Translating HIV/AIDS research evidence into policies and practices in Africa has improved our response

23 August 2011

Prof Geoffrey Setswe, Head of the School of Health Sciences, Monash South Africa

From the left: Prof Aubrey Redlinghuis, Deputy Pro Vice-Chancellor: Academic, Monash South Africa; Prof Geoffrey Setswe, Head of the School of Health Sciences, Monash South Africa; Prof Laetitia Rispel, Health Policy Research Unit Director, Wits; Prof Tyrone Pretorius, Pro Vice-Chancelor and President, Monash South Africa.

Keitshepile Geoffrey Setswe, Professor  of Public Health at Monash University, Australia and Head of the School of Health Sciences at Monash South Africa, discussed “The HIV/AIDS epidemic in Africa: Translation of evidence-based research into policies and practices,” at his Inaugural Lecture on 11 August 2011, at Monash South Africa’s campus in Johannesburg. 

He first looked at the research, policies and practices relating to biomedical HIV prevention interventions such as antiretroviral therapy (ART), prevention of mother to child transmission (PMTCT), male medical circumcision, male and female condoms, treatment of sexually transmitted infections, microbicides and vaccines.

He showed evidence that providing ART to a patient with AIDS reduces mortality and morbidity by 60-80%. The World Health Organisation (WHO) recommended a policy on triple therapy for HIV positive patients with CD4 count of 350 or less with an opportunistic infection. South Africa has made great strides in this area by developing the largest antiretroviral treatment programme in the world with more than 1.4 million people (of the 5.6 million who are HIV positive) receiving antiretroviral treatment by 2010.
Eight low and middle-income countries (LMICs) achieved the goal of 80% coverage of patients in need of antiretrovirals with Botswana (83%) and Rwanda (88%) showing the greatest progress on the continent.
Prof Setswe also showed evidence that that infection rates among children born to HIV positive women are as high as 22% without intervention and below 5% with dual antiretroviral treatment and appropriate care.

The WHO recommends a policy of dual therapy for PMTCT and in practice 15 countries, including Botswana and South Africa, were able to provide more than 80% of HIV-positive pregnant women with ARVs to prevent mother to child transmission by 2009. In poorer countries 53% of pregnant women, who needed services for PMTCT, received them by 2009.

When discussing evidence relating to use of male and female condoms, treatment of sexually transmitted infections as well as the use of microbiocides and vaccines, he noted that several African countries such as Kenya, South Africa, Zimbabwe, Botswana, etc., have implemented national condom programmes for the general population. Results from microbicide research (called CAPRISA 004, in July 2010) were promising, and were confirmed by the most recent findings from the VOICE (Vaginal and Oral Interventions to Control the Epidemic) clinical trials in July 2011. The decision to develop policy on, and implementation of, microbicides in various African countries now rests with authorities such as the National AIDS Councils and policymakers in the Departments of Health.

Setswe also focused on the translation of research on behavioural HIV prevention interventions into policies and practices, for example, ABC (abstinence, be faithful and condomise) as well as HIV counselling and testing (HTC) programmes. For example, the South African HCT campaign, launched in April 2010, aimed to test 15 million people by June 2011 and to serve as an entry point to access wellness and treatment services for those who test HIV positive, was fairly successful in that more than 12 million people were actually tested by that date.
Although there is mixed evidence on whether having multiple concurrent partners was the driver of the HIV/AIDS epidemic in Africa, SADC leaders adopted the Maseru Declaration in 2006 and recommended policy on reducing the number of partners in their countries.
Prof Setswe said: “It is critical to note that there is no ‘magic bullet’ for HIV prevention. No single new prevention method currently being tested is likely to be 100 percent effective.” He recommended the use of combination prevention approaches if we are to reduce the global burden of HIV/AIDS particularly in Africa, the epicenter of the epidemic.

The ‘Rome Statement’ released at the International AIDS Conference in Rome on 18 July 2011, sets in motion the development of a global scientific strategy Towards an HIV Cure, which will strive to build global consensus on scientific problems that must be tackled on the road to an AIDS cure. Prof Setswe felt that this shows the confidence that the scientific community has developed 30 years into the epidemic.

When discussing where we are currently he said: “The bad news is that there is still no cure for HIV/AIDS and it remains the world’s worst epidemic. It is disappointing that there is often failure, or long delays, in translating evidence into policy and practice - as was the case with male medical circumcision and PMTCT. It is also surprising to find that policies are sometimes implemented despite there being weak or mixed evidence - as is the case with multiple concurrent partners.”
He felt that it is promising that there have been remarkable advances in obtaining research evidence of HIV prevention interventions that do work, for example, in the area of microbiocides.  
He concluded that: “The good news is that HIV is being halted in its tracks in many African countries including Uganda, Rwanda and Botswana through implementation of evidence-based policies and programmes.”