THE TREATMENT RESEARCH DIVISION
The DTHF is involved in researching new and more effective therapies, drug classes, and antiretroviral drug combinations that can extend and improve the quality of life for people living with HIV/AIDS. Our research began at Somerset Hospital in the early 1990s and focused on early antiretroviral drug trials. These have continued at Groote Schuur Hospital where we have established the University of Cape Town Clinical Research Centre, a dedicated clinical trials unit in partnership with the University of Cape Town’s Departments of Medicine and Pharmacology.
The treatment division was instrumental in supporting the roll-out of antiretroviral treatment in Cape Town. The DTHF, in partnership with the Western Cape Department of Health, established one of the first dedicated community ART clinics, the Hannan Crusaid Treatment Centre in Gugulethu. In 2005, the treatment division facilitated ART initiation in Masiphumelele through the Cipra-SA Project 1 ART trial. This study compared ART treatment outcomes between patients managed by nurses and those managed by doctors. Both these sites also received Pepfar support via the DTHF.
Alongside the initiation of life saving interventions, comprehensive databases were developed in both these patient cohorts and this data, which has been meticulously collected over many years, has contributed to our understanding of the impact of the antiretroviral treatment programs at a community level in South Africa.
The operational research carried out at both Hannan Crusaid and Masiphumelele has helped inform HIV policy and guidelines in South Africa as well as contributing to national and international collaborations including the IeDEA Network, The Harvard University Center for AIDS Research and the South African Centre for Epidemiological Modelling and Analysis (SACEMA)
Assoc Prof Catherine Orrell, whose research focus is on adherence to ART treatment and care, recently completed the TAP study at the Hannan Crusaid Treatment Centre. This study aimed to determine whether a real-time electronic adherence monitoring device with text message and dosing feedback improved adherence, retention in care and virological outcomes among patients receiving new antiretroviral therapy.
Prof Orrell and her team are currently recruiting patients for the following studies:
- The META study which aims to measure early treatment adherence in different cohorts of HIV-positive patients. This study which is funded by the Bill and Melinda Gates Foundation is a collaboration with Professor David Bangsberg and Dr Jessica Haberer of Harvard Medical School and will be carried out at two research sites in Uganda and South Africa. This study recruits people starting ART, either with a low CD4 cell count (<200) or a high CD4 cell count (>350).
- Use of ARV Drug Levels in DBS to Assess and Manage ART Adherence in South Africa (the ADD-ART study). This prospective study will determine the ability of the DBS TFV-DP assay to provide an objective, clinically relevant, and actionable measure of adherence in low-resource settings. This study will recruit people with suppressed viral loads at 4 to 24 months into ART.
- ART Refusal Study which will examine the correlates and outcomes of HIV treatment refusal in an adult South African cohort. This study will recruit people who have not yet commenced ART.
Recruitment: Ethics and Department of Health or City of Cape Town approvals are always obtained prior to recruitment commencing
- The studies recruit from the following Provincial DoH clinics:
- Hannan Crusaid Treatment Centre, on the same site as the GRO.
- Nyanga Clinic, a Provincial Department of Health (DoH) service of similar magnitude to the Hannan Crusaid Treatment Centre.
- The studies recruit from the following City of Cape Town Clinics:
- NY 1 and Vuyani clinics
Prof Linda-Gail Bekker, Dr Richard Kaplan and Sr Lulu Mtwisha from the DTHF in collaboration with Judy Caldwell and Sr Shabirah Adriaanse from Cape Town City Health helped establish the integration of antiretroviral and TB services in the Cape Town metropole. This exciting and important collaborative project began as a pilot project at the Nyanga CHC. The integrated adherence support programme for TB and HIV patients that was developed for this project was adopted as provincial policy and rolled out in the Cape Metro. A further integration project was carried out at the Masincedane Clinic in Nyanga and Dr Richard Kaplan and Judy Caldwell continue to collaborate on epidemiological research evaluating the impact of ART on treatment outcomes in the TB primary care service in Cape Town.
Christie Heiberg – Christie.Heiberg@hiv-research.org.za