ICAP News - September 2009

EPIC Study Looks at HIV Transmission within Couples

The National Institute of Allergy and Infectious Diseases has awarded a $3.9-million grant to ICAP for a study on preventing HIV transmission within couples. The Enhanced Prevention in Couples (EPIC) study, which will take place in the southern African country of Lesotho, will be undertaken by a multinational team of researchers led by ICAP Global Director Wafaa El-Sadr, MD, MPH, and in collaboration with the National University of Lesotho and the HIV Center for Clinical and Behavioral Studies at Columbia University.

In Lesotho, an estimated one-quarter of adults are HIV infected, and the country has the third-highest seroprevalence rate in the world. HIV transmission within married or cohabitating couples has been noted as a major contributor to the spread of the disease. Since 2004, with funding from the U.S. Agency for International Development, ICAP has been working with the Lesotho Ministry of Health and Social Welfare and other partners to support HIV prevention, care, and treatment programs.

The EPIC study ultimately aims to assess an “Enhanced Prevention Package” in couples in which only one partner is HIV infected. Some of the interventions under consideration include antiretroviral therapy (HIV treatment), couples-focused counseling, and circumcision of HIV-infected male partners.

“The insights from the pilot work and the study can hopefully guide future efforts to stem transmission within serodiscordant couples and contribute to tackling HIV in Lesotho and similar settings,” said El-Sadr.

For more about ICAP Lesotho, visit here.

Tanzania Implements Male Circumcision as Part of a Comprehensive HIV Prevention Strategy

ICAP is supporting a one-year pilot project at Kagera Regional Hospital in Tanzania that aims to integrate male circumcision in the facility's comprehensive package of HIV prevention services and lay the groundwork for regional expansion of this intervention.

Evidence from studies in three African countries supports the role of circumcision in significantly decreasing the risk of HIV acquisition among men. Scale-up of male circumcision, however, has been complicated by cultural and societal beliefs, and attitudes.

The pilot project will assess the capacity of Kagera Hospital’s HIV service program to implement safe male circumcision, training, outreach, message development, service delivery, and client follow-up. In support of this effort, ICAP has supported training of healthcare providers in male circumcision and the renovation of a dedicated facility to perform the procedure.

Kagera Region, which is served by Kagera Hospital, has relatively low rates of male circumcision of approximately 38 percent as compared to the national average of 66 percent. HIV prevalence in Kagera is 3.4 percent.

“The Kagera project presents an opportunity to implement an effective intervention to prevent escalation of HIV rates,” said Abubakari Mwinyi, MD, ICAP-Tanzania prevention coordinator for male circumcision. “The lessons from this project will inform a broader scale up of male circumcision to other regions with similarly low rates of circumcision among men.”

Male circumcision is part of a comprehensive strategy under consideration for reducing HIV prevalence in Tanzania. Other interventions include HIV counseling and testing, treatment for sexually transmitted infections, promotion of safer sex practices, prevention of mother-to-child transmission of HIV, prevention within HIV care and treatment settings, and prevention for most at-risk groups.

ICAP is working closely with the Ministry of Health and Social Welfare, which is spearheading this initiative, along with other partners. In addition to Kagera, circumcision demonstration projects are being conducted in Iringa and Mbeya Regions of Tanzania concurrently by other partners.

Photo caption: Kagera Hospital has been equipped with a new operating room to perform male circumcision.

For more about ICAP Tanzania, visit here.

Strengthening Nurse Training in South Africa

The ICAP Nurse Capacity Initiative (INCI) in South Africa is working with eight nursing colleges and universities in the country’s Eastern Cape Province to strengthen pre-service training in comprehensive HIV services.

The one-year pilot project called the Campus-to-Clinic Tutor Mentorship Program consists of direct collaboration between nurse mentors and nursing instructors to build their knowledge and skills in teaching HIV prevention, care, and treatment. Emphasis is placed on “hands-on” approaches, such as demonstrations of early infant diagnosis of HIV using DNA PCR technology. The project’s goal is for the nursing instructors to become mentors themselves, providing sustainability for the initiative. ICAP is partnering with the Eastern Cape Department of Health on the project.
“We want to build a sustainable system in which nursing instructors can integrate comprehensive HIV services into their teaching,” said Jennifer Dohrn, DNP, INCI program director. “Depending on the outcome of this pilot project, we hope to roll out this program to other nursing schools in South Africa.”

In addition to training and mentorship, INCI aims to bolster the nursing workforce through policy advocacy and efforts to enhance nurse retention. INCI supports nurses and nursing institutions in Ethiopia, Mozambique, Nigeria, Rwanda, South Africa, and Swaziland. Expansion to additional countries is planned.

INCI is supported by the U.S. Health Resources and Services Administration, the University of Fort Hare Department of Nursing Sciences in South Africa, the Columbia University School of Nursing, and the International Council of Nursing.

For more about ICAP South Africa, visit here.

HIV Testing Campaign Reaches At-Risk Children in Nigeria

HIV tests were recently provided to 220 at-risk children in a two-day testing campaign organized by Positive Media Support, a community-based organization in Benue State, Nigeria. Four children tested positive and were referred for follow-up at General Hospital North Bank.

The testing campaign was organized by Positive Media Support with ICAP support as part of its wide-ranging support for at-risk children. Other activities sponsored by the group include clubs for both children and youths to provide life-building skills, HIV prevention messages, and psychosocial support. Positive Media Support also works with communities to develop small-scale businesses whose profits benefit at-risk children.

“Community-based organizations such as Positive Media Support are essential to helping provide the full continuum of services for those infected and affected by HIV,” said Bola Oyeledun, MD, ICAP-Nigeria country director. “ICAP will continue working closely with the group to build its capacity for sustainable support services.”

For more about ICAP Nigeria, visit here.

Renovated Laboratories Unveiled in Ethiopia

Newly renovated laboratories were recently inaugurated at ICAP-supported Adama and Jimma University Specialized Hospitals to support expanded HIV services and strengthened health systems in Ethiopia’s Oromiya Region.

The laboratory renovations involved improvements in building structures and the addition of new equipment to diagnose and monitor HIV, tuberculosis (TB), and other infectious diseases. Jimma University laboratory will serve as a regional center for care and treatment of TB and early infant diagnosis of HIV, as well as a training center for medical students.

Ethiopia’s National Laboratory Master Plan spearheaded the renovations, which were supported by ICAP, the Ethiopian Health and Nutrition Research Institute, the President’s Emergency Plan for AIDS Relief/U.S. Centers for Disease Control and Prevention, and the Foundation for Innovative New Diagnostics.

For more about ICAP Ethiopia, visit here.