Category: HIV

Categories : Ageing HIVTags :

Older Adults are Getting Infected with HIV, but Prevention Focuses on Young People

On By ModernMedia

Prevention and treatment campaigns are not adequately targeting the particular needs of the 50+ years age group.

Photo by Sergey Mikheev on Unsplash

Indeed, between 2000 and 2016, the number of adults aged 50 years and older living with HIV in sub-Saharan Africa doubled. At present, their HIV prevalence is exceeding that of younger adults.

By 2040, one-quarter of people living with HIV in Africa will be aged 50 years and older; tailored awareness and treatment campaigns are pressing.

Dr Luicer Olubayo, a researcher at the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University and the first author of a study published in The Lancet Healthy Longevity journal, which investigated HIV in older people in Kenya and South Africa, noted that perceptions on who acquires HIV are limited. “We often think of HIV as a disease of younger people. It doesn’t help that intervention campaigns are mainly targeted at the youth.”

Moreover, older adults are less likely to believe that they can get HIV. This misconception is pervasive and has consequences for reaching global targets to achieve UNAIDS’ 95-95-95 targets by 2030 (95% of people living with HIV know their status, 95% of people who know their status are on treatment, and 95% have a suppressed viral load).

“While HIV prevalence among individuals over 50 years of age is similar to or even exceeds that of younger adults, HIV surveys focus on younger individuals, leaving considerable gaps in understanding HIV prevalence, incidence and treatment outcomes in older populations,” says Associate Professor F. Xavier Gómez-Olivé, at the MRC/Wits-Agincourt Research Unit.

Stigma remains a barrier to treatment

The uptake of HIV testing among older adults is poor, which delays diagnosis and limits access to care. This is, indeed, one of the signifiers of the pervasiveness of stigma surrounding the disease.

“We know that there is significant social stigma related to HIV infection. This is why understanding HIV-related stigma in older adults remains crucial as a way to inform interventions to support older people’s mental health and overall well-being,” says Olubayo.

Interventions could focus on repeated testing, the use of pre-exposure prophylaxis (PrEP), and campaigns to increase awareness and reduce infections among the elderly.  

“HIV can be managed alongside other chronic conditions, too, since HIV is managed as a long-term illness,” says Gómez-Olivé.

Non-communicable diseases, such as hypertension, diabetes, and obesity, have dramatically increased in sub-Saharan Africa, particularly among older people. HIV treatment and intervention can be included in the healthcare ecosystem of long-term illnesses.

Apart from stigma, a complex interplay of factors shapes HIV risk

The study shows that age, education, gender, and where people live all affect their risk of HIV. Even though more people now have access to HIV treatment, older adults—especially in rural areas—still face significant challenges in preventing HIV, such as low education levels and gender inequality.

Widowed women had the highest HIV rate (30.8%). This may be due to losing a partner to HIV, stigma, and a greater risk of unsafe behaviours like transactional sex and limited power to negotiate condom use. People without formal education and those with low income also had higher rates of HIV infection.

The benefit of longitudinal data to make decisions

 An important added value of this study is the provision of longitudinal insights into the HIV epidemic among older adults in sub-Saharan Africa. “Our study is beneficial in that older populations are under-represented, and not much is known about them over time. What changes are occurring? We have to answer these kinds of questions. With longitudinal data, we can look at the effectiveness of antiretroviral therapy coverage in older people,” says Gómez-Olivé.

The study used data collected in urban Kenya and in urban and rural sites across South Africa during two data collection waves: 2013-2016 and 2019-2022.  

Throughout a decade of research, the team has been gaining a deeper understanding of this ageing HIV epidemic. Numerous important insights about HIV in older populations have been achieved, and research gaps are being covered.

Data for the study were drawn from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen) from adults aged 40 years and older. AWI-Gen is a multicentre, longitudinal cohort study conducted at six research centres in four sub-Saharan African countries (South Africa, Kenya, Burkina Faso, and Ghana) to investigate various health determinants.

Source: University of the Witwatersrand

Categories : HIV VaccinesTags :

Supercharged Vaccine Could Offer Strong Protection with Just One Dose

On By ModernMedia

By delivering an HIV vaccine candidate along with two adjuvants, researchers showed they could generate many more HIV-targeting B cells in mice.

Anne Trafton | MIT News
Image shows the vaccine antigen (pink) being concentrated in a germinal center (yellow) within B cell follicles (cyan), triggered by the researchers’ combination adjuvant vaccine. Credits: Image: Courtesy of the researchers

Researchers at MIT and the Scripps Research Institute have shown that they can generate a strong immune response to HIV with just one vaccine dose, by adding two powerful adjuvants — materials that help stimulate the immune system.

In a study of mice, the researchers showed that this approach produced a much wider diversity of antibodies against an HIV antigen, compared to the vaccine given on its own or with just one of the adjuvants. The dual-adjuvant vaccine accumulated in the lymph nodes and remained there for up to a month, allowing the immune system to build up a much greater number of antibodies against the HIV protein.

This strategy could lead to the development of vaccines that only need to be given once, for infectious diseases including HIV or SARS-CoV-2, the researchers say.

“This approach is compatible with many protein-based vaccines, so it offers the opportunity to engineer new formulations for these types of vaccines across a wide range of different diseases, such as influenza, SARS-CoV-2, or other pandemic outbreaks,” says J. Christopher Love, the Raymond A. and Helen E. St. Laurent Professor of Chemical Engineering at MIT, and a member of the Koch Institute for Integrative Cancer Research and the Ragon Institute of MGH, MIT, and Harvard.

Love and Darrell Irvine, a professor of immunology and microbiology at the Scripps Research Institute, are the senior authors of the study, which appears today in Science Translational Medicine. Kristen Rodrigues PhD ’23 and Yiming Zhang PhD ’25 are the lead authors of the paper.

More powerful vaccines

Most vaccines are delivered along with adjuvants, which help to stimulate a stronger immune response to the antigen. One adjuvant commonly used with protein-based vaccines, including those for hepatitis A and B, is aluminum hydroxide, also known as alum. This adjuvant works by activating the innate immune response, helping the body to form a stronger memory of the vaccine antigen.

Several years ago, Irvine developed another adjuvant based on saponin, an FDA-approved adjuvant derived from the bark of the Chilean soapbark tree. His work showed that nanoparticles containing both saponin and a molecule called MPLA, which promotes inflammation, worked better than saponin on its own. That nanoparticle, known as SMNP, is now being used as an adjuvant for an HIV vaccine that is currently in clinical trials.

Irvine and Love then tried combining alum and SMNP and showed that vaccines containing both of those adjuvants could generate even more powerful immune responses against either HIV or SARS-CoV-2.

In the new paper, the researchers wanted to explore why these two adjuvants work so well together to boost the immune response, specifically the B cell response. B cells produce antibodies that can circulate in the bloodstream and recognise a pathogen if the body is exposed to it again.

For this study, the researchers used an HIV protein called MD39 as their vaccine antigen, and anchored dozens of these proteins to each alum particle, along with SMNP.

After vaccinating mice with these particles, the researchers found that the vaccine accumulated in the lymph nodes — structures where B cells encounter antigens and undergo rapid mutations that generate antibodies with high affinity for a particular antigen. This process takes place within clusters of cells known as germinal centers.

The researchers showed that SMNP and alum helped the HIV antigen to penetrate through the protective layer of cells surrounding the lymph nodes without being broken down into fragments. The adjuvants also helped the antigens to remain intact in the lymph nodes for up to 28 days.

“As a result, the B cells that are cycling in the lymph nodes are constantly being exposed to the antigen over that time period, and they get the chance to refine their solution to the antigen,” Love says.

This approach may mimic what occurs during a natural infection, when antigens can remain in the lymph nodes for weeks, giving the body time to build up an immune response.

Antibody diversity

Single-cell RNA sequencing of B cells from the vaccinated mice revealed that the vaccine containing both adjuvants generated a much more diverse repertoire of B cells and antibodies. Mice that received the dual-adjuvant vaccine produced two to three times more unique B cells than mice that received just one of the adjuvants.

That increase in B cell number and diversity boosts the chances that the vaccine could generate broadly neutralizing antibodies — antibodies that can recognize a variety of strains of a given virus, such as HIV.

“When you think about the immune system sampling all of the possible solutions, the more chances we give it to identify an effective solution, the better,” Love says. “Generating broadly neutralizing antibodies is something that likely requires both the kind of approach that we showed here, to get that strong and diversified response, as well as antigen design to get the right part of the immunogen shown.”

Using these two adjuvants together could also contribute to the development of more potent vaccines against other infectious diseases, with just a single dose.

“What’s potentially powerful about this approach is that you can achieve long-term exposures based on a combination of adjuvants that are already reasonably well-understood, so it doesn’t require a different technology. It’s just combining features of these adjuvants to enable low-dose or potentially even single-dose treatments,” Love says.

The research was funded by the National Institutes of Health; the Koch Institute Support (core) Grant from the National Cancer Institute; the Ragon Institute of MGH, MIT, and Harvard; and the Howard Hughes Medical Institute.

This story is republished courtesy of MIT News (web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

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Categories : Expert Opinion HIVTags :

OPEN LETTER | Minister of Health Aaron Motsoaledi, Please Explain the HIV Numbers

On By ModernMedia
Minister of Health Dr Aaron Motsoaledi. Source: GCIS

By Anna Grimsrud and Sibongile Tshabalala-Madhlala

Minister of Health Dr Aaron Motsoaledi’s recent claim that over half a million people have been newly started on HIV treatment in less than six months has raised eyebrows in health circles. In this open letter, Anna Grimsrud and Sibongile Tshabalala-Madhlala, associated with CHANGE – South Africa, ask the Minister to explain numbers that, on the face of it, seem contradictory.

Dear Minister Motsoaledi,

We write to you in response to your 15 May 2025 press statement and subsequent remarks in Parliament on the current status of the national HIV, AIDS, and TB campaign. 

You stated that since the launch of the Close the Gap campaign, 520 700 people have been initiated on HIV treatment, reaching “more than 50% of the target”. You also stated that 5.9 million people are currently on antiretroviral therapy (ART). However, at the campaign’s launch on 25 February 2025, you reported the same number on HIV treatment — 5.9 million. This raises a critical question: if over half a million people have started or restarted treatment, why has the total number of people on treatment not increased?

If both figures are accurate, this would mean that approximately 520 000 people have been lost from care over the past few months — a deeply concerning and unprecedented level of attrition. We respectfully request that you provide the underlying data and clarify the current total number of people remaining on HIV treatment.

There are several reasons why we are concerned:

  1. Static treatment numbers: As noted, the number on treatment was reported as 5.9 million in both February and May 2025. If 520 700 people have been initiated or re-initiated during this period, the same number must have exited care — a scenario that requires urgent explanation.
  2. Slow growth in the number of people on treatment: According to official statements, the total number of people on HIV treatment increased by only 100 000 between March and December 2023 — from over 5.7 million to 5.8 million. The claim that the cohort has now grown by over 500 000 in a matter of months contradicts recent trends.
  3. Declining lab numbers: National Health Laboratory Service data reported by the Daily Maverick and Reuters, show notable declines in viral load testing and early infant diagnosis in March and April 2025 compared to the same months in 2024. These indicators should increase alongside meaningful growth in treatment uptake — not decrease.

In light of these concerns, we believe it is essential that you provide a transparent accounting of the current number of people on treatment and the metrics being used to assess progress under the Close the Gap campaign. Specifically, we request data demonstrating that the programme is on track to meet its stated goal: increasing the number of people on treatment from 5.9 million to 7 million.

We share your commitment to a strong and effective HIV response, especially in this period of financial and operational strain. Like you, we believe it is vital that accurate and complete information is shared with the public and Parliament at this critical moment.

*Anna Grimsrud is an epidemiologist with a PhD in Public Health and writes in her personal capacity. Sibongile Tshabalala-Madhlala is openly living with HIV and currently serves as the National Chairperson of the Treatment Action Campaign (TAC).” CHANGE is a coalition of more than 1 500 people from civil society organizations in South Africa and around the work — people living with HIV, activists, community health workers, researchers, programme members, epidemiologists, clinicians, economists, and others. CHANGE stands for Community Health & HIV Advocate Navigating Global Emergencies.

Published by Spotlight and GroundUp.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence. Views expressed in the original article are not necessarily shared by Quicknews.

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Categories : Genetics HIVTags :

Researchers Map 7000-year-old Genetic Mutation that Protects Against HIV

On By ModernMedia

Modern HIV medicine is based on a common genetic mutation. Now, researchers have traced where and when the mutation arose – and how it protected our ancestors from ancient diseases.

Photo by Sangharsh Lohakare on Unsplash

What do a millennia-old human from the Black Sea region and modern HIV medicine have in common? Quite a lot, it turns out, according to new research from the University of Copenhagen.

18–25% of the Danish population carries a genetic mutation that can make them resistant or even immune to HIV. This knowledge is used to develop modern treatments for the virus.

Until now, it was unknown where, when, or why the mutation occurred. But by using advanced DNA technology, researchers have now solved this genetic mystery.

“It turns out that the variant arose in one individual who lived in an area near the Black Sea between 6700 and 9000 years ago,” says Professor Simon Rasmussen from the Novo Nordisk Foundation Center for Basic Metabolic Research (CBMR) at the University of Copenhagen, corresponding author of a new study mapping the mutation. He adds:

“HIV is a relatively new disease – less than 100 years old – so it’s almost coincidental and very fascinating that a genetic variation that arose thousands of years ago also protects against a modern virus like HIV.”

Analyzed 900 skeletons

To determine where and when the mutation arose, researchers first mapped it by analysing the genetic material of 2000 living people worldwide. They then developed a new AI-based method to identify the mutation in ancient DNA from old bones.

The researchers examined data from over 900 skeletons dating from the early Stone Age to the Viking Age.

“By looking at this large dataset, we can determine where and when the mutation arose. For a period, the mutation is completely absent, but then it suddenly appears and spreads incredibly quickly. When we combine this with our knowledge of human migration at the time, we can also pinpoint the region where the mutation originated,” explains first author Kirstine Ravn, senior researcher at CBMR.

Thus, the researchers were able to locate the mutation in a person from the Black Sea region up to 9000 years ago – an individual from whom all carriers of the mutation descend.

Immune weakening was beneficial back then

But why do so many Danes carry a millennia-old genetic mutation that protects against a disease that didn’t exist back then?

The researchers believe the mutation arose and spread rapidly because it gave our ancestors an advantage:

“People with this mutation were better at surviving, likely because it dampened the immune system during a time when humans were exposed to new pathogens,” explains Leonardo Cobuccio, co-first author and postdoc at CBMR. He and Kirstine Ravn elaborate:

“What’s fascinating is that the variation disrupts an immune gene. It sounds negative, but it was likely beneficial. An overly aggressive immune system can be deadly – think of allergic reactions or severe cases of viral infections like COVID-19, where the immune system often causes the damage that kills patients. As humans transitioned from hunter-gatherers to living closely together in agricultural societies, the pressure from infectious diseases increased, and a more balanced immune system may have been advantageous.”

Source: University of Copenhagen – The Faculty of Health and Medical Sciences

Categories : General Interest HIVTags :

Girl Effect in the Youth Drive at VUT to Close the HIV Treatment Gap

On By ModernMedia
Image caption, left to right: Dr Lisa Mulenga, Country Director of Girl Effect and Gauteng MEC for Health, Ms. Nomantu Nkomo-Ralehoko, engaging with a student at VUT.

Johannesburg, 13 May25: Girl Effect South Africa, a non-profit organisation, joined the Department of Health, South African National Aids Council, Higher Health, and other partners at the ‘Close the Gap Higher Education’ event which took place on Friday, 9 May, at the Vaal University of Technology (VUT). The campaign aims to connect young people with essential health services, encourage HIV testing and treatment, and help close the country’s significant treatment gap.

With young people making up a large proportion of the estimated 5.7 million South Africans living with HIV but not on antiretroviral therapy (ART), the campaign focuses on improving access to youth-friendly healthcare on campuses and in communities. The VUT activation is part of a national strategy to achieve the UNAIDS 95-95-95 targets, which aims to ensure that 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment achieve viral suppression.

Girl Effect brings its experience in youth-centred communication, behaviour change, and media to help break down stigma and promote informed, confident decision-making among young people. Its focus is especially on adolescent girls and young women, who remain at higher risk of HIV infection and are often underserved by the health system.

Through its flagship programme, Jik’iZinto, Girl Effect connects young women with transformative health education and digital engagement, empowering them to make informed decisions about their health and wellbeing.

Over 1 687 students accessed HIV counselling, testing, ART initiation and contraceptive services at the event and 38 700 female and male condoms where distributed amongst the young people. The young people were educated on oral Pre-Exposure Prophylaxis (PrEP), a daily pill that significantly reduces the risk of contracting HIV. Young people were also encouraged to conduct screenings for STIs, TB, and chronic diseases. Additionally, students actively participated in youth dialogues and peer-to-peer health education.

“Too often, young people face barriers, whether social, structural or emotional, that prevent them from seeking the healthcare they need,” said Dr Lisa Mulenga, Country Director of Girl Effect South Africa. “At Girl Effect, we work to remove those barriers by creating platforms where young people can access accurate information, engage with relatable content, and feel supported in making decisions about their health.”

Dr Mulenga, a public health and health systems expert with over two decades of experience, leads Girl Effect’s national strategy and programme delivery. The organisation collaborates with government departments, civil society and local partners to strengthen health messaging and improve access to services for underserved groups.

Gauteng MEC for Health, Ms. Nomantu Nkomo-Ralehoko, engaged with stakeholders during the event, culminating in a pledge signing ceremony. This event demonstrated the health department’s commitment to collaborative efforts in addressing health challenges and promoting meaningful partnerships.

The ‘Close the Gap Higher Education ’ campaign aligns with the National Strategic Plan on HIV, TB and STIs (2023 – 2028), which calls for improved service integration, greater community outreach, and targeted youth interventions. In addition to healthcare services, the VUT activation featured student-led dialogues, physical wellness activities, live performances, and keynote addresses from key decision-makers.

The campaign is being delivered in partnership with Shout It Now, Soul City, LoveLife, Aids Healthcare Foundation, the South African Police Service (SAPS), and various youth organisations. The goal is not only to increase uptake of services but to change the way young people experience healthcare, making it accessible, welcoming, and relevant to their lives.

Categories : HIVTags :

How US Funding Cuts are Forcing Sex Workers to Share HIV Medicines

On By ModernMedia

By Kimberly Mutandiro

Sex workers in Vosloorus, Johannesburg and Springs talked to GroundUp about their struggle to access health services, particularly antiretroviral treatment, since the closures of US funded clinics. Photos: Kimberly Mutandiro

It’s afternoon on Boundary Road in Vosloorus. Sex worker Simangele (not her real name) hopes to secure her next client.

Making enough money to pay rent has always been a concern for Simangele. But now she has a new worry: how to keep up with her antiretroviral treatment.

Two months ago the closure of a mobile clinic — where Simangele and other sex workers in Vosloorus went for checkups and to collect their treatment — left her without access to the life-saving medication.

The mobile clinic was run by the Wits Reproductive Health and HIV Institute (WITS RHI) which heavily relied on US funding. The institute has been providing critical sexual and reproductive health services since 2018. The programme was one of many health facilities forced to halt services at the end of January in the wake of US funding cuts for global aid.

Speaking to GroundUp, Simangele says she ran out of antiretroviral medicines (ARVs) over a month ago and has resorted to borrowing a few tablets from a friend. “I don’t know what I will do because the tablets my friend gets give me side effects,” she says. (Antiretrovirals treat HIV. They have to be taken daily for life.)

She says the clinic closed without any warning or before they could give them transfer letters to public healthcare facilities. She is now dreading having to go to a public facility where she says sex workers are frequently discriminated against, particularly those who are undocumented.

We spoke to a dozen other sex workers in Joburg and in Springs who are worried about defaulting on their antiretroviral treatment following the closure of the Wits RHI clinics. The clinics also provided pre-exposure prophylaxis (PrEP) (to prevent HIV-negative people contracting HIV), and treatments for sexually transmitted infections, TB, sexual reproductive health services, and counselling.

A sex worker shows the last few ARVs she has left.

Another sex worker said, “The minute we go to public clinics, they will need documents, which some of us do not have … Wits made time to listen to our problems as sex workers. Even when we faced challenges with clients, they never judged us.”

Sisi (not her real name), who rents rooms and assists sex workers in Vosloorus, said she’s aware of several sex workers who have defaulted and no longer have access to condoms, lubricants, and treatment for sexually transmitted infections. “The Wits clinic did not discriminate against people without documents and would sometimes provide food, branded T-shirts, caps, and even jobs,” she said.

“Many of us will die”

We visited Zig Zag Road in Springs, where several sex workers said they were out or almost out of ARVs. When asked why they didn’t just go to a local clinic, they told GroundUp about instances where they experienced stigma while trying to access treatment at public clinics.

“I used to receive PrEP to help prevent HIV (from the Wits clinic). We would also receive birth control services. Now I can’t go to a public clinic because we are mocked for being sex workers,” said Siphesihle.

Ntombi, who waits for clients along End Street, attended one of the Wits clinics in Hillbrow which closed down. She said those on PrEP were given transfer letters before the clinic closed.

Other workers nearby told GroundUp that they now pay up to R250 for PrEP, which is more than they can afford.

Sisonke calls for urgent response to crisis

The Sisonke National Movement, which advocates for the rights of sex workers, has been raising the alarm since the closure of US-funded facilities. Before the closures, Sisonke was in talks with National Department of Health through the South African National AIDS Council about the provision of services to sex workers and other vulnerable groups, said the organisation’s spokesperson Yonela Sinqu.

She said that the department never answered activists when they asked what would happen should donor funds no longer be available for these facilities.

She said the plea for assistance without referral letters is made to all provinces, not only Gauteng. However, Gauteng is the only province that has approached us with the crisis of people without referrals, she said.

Department of Health spokesperson Foster Mohale has not responded to requests for comment.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : HIV PaediatricsTags :

Cape Town Study Brings Hope to Newborns Left Behind in HIV Treatment Advances

On By ModernMedia
Professor Adrie Bekker explains the findings of a study on two novel formulations for the administration of dolutegravir in babies born to mothers living with HIV. (Photo: Biénne Huisman/Spotlight)

By Biénne Huisman

Research led by Professor Adrie Bekker is paving the way for an important HIV medicine to be made available to neonates in a way that is both safe and much more convenient than previous options. Spotlight met with the passionate clinician-scientist at her office in Cape Town.

Two new ways of giving the important HIV medicine dolutegravir to newborn babies have been found to be safe and effective, according to new research done in Cape Town. The new findings support for the first time the broader use of dolutegravir in infants who are less than 28 days old.

Dolutegravir is recommended by the World Health Organization (WHO) for infants, children and adults and is the preferred HIV medicine in South Africa. It exists in a scored 10 milligram child-friendly dispersible tablet. But until now, there hasn’t been any guidance on how to safely use it for newborns in their first four weeks of life. A study called PETITE-DTG aimed to bridge this critical gap in neonatal HIV care.

Forty-one full-term babies, each weighing at least 2 kilograms and born to mothers receiving dolutegravir-based HIV treatment, were enrolled in the study at Tygerberg Hospital to test two paediatric formulations of dolutegravir.

The first method involved using a 5 milligram dispersible tablet dissolved in 5 millilitres of water and given every second day for the first 14 days of life, then once daily until the baby was four weeks old. This was administered with a syringe.

The second method involved using a novel 5 milligram mint-flavoured film the size of a fingernail that dissolves on the tongue in seconds. It followed the same dosing schedule as the first method.

Findings showed that both formulations were safe and effective, achieving drug concentrations comparable to adults receiving 50 milligram of dolutegravir twice daily.

The study’s findings were presented at the Conference on Retroviruses and Opportunistic Infections in March. Researchers are currently writing up the final results of the study for publication in a peer-reviewed medical journal.

Professor Adrie Bekker, a neonatologist from the University of Stellenbosch is co-principal investigator of the PETITE-DTG study alongside Dr Tim Cressey, a clinical pharmacologist from the University of Chiang Mai in Thailand.

“The study results confirmed that the regimen [both 5 milligram dolutegravir formulations] was safe, effective, and highly acceptable to mothers, with the dolutegravir film being particularly easy to administer,”

says Bekker, speaking to Spotlight in her office at Stellenbosch University’s medical campus next to Tygerberg Hospital.

In examining dosing safety and efficacy, she says that the study found that both formulations “achieved target concentrations” in the neonates, without the newborn babies experiencing any adverse effects related to the medicine. All neonates were HIV negative at the end of the study.

Babies born to a mother living with HIV may need antiretroviral medicines for the prevention or treatment of HIV. Bekker explains that neonates are currently given an older type of liquid HIV medication that doesn’t taste good, costs more than dolutegravir, is harder to give properly, and can’t be stored for long.

The novel film method was popular with mums in the study, who cited its simplicity of administering and dose accuracy as highly advantageous, with no risk of the medicine being spit out or other spillage.“I wash and dry my hands and I cut the paper, it’s quick. As soon as I put it on his tongue, it just dissolves in a few seconds, he enjoys it,” said one mother, as quoted on a poster highlighting the results of the study.

Commenting on the film strip, Bekker notes it is one of the least disruptive ways to give medication.

“So what has been amazing to me is that the babies seem to be completely oblivious of what is happening when the mother puts the film in their mouth,” she says pointing out a video clip on her desktop of a film strip being placed in a tiny baby’s mouth.

“If they were crying, they would just keep on crying. If they were sleeping, they would just keep on sleeping. If they were happy, they would just keep on being happy. It really is the most unintrusive way of administering medication.”

Bekker says the colourless dolutegravir film is made by the Indian multinational pharmaceutical company Laurus Labs. Previously, it had only been tested in adults and is not yet commercially available. “It’s actually never even been used in children…And so our study for the first time tested the dolutegravir film in newborns to see what drug levels are found in a baby when you use it,” she says.

She says the research findings have been presented to the World Health Organization (WHO) and expects they will be included in the organisation’s upcoming updated dosing guidelines for infants and children.

Commenting on dolutegravir for neonates, Bekker says: “I think the first step is to actually get this recommendation into the WHO guidelines. As soon as the WHO releases their updated HIV guidelines, then countries can decide whether they want to adopt it or not.”

Commenting on the availability and possible roll-out of dolutegravir for neonates, she adds: “The generic 10 milligram dolutegravir scored dispersible tablet is already available and being used in children. What we’ve shown now is that 5 milligram of dolutegravir with this dosing strategy is safe for neonates…The film is a bit more complicated because it is not yet commercially available. And we don’t know the price of the drug; all of that will need to be discussed and negotiated with the company and relevant parties before it can become available.”

The PETITE-DTG research has been welcomed by fellow scientists.

“Adrie Bekker and her colleagues at Tygerberg Hospital and in Thailand have done great work and are really moving the field forward for neonatal antiretroviral treatment,” says Associate Professor James Nuttall, a paediatric infectious diseases sub-specialist at the Red Cross War Memorial Children’s Hospital and the University of Cape Town.

He says the research “provides really nice information about how we could use our existing drugs to treat neonates, potentially”.

Nuttall described the new film as extraordinary, and suggested that it might eventually replace the current drug formulations.

For Nuttall though, making provision for using a pill like the scored 10 milligram dispersible tablet that’s already available and routinely used to treat children in South African hospitals is more immediately relevant. “Using this 5 milligram dispersible tablet in neonates and working out the dosing schedule for that, that’s the real advance of this study to me, the big win.”

He anticipates these findings to be implemented in South Africa in the next few years. “From what I understand, she [Bekker] has presented this to WHO already. And once it gets accepted and included into WHO guidelines, then countries tend to really take note and follow, that’s when it makes its way into national guidelines…”

While the study focused on healthy full-term babies weighing at least two kilograms, Nuttall noted that many babies born to mothers living with HIV are either premature or have low birth weight. “So this dosing and safety information doesn’t yet apply to those children,” he said.

Bekker already has her eye set on assessing dosing safety for pre-term newborns. “So obviously our dream is to extend this to pre-term babies,” she says. “And there is a possibility that a 2.5 milligram dolutegravir film may be a good dose for pre-term neonates. Obviously, that will have to be studied very rigorously first.”

Other research goals include the hope of being involved in studies assessing long-acting antiretroviral drugs in neonates. Bekker notes that the WHO-led Paediatric Drug Optimisation group identified long-acting cabotegravir injectables as a high research priority for HIV prevention in neonates. She adds that developing patches with tiny microneedles that deliver HIV medication could hold great promise for treating newborns in the future.

Commenting on the PETITE-DTG study, Dr Moherndran Archary, who has been at the forefront of South Africa’s HIV response for children, said: “Professor Bekker’s research has directly impacted access to life-saving HIV medication for newborn infants – the most vulnerable of populations who have not traditionally benefited from the significant advances in HIV treatment.”

The PETITE-DTG study is one of many under the Unitaid-funded BENEFIT Kids project aiming to improve treatment for children with HIV or multidrug-resistant tuberculosis. UNITAID is a global health initiative that, amongst others, funds research and helps facilitate the more rapid introduction of new health technologies.

Republished from Spotlight under a Creative Commons licence.

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Categories : HIVTags :

How an SAMRC Study Found that HIV Deaths in SA May be Massively Undercounted

On By ModernMedia
Photo by Sergey Mikheev on Unsplash

By Chris Bateman

It is widely acknowledged among health and demographic experts that relying solely on what is written on death certificates does not paint an accurate picture of what people in South Africa are actually dying of. Now, an SAMRC study has provided evidence that the undercounting of deaths due to HIV might be even greater than previously thought.

Many in health circles were surprised by a recent South African Medical Research Council (SAMRC) study that found that 23% of deaths in a nationally representative sample drawn from 2017/2018 were due to HIV. By comparison, Stats SA data for roughly the same period puts the figure at only 5.7%.

That Stats SA’s HIV mortality figures differs from other sources is not new and not in itself surprising. This is because Stats SA reports a relatively straight-forward count of what is written on death certificates – where it is known HIV is often not indicated, even if it is the underlying cause of death. By contrast, the new SAMRC study looked at autopsy reports, death certificates, medical records, and interviews with next of kin to come up with its much higher estimate.

The thing that did come as a surprise, is just how much higher the SAMRC figures were than anticipated. Previously, the real number of HIV deaths were thought to be around double the Stats SA number, rather than four times as much. For example, according to Thembisa, the leading model of HIV in South Africa and the basis for UNAIDS’s estimates for the country, around 12% of deaths in the country in 2018 were due to HIV.

“Accurate mortality data are essential for informed public health policies and targeted interventions; however, this study highlights critical gaps in our cause-of-death data, particularly in the underreporting of HIV/AIDS and suicides,” says Professor Debbie Bradshaw, study co-author and Chief Specialist Scientist at the SAMRC Burden of Disease Research Unit, in a media statement. (The study also found substantial under-reporting of suicide on death certificates.)

Multiple data sources

The study was conducted in three phases, examining deaths that were registered in 27 randomly selected health sub-districts between 1 September 2017 and 13 April 2018.

In addition to the examination of autopsy reports, death certificates, and medical records, trained fieldworkers interviewed next of kin to conduct verbal autopsies using a World Health Organization (WHO) questionnaire that had been translated into the country’s nine official languages.

Based on these various sources of data, the cause of each death was categorised into one or more of 44 categories and then compared to the cause of death indicated on the person’s death certificate. (The process for ensuring accuracy, including a review shared by a team of 49 medical doctors, is described in detail in this report.)

The researchers collected data for over 26 000 deaths, although not all types of data were available for each death. Medical records were available for over 17 600 cases, forensic pathology (autopsy) records for 5 700, and about 5 400 verbal autopsies were conducted. In the end, “to save costs”, not all medical records were reviewed.

Overall, for just over 15 000 deaths, the researchers could link and compare their assessment of why a person died to what was written on death certificates.

‘Poor agreement’

The researchers found that “there was poor agreement between the underlying cause of death obtained from the study and the official cause of death data”. The cause of death was the same in only 37% of cases. In addition to the under-reporting of HIV, the researchers also identified “severe under-reporting” of suicide as a cause of death.

A strong link between TB and HIV was observed, with TB responsible for 46% of deaths among people with HIV and 63% of TB deaths occurring in individuals with HIV. Together, these two diseases accounted for almost 30% of deaths.

Some question marks

As noted earlier, the new numbers are substantially higher than estimates from the highly respected Thembisa model. According to their data only 12% of deaths from mid-2017 to mid-2018 were due to HIV-related causes, with a further 9% of deaths occurring in persons with HIV but due to other causes.

Dr Pam Groenewald, a co-author of the new study and also with the SAMRC, describes Thembisa as “an excellent source”. She tells Spotlight they had a long discussion with the Thembisa researchers, “but we weren’t able to fully explain the differences”.

The study authors cite several factors that might contribute to a higher proportion of HIV deaths in their study. Firstly, the weighted national causes of death validation sample aimed to represent the registered deaths in the country, and it was known that deaths in rural areas and child deaths were under-represented. Secondly, deaths that occurred in private sector hospitals were not represented. Groenewald says the HIV-linked deaths in private hospitals are “definitely lower”, but doubts they would have had a significant impact on their findings.

One thing in favour of the study numbers is the fact that the cases they identified with HIV/AIDS as the underlying cause of death were independently reviewed by clinicians. As Groenewald points out, they looked at medical records of people admitted to and who died in hospital, including CD4 cell counts and HIV viral loads. The suggestion is that if someone had a very low CD4 count and a very high HIV viral load at the time of death, then it is very likely HIV played a role in their death, unless of course they died of a clearly non-associated cause like injuries from a car accident.

On the other hand, it might be argued that since HIV is very widely tested for in South Africa, it is more likely to appear on medical records than other less tested for diseases.

Another interesting wrinkle is that the proportion of deaths from HIV/AIDS from this study was higher than anticipated based on observed declines in adult mortality. It is widely accepted that the decline in adult mortality and the increase in life-expectancy over the last two decades was driven by antiretroviral therapy keeping more people with HIV alive. While the new findings do not challenge this narrative, it does suggest the effect may be less pronounced than previously thought.

What to do?

The researchers suggest their study has immediate implications for the country’s response to HIV and TB.

“The study recommends strengthening case finding, follow-up, prevention, and treatment for HIV, AIDS and TB to reduce mortality rates, and underlines the importance of government’s rapid response to counter the recent abrupt withdrawal of Pepfar funding,” Bradshaw comments in the media release.

But more broadly, the findings put the spotlight on major problems in the country’s death certification systems.

“Our findings highlight the need for improved record quality and adherence to testing guidelines within the medical community. Poor record keeping included incomplete documentation of clinical findings and results,” the study authors write.

“A lot of doctors’ report HIV as ‘retroviral disease’, for example, and it’s not coded as HIV,” Groenewald explains to Spotlight.

Urging doctors to record the actual underlying cause of death when writing up death certificates, she also called for improved training in death certification at medical schools.

Doctors’ reluctance to report HIV on death certificates likely has various reasons, including stigma related to HIV and the fact that some medical insurance policies used to exclude HIV, though policies now treat HIV like any other chronic condition.

Overall, Groenewald says, we need to step back and probe the rationale of compiling underlying cause of death statistics.

“The public health aim of the medical certificate of cause of death, (MCCD), is to prevent premature deaths. We therefore need to record the cascade of events or causal sequence of medical conditions leading to death and target our interventions at the underlying cause of death. The coding rules focus on the underlying cause of death, (UCOD), to compile the mortality statistics,” she says.

Groenewald stresses that the law requires doctors to provide accurate information on death causation. The Health Professions Council of SA’s ethical rules also recognised that a statute requiring disclosure about a deceased person’s health must be complied with and is not considered unethical. Contrary to common physician misconception, Groenewald says all this combined to show “it is completely ethical to disclose on a death certificate that a person has died from an AIDS related illness”.

In the meantime, routine mortality data from Stats SA should clearly be taken with a pinch of salt. As Groenewald points out, vital registration data should not be accepted at face value but should be interrogated and cross-checked with other data sources to get coherent and consistent estimates that fit within an envelope of all causes of mortality.

– Additional reporting by Marcus Low.

Republished from Spotlight under a Creative Commons licence.

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US Funding Cuts Could Cause Over 150 000 Extra HIV Infections in SA by 2028

On By ModernMedia
Photo by Andy Feliciotti on Unsplash

By Jesse Copelyn

The cancellation of PEPFAR funding to South Africa could cause between 150 000 and 295 000 additional HIV infections by the end of 2028. This is unless the South African government covers some of the defunded services.

These are the preliminary findings of a new modelling study commissioned by the National Health Department to look into the impact of PEPFAR funding cuts in South Africa. It was authored by researchers at the University of Cape Town (UCT) and University of the Witwatersrand (WITS). PEPFAR is a multi-billion dollar US initiative that supports HIV-related services globally, but which has been significantly slashed by the Trump administration since February. 

The research on South Africa comes at the same time that a separate modelling study was published in The Lancet which found that the discontinuation of PEPFAR could cause an additional 1-million HIV infections among children in sub-Saharan Africa by 2030. This would lead to the deaths of about 500 000 children according to the study, while over 2-million others would be left orphaned.

On 20 January, newly-elected US president Donald Trump issued an executive order which suspended virtually all US foreign development assistance for 90 days pending a review. As a result, US-backed aid programmes were brought to a standstill across the world, including in South Africa. While a waiver was published which supposedly allowed some PEPFAR-related activities to continue, this had a limited effect in practice.

Since then, some US grants have resumed, while others have been cancelled. The value of all terminated grants comes to tens of billions of dollars globally. In South Africa, numerous awards have been cancelled from PEPFAR, which had provided roughly R7.5-billion to non-profit organisations in the country in 2024. These organisations primarily used the money to hire and deploy health workers in government clinics, or to operate independent health facilities. Many of these have now been forced to close.

While there are still some active PEPFAR grants in South Africa, it’s unclear how much longer these will be retained, as many are only approved until September. The new study focusing on South Africa models what would happen if all PEPFAR funding was eliminated.

Up to 65 000 additional deaths expected by 2028

In 2024 roughly 78% of all people who had HIV in South Africa were on antiretroviral (ARV) treatment. This figure has been steadily rising over time. By 2026, it was expected to climb to 81%, according to Dr Lise Jamieson, lead author of the local modelling study.

But this trend will be reversed if the entire PEPFAR programme is cancelled and the government fails to step in. ARV coverage among people with HIV would drop to 70% by 2026, according to the study. Under the model’s more pessimistic scenario, the figure would drop even lower – to 59% by 2026.

This is partly because some people living with HIV in South Africa get their ARVs directly from PEPFAR-funded drop-in centres. If these centres close down, some patients may stop taking their ARVs. Indeed, this is precisely what happened after one centre in Pretoria stopped providing services.

The loss of PEPFAR funds could also hinder the health system’s capacity to get newly-infected people on HIV treatment. For instance, PEPFAR-funded organisations had employed nearly 2000 lay counsellors across South Africa who tested people for HIV. Without these staff, fewer people will be diagnosed and get started on treatment.

Not only will ARV coverage drop due to the cuts, but HIV prevention services will also be affected, according to the study. For instance, PEPFAR-funded drop-in sites had been providing people with pills that prevent HIV, called pre-exposure prophylaxis (PrEP). These services were targeted at groups most likely to contract and transmit HIV, like sex workers. According to the new modelling study, the full termination of PEPFAR would lead to as much as a 55% reduction in PrEP coverage for female sex workers by 2026.

Because of factors like these, the researchers estimate that the PEPFAR cuts would cause between 56 000 and 65 000 additional HIV-related deaths in South Africa by 2028. By 2045, this would increase to between 500 000 and 700 000 deaths.

Nearly 90% of USAID contracts terminated in South Africa

All of these results only hold if the South African government fails to step in, according to Jamieson. The modelling study finds that to cover all PEPFAR services from 2025 to 2028, the government would need to spend an extra R13 to 30-billion in total.

It’s unlikely that the government will cough up this amount, but according to Jamieson the National Health Department is taking steps to identify and support certain key services that were defunded by PEPFAR. She is hopeful that the results may not be as drastic as what the study suggests.

Another caveat is that the modelling study estimated what would happen if South Africa lost all of its PEPFAR funding. But at least for now, there are still some grants reaching beneficiaries in the country.

PEPFAR funds are primarily distributed by two US agencies – the US Agency for International Development (USAID) and the US Centres for Disease Control and Prevention (CDC). While both agencies paused funding after the initial suspension order in late-January, the CDC resumed its funding roughly two weeks later. This was after a US federal court ruled that the Trump administration could not freeze congressionally appropriated funds.

CDC grants only appear to be active until September (at least for South African beneficiaries), though uncertainty remains about this.

USAID has taken a much harder line – funding was suspended from late January. By late-February, the agency moved from pausing funds to issuing termination notices to most of its beneficiaries.

In South Africa, roughly 89% of all USAID funding has been cancelled. The value of all cancelled funds comes to about US$261-million (R5.2-billion). Only five other countries have faced larger cuts in absolute terms (see all country-level estimates here). Spotlight and GroundUp have confirmed that at least some of the remaining 11% of USAID funding has once again begun flowing to beneficiaries in the country.

Thus, a small amount of USAID funding is trickling into South Africa, while CDC funds have largely been retained in full. Though it’s unclear for how much longer.

Published by GroundUp and Spotlight

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : HIVTags :

8 Million People Living with HIV in SA, According to Latest Estimates

On By ModernMedia
Photo by Miguel Á. Padriñán

By Marcus Low

The number of people living with HIV in South Africa has for the first time reached the eight million mark. Of these, around 6.2 million are on treatment, according to new estimates.

The number of people living with HIV in South Africa continues to rise, surpassing eight million in 2024. This is according to just-released estimates from Thembisa, the leading mathematical model of HIV and TB in South Africa. The eight million amounts to 12.8% of the population.

The continued rise is due to the fact that there are more people becoming newly infected with HIV than there are people with HIV who are dying. The increasing numbers are thus a reflection of the fact that antiretroviral medicines are keeping people alive who would otherwise have died.

There was an estimated 178 000 new HIV infections in 2023/2024 (mid-2023 to mid-2024). Over the same period, around 105 000 people with HIV passed away – 53 000 due to HIV-related causes and 52 000 for reasons not related to HIV.

The estimates of new HIV infections are slightly higher than in last year’s Thembisa publications. According to Dr Leigh Johnson, of the University of Cape Town and the key developer of the Thembisa model, this is mainly due to the model factoring in new evidence that condom usage is declining.

78% treatment coverage

Of the eight million people living with HIV, around 6.2 million, or 78%, were taking antiretroviral treatment in 2024. Around one in five people living with the virus were thus not on treatment. Treatment is recommended for everyone living with HIV.

On the UNAIDS 95-95-95 targets, also endorsed in South Africa’s National Strategic Plan for HIV, TB and STIs 2023 – 2028, the middle target, helping people start and stay on treatment, continues to be the main area of underperformance. Around 95% of people living with HIV in South Africa knew their status in 2024, around 81.5% of these were on antiretroviral treatment, and of those on treatment, around 92% had viral suppression. (Note that the 78% treatment coverage figure is the product of multiplying the performance on the first two 95 targets.)

There continues to be stark gender disparities in South Africa’s HIV epidemic. On the one hand, there are many more women living with HIV than men – 5.2 million compared to 2.6 million as of mid-2024. On the other hand, slightly more men died of HIV-related causes than women in 2023/2024 – 27 100 men compared to 24 200 women.

Worrying trends

One ongoing area of concern is that many people only start treatment once their immune systems have been severely compromised. In 2023/2024, around 54 000 adults started treatment for the first time with CD4 counts below 200 cells/mm3. A CD4 count above 500 cells/mm3 is generally considered to be healthy. CD4 cells are a type of white blood cell that is vital to the functioning of the immune system. People who start treatment with low CD4 counts tend to have worse long-term outcomes.

The latest Thembisa outputs also contain worrying findings on the extent to which people drop in and out of care. In 2023/2024, an estimated 714 000 people restarted antiretroviral treatment after previously having stopped for at least a month – of these, around 326 000 had CD4 counts below 200 cells/mm3.

Finally, on a more positive note, the latest Thembisa outputs continue to show a rise in life expectancy in South Africa. As shown in the above graph, life expectancy declined severely round the turn of the century, largely due to people dying of AIDS, but then increased over time as antiretroviral therapy started keeping people living with HIV alive. The blip in 2020 and 2021 is due to the COVID-19 pandemic.

Note: This article is based on outputs from Thembisa version 4.8 – published in late March 2025. We have quoted 2023/2024 figures since they are based on more data, and thus more reliable than the estimates for 2024/2025. We have rounded some numbers to make the text more accessible. Graphs were made using the R package ggplot2. Spotlight will soon publish an #InTheSpotlight special briefing in which we will unpack the Thembisa 4.8 outputs in more detail.

Republished from Spotlight under a Creative Commons licence.

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