Blvd., Los Angeles. Continuing Education Credits (CEUs) will be offered, however registration is required.
Continental breakfast, lunch and raffle prizes will be provided.
For more information, please feel free to contact me. Otherwise, please RSVP/register at: http://hivdatf.org/2015trainings/trans-health-hiv/ .]]>
Dr. Williams' Slides (42)
David R. Williams, PhD
Florence and Laura Norman Professor of Public Health,
Harvard T.H. Chan School of Public Health
Professor of African and African American Studies and of Sociology, Harvard University
“Research on Discrimination and Health: Lessons for the Study of HIV”
Monday, March 30, 2015
12:00pm to 1:00pm
UCLA CFAR/AIDS Institute Grand Rounds
This monthly lecture series, which is offered by the UCLA CFAR / AIDS Institute, consists of hour-long lunchtime lectures, delivered by invited guests or distinguished members of the Institute faculty, on a broad range of subjects. The aims of the program are to highlight important developments in AIDS-related research, encourage collaborations between UCLA investigators and invited speakers, interest young investigators in AIDS research, and provide information about new findings and new funding opportunities.
CHIPTS Methods Seminar – UCLA-Semel Institute Center for Community Health
Recognizing Trust and Understanding as Twin Pillars of Statistical Ethics
Thomas R. Belin, PhD Professor UCLA Department of Biostatistics Monday, March 9, 2-3pm Center for Community Health, UCLA Wilshire Center 10920 Wilshire Blvd., Suite 350, Conference Room
Accepting the imperative for professional ethics in the field of statistics to be codified, how might it be possible to encompass the scope and generality of what statisticians do into a complete yet digestible set of guidelines? Drawing on reflections by leading statisticians on the field’s essential elements, scientific insights regarding the human condition, and philosophical discourse on the ethics of interpersonal interactions, it is argued that trust and understanding are essential core principles that can serve as the basis for a test of whether a statistical approach is ethical. The framework’s simplicity makes it easy to communicate, its generality gives it power, and its positive-sum appeal could be used to promote professional identity development around ethics. Adopting trust and understanding as twin pillars of statistical ethics thus offers great potential as a strategy to elevate statistical practice, to enhance the reputation of the field of statistics as a discipline, and to contribute to society both by advancing knowledge and by serving as a beacon for the highest standards of integrity. The presentation will include illustrations of true statements that are misleading, giving rise to predictable misunderstandings that in the long run damage trust, and will underscore how the scientific perspective underlying the field of statistics can help guard against breaches of trust and strengthen the social fabric in our communities.]]>
Evidence that HIV and hepatitis C are spreading among intravenous drug users is prompting more state and local officials to consider setting up needle exchanges—including some who had been resistant to such programs.
The problem comes in tandem with rising intravenous use of heroin and prescription painkillers nationwide.
In Kentucky, Democratic Gov. Steve Beshear last week signed a bill into law aimed at combating the state’s epidemic of heroin and painkiller abuse. One provision allows local health departments to set up needle exchanges after obtaining approval from city and county governments.
To read the full article, click here.]]>
The 80 cases in Scott County, in the state’s southeast, were attributed to intravenous drug use.
Gov. Mike Pence said the infections constituted an epidemic, and he pledged state resources to help local health officials contain the virus. In his emergency declaration, which lasts 30 days, Governor Pence authorized a short-term, state-supervised needle exchange program that would provide drug users with access to safe needles.
To read the full article, click here.]]>
To date, an estimated 78 million people have become infected, 39 million of whom have died.
As the true scale of the virus’s devastation began to emerge, a number of scientists set out to investigate its origins. Piece by piece, year after year, the scientists reconstructed its history. Their research slowly revealed that the virus did not make a single leap from animals, but several.
To read the full article, click here.]]>
To view Dr. Coates’ presentation, please click here.
To view other presentations on the “Current Imperatives in HIV Prevention and Treatment” panel, please click here.]]>
CROI 2015, February 23-26, 2015, Seattle, Washington
FACTS 001, a double-blind placebo-controlled phase 3 trial, found that tenofovir 1% vaginal gel did not protect South African women who used it before and after sex from acquiring HIV infection . As in the VOICE trial , poor adherence appeared to contribute to tenofovir gel’s failure in the 2000-woman FACTS study. So far only a 900-woman phase 2b study, CAPRISA 004 , found that tenofovir gel protects women from HIV. FACTS findings proved particularly disappointing because the trial went to some length to encourage good adherence to gel use.
FACTS 001 enrolled 18- to 30-year-old HIV-negative sexually active women willing to use effective contraception and condoms. Researchers randomized over 2000 women to tenofovir 1% gel or to placebo and instructed women to apply the gel 12 hours before and within 12 hours after sex, the same schedule used in CAPRISA 004. All women received intensive ongoing counseling on gel adherence and HIV risk reduction. Study participants made monthly visits for HIV testing, safety checks, and new gel. A case-cohort substudy of 214 women assessed tenofovir levels in cervicovaginal fluid collected monthly.
The FACTS efficacy analysis involved 1015 women randomized to tenofovir and 1014 randomized to placebo More than 90% of women attended study visits. Median age of the study group stood at 23, collectively younger than women in VOICE or CAPRISA 004. Almost 90% of women were single, and almost two thirds were living with parents or siblings, so they probably were not having sex at home, where applying gel before and after sex would be more convenient.
In both study arms 56% of women had secondary or higher education. Only one third of women reported consistent condom use, and only 1% reported anal sex. Few study participants–18% in the tenofovir arm and 17% in the placebo arm–said they perceived greater than usual HIV risk in the past 28 days. Women had a median of 1 sex partner in the past 28 days.
After more than 1500 person-years of follow-up, the investigators counted 61 HIV infections in the tenofovir group and 62 in the placebo group. HIV incidence was precisely the same in both study arms–4.0 per 100 person-years (95% confidence interval [CI] 3.1 to 5.2). As a result the incidence rate ratio comparing the tenofovir group with the placebo group sat squarely at 1.0 (95% CI 0.7 to 1.4).
In the case-cohort analysis of 1075 samples from 214 women, tenofovir could be detected in 64% of cervicovaginal samples. Two thirds of women had detectable tenofovir at some quarterly visit, 22% had detectable drug at all quarterly visits, and 13% never had detectable tenofovir.
In an analysis adjusted for age, HSV-2 status, living with parents, and baseline factors related to HIV incidence, women who had detectable tenofovir in cervicovaginal samples and reporting sex in the past 10 days had lower HIV incidence that women using placebo (adjusted hazard ratio 0.48, 95% CI 0.23 to 0.97). That result indicated 52% protection with tenofovir (P = 0.04).
Considering all adherence data, the FACTS 001 team calculated that women used gel for an average of 50% to 60% of sex acts. The investigators concluded that “the majority of participants were not able to achieve sufficiently high levels of gel coverage required for protection.” They stressed the “urgent need for a range of HIV prevention options for young women which may be easier to integrate into their lives.”
1. Rees H, Delany-Moretlwe SA, Lombard C, et al. FACTS 001 phase III trial of pericoital tenofovir 1% gel for HIV prevention in women. CROI 2015. February 23-26, 2015. Seattle, Washington. Abstract 26LB.
2. Marrazzo JM, Ramjee G, Richardson BA, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509-518. http://www.nejm.org/doi/full/10.1056/NEJMoa1402269
3. Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168-1174. http://www.sciencemag.org/content/329/5996/1168.long
Click here for the webcast.]]>
To learn more about Dr. Landovitz, please visit http://chipts.ucla.edu/people/raphael-landovitz/
For other presentations from CROI 2015, please visit http://www.croiconference.org/]]>