Southern African Treatment and Resistance Network (SATuRN) Executive Summary

Authors: Tulio de Oliveira, Justen Manasa, Lungani Ndwandwe, Richard Lessells, David Katzenstein, Chris Seebregts

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Executive Summary

To build innovative collaborations between researchers, clinicians and public health experts focused on the monitoring, evaluation and delivery of anti-retroviral (ARV) and anti-TB therapy in Africa.

SATuRN

SATuRN is a network consisting of biomedical scientists, clinicians, epidemiologists and public health experts working in collaboration to monitor, evaluate and deliver Anti-retroviral (ARV) and TB therapy in Africa. SATuRN currently includes 24 research partners in Southern Africa. SATuRN has collated over 7,000 resistance genotypes linked to treatment and clinical information. These datasets are open to researchers and post-graduate students through the submission of a dataset request.

Problem

With the massive scale up of HIV/AIDS antiretroviral therapy (ART), the development of HIV-1 drug resistance poses a major threat to sustaining the achievements of ART programmes in Africa. Drug resistance monitoring is limited by the lack of laboratory resources and adequately trained personnel to manage patients with drug resistance. Furthermore, Africa, particularly Southern Africa is the hardest hit, with the largest patient burden.

Solution and what makes us unique

SATuRN has developed an approach to virological failure management that ensures the delivery of drug resistance genotyping and clinical management to remote clinics without elaborate computer systems or infectious disease specialists on site. By applying telemedicine, off site laboratories and specialists physicians from medical centers across the world can review the cases, including clinical and resistance data, and give feedback and advice to the clinician managing the patient at the primary clinic.

To increase access to efficient, low cost genotyping and drug resistance testing in Africa, SATuRN has been working with a network of governments, academics and laboratories to develop and implement a cheaper resistance genotype test. SATuRN current in-house genotyping system is based on the Sanger ABI sequencing technology. Working in partnership with a key player in the field of molecular diagnostic, Life Technologies Inc, we have managed to reduce the cost of reagents for genotyping from around $250 to about $50. We are working now with the next generation DNA sequencing to further decrease the price of resistance genotyping.

SATuRN collaborators have produced over 7,000 drug resistance genotypes that were used for the surveillance and monitoring of drug resistance in the region. These genotypes are stored and it is publically available at the first African Public Drug Resistance in Africa (de Oliveira et al. Nature 2010). SATuRN distributes information to researchers, public health officials and international funding agencies in the form of open access reports and publications on the level of HIV & TB drug resistance in southern Africa

In addition to these progressive initiatives, SATuRN also offers training to over 1,000 physicians and nurses in Southern Africa for drug resistance testing.

The long-term goal being to expand clinical and laboratory training, to build research capacity and to enhance treatment throughout Africa.

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