While policy makers,
experts and advocates debate whether widespread antiretroviral therapy
(ART) can reverse the direction of the epidemic, treatment is
unequivocally saving lives across Africa (1). The massive scale
up of ART as treatment, pre and post exposure prophylaxis are changing
the course and outcomes of infection and transmission.
The Southern Africa treatment and Resistance Network (SATuRN) mission
is to
build innovative collaborations between researchers, clinicians
and policy makers focused on the monitoring, evaluation and delivery of
anti-retoviral (ARV) and anti-TB therapy in Africa.
We have developed an approach to virologic failure,
delivering genotyping, interpretation and clinical
management to remote clinics, without elaborate computer systems
or infectious diseases specialists at each clinic. Applying the
concepts of telemedicine, laboratorians and specialists, in medical
centers throughout the world can review cases, including clinical
and resistance data contend provide feedback and advice to the
physician/nurse managing the patient at the primary clinic. This system
also allows the collection of complete
treatment and clinical information to be used in surveys that can be
harnessed to systematically track the transmission and acquisition of
drug resistance.
Results
from three settings are seen on our webpages and in the 2011 SATuRN
report.
Another objective of the SATuRN project is to collect, curate,
interpret and disseminate sequence and drug
resistance data, we have installed in South Africa and Botswana two of
the best HIV
drug resistance databases in the world (
The
Stanford HIV Drug
Resistance Database and
RegaDB
Clinical Management and Drug resistance
Database) (2). These databases are public accessible at the
bioafrica.net/saturn
bioinformatics
servers.
To increase access to
efficient, lower cost genotyping and drug resistance testing in Africa,
we have
been working with a network of governments and academics laboratories
to develop and
implement a cheaper resistance genotype test. This activity has
received support from Life Technologies, with the provision of a
discount of 25% for reagents needed for resistance genotyping and we
are working on the production of a more discounted kit that can be
easily implemented in resources limitted settings.
SATuRN
currently includes 24 research partners in southern Africa that
support our initiatives and we have collated over 3,200 resistance
genotypes linked to treatment and clinical information. These datasets
are open for researchers and post-graduate students through the
submission of a data request and proposal to our management
committee.
We have also delivered training in drug resistance testing
and management to nearly 1,000 physician and nurses in southern
Africa. Our long-term vision is to expand clinical and laboratory
training and capacity building to build research capacity and enhance
treatment throughout Africa.
Tulio de Oliveira, David
Katzenstein and
Christopher
Seebregts on behalf of
SATuRN.
References:
1) Bendavid E, BhaFacharya J. The President's Emergency Plan for AIDS
Relief in Africa: an evaluation of outcomes. Ann Intern Med.
2009;150(10):688-95.
2) de Oliveira T, Shafer WR, Seebregts C for SATuRN. Correspondence:
Public
Database for HIV Drug Resistance in southern Africa. Nature, 2010,
464(7289):673.