Study on ‘Test and Treat’ for Inmates Takes Flight

Inmates around the world are at higher risk for both TB and HIV. This week in Brandvlei correctional centre, TB/HIV Care will launch the local arm of a new Southern African study to help HIV positive inmates stay healthy.

In May 2016, the South African Government announced it will be adopting the World Health Organisation’s (WHO) new “test and treat” guidelines for HIV infected people, enabling immediate anti-retroviral (ARV) treatment upon HIV diagnosis. These guidelines will help place South Africa in the position to address at least one of the UNAIDS ’90-90-90′ treatment targets; that 90% of people who test HIV positive are initiated onto treatment. This policy was adopted after the seminal ‘START’ study showed that starting people on ARVs early helped to keep them healthy. If people stay adherent to treatment once started, their viral load drops and it also becomes much more difficult to transmit the virus.

The Department of Correctional Services, has been successful in screening high numbers of inmates for HIV, but treatment thus far has only been offered to inmates with CD4 counts of <500. The Treatment as Prevention (TasP) project supported by Evidence for HIV Prevention in Southern Africa (EHPSA) is designed to offer universal test and treat (UTT) as a feasibility pilot study within a correctional centre environment. EHPSA is funded by UK Aid from the Department for International Development (DFID) and Sweden and managed by Mott MacDonald. EHPSA so far has three research arms working with adolescents, prisoners and LGBTI communities. (http://www.ehpsa.org/).

The TasP study has three sites within Southern Africa; Lusaka, Johannesburg and Worcester with two local correctional facilities on board, Brandvlei and Worcester. TB/HIV Care Association (THCA) will be responsible for the Western Cape sites and THCA’s partners on this study, the Centre for Infectious Diseases Research in Zambia (CIDRZ) and the Aurum Institute will run the study from Lusaka and Johannesburg respectively. Although there have been significant delays in study initiation, ethics approval from the Department of Correctional Services (DCS) as well as the University of Witwatersrand has been granted for South African sites.

THCA will commence the study this week from an office set up at Brandvlei training centre. This will also provide a home base for the study team working at both Brandvlei and Worcester correctional facilities. The study team consists of Phunyezwa Langa (Professional Nurse Counsellor), Earl Titus (Data Monitor), Irene Mokwena and Mzi Fosi (Research Assistants) and three HAST counsellors, Angie Solomons, Vanessa Solomons and Juliana Baadjies. THCA are in the process of procuring additional staff members for the Worcester site. THCA believes in expanding staff skillsets and in this spirit, most of the study team have attended workshops and training courses aimed at providing additional training.

The specific study objectives are to (1) describe the continuum of THCA under TasP/UTT by using several key indicators; (2) identify health-system, socio-cultural and inmate barriers and/or facilitators of TasP/UTT to refine TasP implementation; (3) characterize the resources needed and steps taken to achieve a functioning TasP/UTT program within the correctional environment; and (4) identify key policy stakeholder concerns and questions to facilitate TasP/UTT scale-up within correctional facilities in Southern Africa.

To assist study teams recruiting inmates at the various sites, consent and case report forms (CRFs) have been designed to accurately record data for capturing on an electronic database. Currently, CIDRZ has started recruiting inmates onto the study and the THCA team is receiving training on the finalised CRFs and electronic database the will be used to garner data from consented inmates. The THCA study team has started a support group for inmates that are infected/affected by HIV/TB and they have meetings once a week. A novel way to reach more inmates about the study and the work that THCA is doing within correctional facilities, was to use the local radio station at Brandvlei. Angie and Vanessa were invited to give a brief introduction of TasP on air and subsequently THCA has been invited back to give health and wellness talks in scheduled regular slots.

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