1. Southern African HIV Clinicians Society's strategic imperatives Dr Francesca Conradie President of the SAHCS

2. Non-profit membership organisation of HIV health care workers Formed in 1997 by Prof Des Martin to help coordinate response to HIV/AIDS epidemic Governed by an eight member elected Board of Directors WHO ARE WE?

3. Society membership is inclusive of all health care workers in HIV: doctors, related professionals, nurses and 2012 greater focus on lay HCWs as well Approximately 3 700 members 58% doctors; 50% public sector 50% private sector 28% nurse; 5% pharmacist 85% South African, remaining largely Southern African (Botswana and Namibia) 37% reside in Gauteng; ~15% KZN, Western Cape and Eastern Cape each Paediatrics is the largest reported specialty WHO DO WE SERVE?

4. To promote quality comprehensive, evidence-based HIV healthcare in Southern Africa MISSION & OBJECTIVES

5. Objectives: To partner with governments to implement optimal HIV programmes and policies To foster evidence-based HIV related education for healthcare workers To produce evidence-based guidelines To facilitate interactions amongst HIV healthcare workers to optimise patient care To expand access to the activities of the Society To advocate for the best possible HIV treatment, care and prevention To improve TB diagnosis, care and prevention within the context of the HIV epidemic MISSION & OBJECTIVES

6. Presented at the TB Conference 2012 By Dr. Francesca Conradie To provide high quality, evidence-based information and resources to HIV health care workers “Voice of reason” Focus more resources to nurses (e.g. HIV Nursing Matters, clinical tip, nurse training, developing capacity, supporting health systems strengthening, leadership hubs) To develop regional foot-print To run first clinical conference focusing on HIV medicine in Southern Africa WHAT IS OUR MANDATE 2012?

7. Presented at the TB Conference 2012 By Dr. Francesca Conradie Southern African Journal of HIV Medicine HIV Nursing Matters magazine Clinical practice guidelines Website: clinical case study programme & searchable provider directory SMS clinical tips Limited Bursaries and educational opportunities Bi-annual clinical conference CPD-accredited branch meetings & Leadership Hubs PROGRAMMES & ACTIVITIES

8. NATIONAL HIV PREVALENCE TRENDS (1990 – 2010) SANDOH. National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa. 2011

9. What has been achieved so far? Treatment Prevention Then Treatment as prevention?

10. Numbers 1.8 million on antiretroviral therapy in public sector +/- 200 000 in private sector Successful program Reduction in mother to child transmission 3.5% Increase in life expectancy

12. Prevention Generally not successful Drivers of the epidemic different in different places, ages etc Behaviour difficult to change Very high awareness of HIV in South Africa in general. Voluntary medical male circumcision.

13. Prevalence by Gender

14. Treatment as prevention Pivotal study done, HPTN 052. Discordant couple- one HIV+ and one HIV- One arm was given antiretroviral therapy at a high CD4+ and one arm at CD4+ of 250.

17. Total HIV-1 Transmission Events: 39 HPTN 052: HIV-1 Transmission Immediate Arm 4 Delayed Arm 35 p < 0.0001

18. Total HIV-1 Transmission Events: 39 HPTN 052: HIV-1 Transmission Linked Transmissions: 28 Unlinked or TBD Transmissions: 11 p < 0.001 Immediate Arm: 1 Delayed Arm: 27 18/28 (64%) transmissions from infected participants with CD4 >350 cells/mm 3 23/28 (82%) transmissions in sub-Saharan Africa 18/28 (64%) transmissions from female to male partners

19. Treatment as prevention Pre- exposure prophylaxis (PrEP) – Truvada – For both heterosexual and homosexual transmission. – Recently approved by the FDA Microbicide - CAPRISA 004 (UKZN)

20. Public enemy No.1 TB

22. Incidence in SA (https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=ZA&o uttype=html

23. The easy answer.

24. The tough answers Policy reasons Diagnostics Treatment Research

25. Diagnostics

26. HIV

27. Diagnostics Time to diagnosis

28. Microscopy Acid fast bacteria visualized on a slide may represent M. tuberculosis or non-tuberculous mycobacteria

29. Gene Xpert MTB/RIF Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance

36. National Strategic Plan for HIV, TB and STIs Very ambitious document www.doh.gov.za/docs/stratdocs/2012/NSPsum.pdf Know you epidemic Getting to zero

38. What are the good things? Political Commitment Dark Mbeki days are over Minister Aaron Motsaeledi

39. What are the challenges? Changing /decrease in international funding Uncertainty about PEPFAR, Global Fund Disbanding of SANAC and the re-formation. Poorly functioning health care system Lack of accountability between provincial and national authorities

40. Role of the SAHCS Brains trust – Training – Guideline development – Taking new research findings and turning them into policy Advocacy – Keeping government on track