South African Healthcare Provider Perspectives on Transitioning Adolescents into Adult HIV Care

Background. The first generation of South African (SA) children perinatally infected with HIV is entering adulthood; and there is now a pressing need for systematised transfer of these patients from paediatric to adult care.Objectives. Previous research has investigated the HIV healthcare transition in North America and Europe; yet none has been conducted in SA. Our study is the first to describe the perspectives of healthcare providers overseeing the transition in resource-limited settings.Methods. We approached healthcare providers working in government paediatric HIV clinics and hospitals in the Western Cape Province; SA. Seven physicians and counsellors in adolescent/paediatric care; representing five clinics; were interviewed; and 43 completed a written survey. Interviews addressed the current state of the transition; barriers and facilitators; and model components. Interviews were assessed for major themes using framework analysis; while logistic regression was applied to survey responses to identify associations with measured covariates.Results. Analysis of interview transcripts revealed several overarching perspectives that were corroborated by survey responses. One barrier identified was the healthcare providers' difficulty in letting go of their relationships with the adolescent patients. Since healthcare providers regarded their patients as particularly vulnerable; they felt a strong and protective attachment towards them. A second barrier identified was a lack of structure and effective communication between adult and paediatric providers; accordingly; healthcare providers feared that they were transferring their adolescents unprepared; to a judgemental; depersonalised and overburdened environment. All interviewees and a majority of survey respondents (80%) agreed that the formation of adolescent support groups in adult care clinics as well as a later transition age would improve the transition process.Conclusion. This study highlights the need for a systematic healthcare transition for HIV-positive adolescents cared for in the Western Cape; while acknowledging the limitations of the current healthcare infrastructure. Several feasible recommendations have been identified; including forming support groups and greater involvement of adolescent healthcare providers to facilitate the transition

Southern African Guidelines on the Safe Use of Pre-Exposure Prophylaxis in Persons at Risk of Acquiring HIV-1 Infection

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline; it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations; including MSM; transgender persons; heterosexual men and women; HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective; safe; biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa; given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition; whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk; rather than continually and lifelong; as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion; but are not extensively covered in these guidelines

Southern African Guidelines on the Safe Use of Pre-Exposure Prophylaxis in Persons at Risk of Acquiring HIV-1 Infection

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline; it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations; including MSM; transgender persons; heterosexual men and women; HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective; safe; biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa; given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition; whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk; rather than continually and lifelong; as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion; but are not extensively covered in these guidelines

Attracting; Equipping and Retaining Young Medical Doctors in HIV Vaccine Science in South Africa

Background: HIV remains a significant health problem in South Africa (SA). The development of a preventive vaccine offers promise as a means of addressing the epidemic; yet development of the human resource capacity to facilitate such research in SA is not being sustained. The HIV Vaccine Trials Network (HVTN) has responded by establishing South African/HVTN AIDS Early Stage Investigator Programme (SHAPe); a programme to identify; train and retain clinician scientists in HIV vaccine research in SA.Objectives: The present study sought to identify factors influencing the attraction and retention of South African medical doctors in HIV vaccine research; to understand the support needed to ensure their success; and to inform further development of clinician research programmes; including SHAPe.Methods: Individual interviews and focus groups were held and audio-recorded with 18 senior and junior research investigators; and medical doctors not involved in research. Recordings were transcribed; and data were coded and analysed.Results: Findings highlighted the need for: (1) medical training programmes to include a greater focus on fostering interest and developing research skills; (2) a more clearly defined career pathway for individuals interested in clinical research; (3) an increase in programmes that coordinate and fund research; training and mentorship opportunities and (4) access to academic resources such as courses and libraries. Unstable funding sources and inadequate local funding support were identified as barriers to promoting HIV research careers.Conclusion: Expanding programmes that provide young investigators with funded research opportunities; mentoring; targeted training and professional development may help to build and sustain SA's next generation of HIV vaccine and prevention scientists