The Centre for AIDS Programme of Research in South Africa (CAPRISA)

The Centre for AIDS Programme of Research in South Africa (CAPRISA) is one of South Africa’s best known research organizations. CAPRISA was established 2002 under the National Institutes of Health program called Comprehensive International Program of Research on AIDS (CIPRA) to investigate:

• Acute HIV infection and
• The course of the disease

CDC and PEPFAR have supported CAPRISA since September 2008 with a five-year cooperative agreement. CAPRISA supports two sites with CDC/PEPFAR funding: the Prince Cyril Zulu Communicable Disease Center, and the Vulindlela research site approximately 50 miles outside of Durban.

Prince Cyril Zulu Communicable Disease Centre

The eThekwini  (Durban) site is located at Prince Cyril Zulu Communicable Disease Centre, a primary health care clinic first opened in 1955 and dedicated to the treatment of TB and HIV among the local community. The Centre provides free HIV and TB services to the community, and is conveniently located in Durban’s central business district, and is adjacent to the transport hub that serves commuters (rail, bus, and minibus taxis) from local townships and outlying areas. This clinic comprises two sections, a Treatment Clinic for HIV-TB co-infected patients and a Prevention Clinic with a high risk population of clients infected with sexually transmitted infections. It is one of the largest TB clinics in South Africa.

The PEPFAR funded CAPRISA AIDS Treatment (CAT) program provides a comprehensive care package to people living with HIV. A group of patients was randomized to determine the appropriate time point at which to start antiretroviral treatment of patients co-infected with tuberculosis (SAPIT). The findings led to changes in WHO, and South African government policy in treating co-infected patients.

Also funded through the PEPFAR grant was Field-based Directly Observed Therapy (DOT). DOT is a public health intervention aimed at enhancing TB and HIV treatment adherence and treatment access for patients. In this model of care, TB treatment, and/or ART are delivered to the patient on a scheduled basis by a health care worker at a convenient location for the patient.

Public Health Evaluation (PHE) funding was awarded to look at TB Recurrence upon Treatment with HAART (TRUTH).  The study aims to determine the extent of and reasons for relapse and re-infection of TB in HIV-infected patients on Highly Active Antiretroviral Therapy (HAART).

HIV and TB Research in Action

“Historically CAPRISA is about doing research. We’ve asked relevant questions in direct response to a WHO document that asked key questions.”— Kogie Naidoo, Head: TB & HIV Treatment, CAPRISA

CDC funding helped enhance TB-treatment completion through community health workers (CHW) who go door to door supporting and following up on patients. Targeted with one of the worst performing subdistricts (45% completion rates for TB), CAPRISA focused on a nearby informal settlement with high unemployment rate. CHWs followed up on defaulting patients, visiting their homes daily to ensure that medications were taken.

Within a seven-month period, the cure and completion rate increased from 45% to 96% for 600 patients in the community. This grant ended in August 2012, and the project was handed over to the community. “This is an effective way to show how to provide low-cost interventions to help adherence and completion of medication,” said Dr. Naidoo.

Using CDC/PEPFAR funds, CAPRISA also started provider-initiated counseling and testing (PICT) for HIV. Initially this service started with 90 tests per month soaring to more than 1,000 per month. Every patient who visited the Prince Zulu Clinic or Vulindela received HIV counseling and testing. CAPRISA was far ahead of the counseling and testing movement by initiating PICT in 2004, which allowed for more patients to be screened, approximately 1,500 per month—70% tested. The organization also routinely screens patients for TB and related HIV diseases such as renal failure. Nearly 70,000 patients were given PICT since CDC funding started. Today 92% of the patients are still on first line ART. Patients are also tested for diabetes, high blood pressure, and renal disease (this is a big problem for HIV).

CAPRISA also led the way in introducing integrated ART and TB treatment for co-infected patients. The public health evaluation provided evidence for effective HIV/TB integrated treatment, which influenced the South African national policy.

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For more information visit: www.caprisa.org