Twenty-four percent, is the figure that I cannot stop thinking about when we land on Durban International Airport, South Africa. One out of four people living here in the province of KwaZulu-Natal is HIV-infected - a number that goes as high as 48% infection for the women living in the area. The impact of these figures becomes real when I immediately bump into a container providing free condoms at the airports restroom. This place is serious.
We watch the houses scattered through the lush and hilly landscape as we drive to the Africa Center for Health and Population Studies in Mtubatuba. With the PharmAccess Studies to Evaluate Resistance (PASER) scientific team we are here to visit our colleagues of the Southern African Treatment Resistance Network (SATuRN). Both of us are working in the field of HIV drug resistance in sub-Saharan Africa where PASER is monitoring HIV drug resistance from the start of antiretroviral treatment, and SATuRN is monitoring resistance from the moment of treatment failure. This meeting enables us to share information on expertise, experience, existing resources and capacities, to explore a joint research agenda.
SATuRN director Prof Tulio de Oliveira welcomes us at the Africa Centre and introduces us to its extensive demographic HIV surveillance including resistance testing. Prof Tobias Rinke de Wit explains the context of the PASER observational cohort studies and the PASER scientific output is further explained by Dr Raph Hamers for the adult studies and Dr Kim Sigaloff for the paediatric studies. Dr Pascale Ondoa explains the development and validation of affordable resistance testing within the PASER network.
We learn from SATuRN's wide expertise in clinical and laboratory science and bioinformatics. Eduan Wilkinson takes us back in time with his phylogenetic research on the history and evolution of HIV-1 subtype C in Cape Town and in southern Africa. Thereafter Justen Manasa presents his genotyping results on acquired and transmitted HIV drug resistance, and shows us his novel approach to an open source protocol: a video detailing the methods of genotypic testing using an affordable in-house assay. The implications of resistance for clinical care become real when Dr Gert van Zyl from Stellenbosch University Cape Town explains the increase of resistance he found in South African adults and children receiving standardized first- and second-line regimens.
Pascal Brandt who works for the nonprofit organization Jembi Health Systems in Cape Town, explains the ins-and-outs of database development for resistance data. SATuRN is using RegaDB, a free and open source system to store and analyze clinical and resistance data while supporting both clinicians and researchers in their work. As we wish to join forces for collaborative research, we explore the possibilities of the coordination of existing datasets.
Furthermore, we make the first steps on a new joint research proposal, focusing the accessibility and marketing of low-cost resistance testing in HIV treatment programs. After spending 2,5 days together, we are all very enthusiastic about our collaboration and we found it hard to leave. Fortunately, we will see each other again for the joint workshop on HIV-TB resistance and treatment monitoring in November this year, in Bloemfontein!