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.