RADAR s portfolio of clinical interventions for TB/HIV include the following:

1. National TB/HIV Pilot Programme
   1. Voluntary Counseling and Testing
   2. The Prevention and Management of Opportunistic Infections
2. HIV/AIDS Wellness Service
3. Addressing the TB Epidemic in Rural South Africa
4. Anti-retrovirals in the Developing Country Contexthttp

1. National TB/HIV Pilot Programme

Since 1998, RADAR has operated one of four National TB/HIV Pilot Sites in South Africa. This effort is part of the World Health Organization s multi-country PROTEST initiative. The mandate of this work is to develop a comprehensive package of prevention, care and support services for the tuberculosis and HIV epidemics. At present, TB is the most common opportunistic infection and cause of death amongst those living with HIV/AIDS in South Africa.

Major components of this programme include the following:

i. Voluntary Counselling and Testing (VCT)

The development of highly accurate rapid HIV tests that provide results within 15 minutes has the potential to greatly increase access to VCT, particularly in rural and underserved areas. Improving access to VCT, while an important entry point for clinical care and support, has also been demonstrated to reduce risk behaviour and potentially prevent new HIV infections.

Rapid HIV test

An important goal of the pilot has been to develop an effective strategy for the introduction of counseling and testing at the Primary Health Care level - where no previous services were available. Furthermore, the evaluation of pilot activities has produced numerous tools to assist the development of these services in other areas.

• The Introduction of Voluntary Counselling and Rapid Testing for HIV in rural South Africa - from theory to practice (Pronyk PM, Kim JC, Makhubele MB, Hargreaves JR, Mohlala R, Hausler HP. AIDS Care, 2002). (36kb)
• Scaling up TB/HIV collaborative activities in South Africa linked to antiretroviral implementation. Hausler HP, Simelela N, Vilakazi K, Mvusi L, Naidoo P, , Penrose A, Pronyk PM, Sallet J, Godfrey-Faussett P. XV International AIDS Conference, Bangkok.: July 11-16, 2004 .(abstract )
  
• VCT Training Manual (265kb): a guide to assist trainers VCT Manual
• VCT Testing register (12kb)
  
• CARE (12kb): a minimum standards for pre and post test counseling
• Evaluating the VCT service using mock-clients : sample evaluation forms Male client evaluation checklist (16kb); Femaleclient evaluation checklist (14kb)

ii. The Prevention and Management of Opportunistic Infections

In 2002, access to antiretroviral agents has not been forthcoming in South Africa s public sector. However, the effective implementation of guidelines for the prevention and better management of opportunistic infections (OI s) has the potential to reduce morbidity and mortality from the epidemic.

Prevention of OI s: The introduction of protocols for the use of co-trimoxazole and INH have been piloted at the level of primary and secondary care.

Management of OI s: Clinical guidelines for the management of OI s have been introduced in South Africa, and are well-suited to most developing country settings. These guidelines have been incorporated into a comprehensive text on Primary Clinical Care for HIV/AIDS, which provides an overview of the epidemic, VCT and these useful clinical protocols.

Primary Clinical Care for HIV/AIDS (288kb): a manual for primary AIDS care in developing countries, including clinical management guidelines
Clinical care form (42kb) / form without INH (38kb): to assist in establishing a continuity of care for HIV/AIDS patients including the WHO Staging System, the HIV Systems Review, condensed clinical care guidelines, and non-clinical advice for patients living with HIV

2. HIV/AIDS wellness services>

In the early stages of HIV infection, a number of critical interventions can assist patients to live longer and healthier lives. In resource poor contexts, many of these interventions have been shown to be both effective and inexpensive. These interventions together constitute a package of Wellness Care for HIV and include:

Screening for sexually transmitted infections at every visit
Screening for tuberculosis at every visit
Asking about safer sexual behaviour and condom use
Offering family planning services to those who wish it
Annual PAP smears for women
Basic nutrition, psychosocial and peer support
RADAR, in partnership with the Perinatal HIV Research Unit are in the process of implementing this package of wellness services for HIV/AIDS in two very different contexts - the urban township and more remote rural areas. A number of research questions are incorporated into this service, to help us better understand the clinical, social and health systems dimensions of the HIV epidemic in the southern African context.

Download complete 2006 abstracts(25KB)

• G de Bruyn, P Pronyk, M Willie, F van der Linde, M Lurie, A Heyer, T Kotzee, N Tshabangu, H Struthers, J McIntyre, G Gray, N Martinson. Predictors of mortality in a cohort of HIV-infected patients in South Africa awaiting ART. XVI International AIDS Conference, Toronto, 13-18 August, 2006
  H Struthers, R van Niekerk, A Heyer, PM Pronyk, N Tshabangu, K Lentle, T Kotzee, G Gray, J McIntyre, N Martinson. Prevalence and predictors of HIV self-disclosure in rural and urban South Africa. XVI International AIDS Conference, Toronto, 13-18 August, 2006
• M Lurie, PM Pronyk, E de Moor, A Heyer, G de Bruyn, N Tshabangu, H Struthers, J McIntyre, G Gray, N Martinson. Sexual behaviour and reproductive health among HIV infected patients in urban and rural South Africa. XVI International AIDS Conference, Toronto, 13-18 August, 2006
• Martinson N, Pronyk P, Mhlongo N, Heyer A, Seroke B, Mbengo T,
  Steyn J, McIntyre J, Gray G. Characteristics of rural and urban HIV-infected adults attending primary care services in South Africa . XV International AIDS Conference, Bangkok : July 11-16, 2004Back

3. Addressing the Tuberculosis Epidemic in Rural South Africa

Since the HIV epidemic has taken hold in the Limpopo Province, the TB epidemic has been in a phase of exponential expansion. Since 1996, there has been nearly a 300% increase in the incidence of hospitalised TB at Tintswalo Hospital (RADAR s base) based on South Africa National Tuberculosis Control Programme quarterly report data.

HIV Prevalence in South Africa and in the Limpopo Province 1990-2000

Incidence of Tuberculosis: Tintswalo Hospital, 1996-2002 (per quarter)

RADAR has been involved in supporting the Directly Observed Therapy (DOTS) Programme and in assisting district structures to manage the increasing burden of TB.

In addition, operational TB research has been conducted in the following areas:

• Adherence to TB Preventive Therapy for HIV-positive patients in rural South Africa : implications for antiretroviral delivery in resource-poor settings? (Rowe et al 2004, International Journal of Tuberculosis and Lung Disease)
• Undiagnosed pulmonary tuberculosis deaths in rural South Africa . (Pronyk et al 2004, International Journal of Tuberculosis and Lung Disease )
• Active Case Finding for Tuberculosis (65kb) - a study on the burden of undiagnosed TB among chronic coughers residing within the 20 villages of a demographic and health surveillance system. (Pronyk PM, Joshi B, Hargreaves JR, Madonsela T, Collinson MA, Mokoena O, Tollman SM, Hausler HP, International Journal of TB and Lung Disease, 2001)
  
• Health Seeking Behaviour (66kb)- a study on the patterns of accessing care among over 300 TB clients in a rural sub-district (Pronyk PM, Makhubele MB, Hargreaves JR, Tollman SM, Hausler HP, International Journal of TB and Lung Disease, 2001)

Forthcoming articles:

• Public health and human rights: the ethics of international public health interventions for tuberculosis (Pronyk PM, Porter JDH, Tuberculosis - an interdisciplinary perspective, Porter JDH, Grange JM (eds). Imperial College Press, 1999) (54kb)
• The way forward: an integrated approach to tuberculosis control. Porter, JDH, Ogden J, Pronyk PM. Tuberculosis - an interdisciplinary perspective, Porter JDH, Grange JM (eds).Imperial College Press, 1999.

4. Anti-retrovirals in the Developing Country Context

The issue of introducing anti-retrovirals in the management of HIV/AIDS has also become an important international issue since the XIII International AIDS Conference in Durban 2000. The challenges surrounding their effective introduction into historically disadvantaged areas are many and complex. While offering hope to people living with HIV, and providing an incentive for counseling and testing, improving access to these medications raises many serious questions, and has the potential to divert attention from addressing more fundamental issues driving the epidemic in countries such as South Africa.

These issues are highlighted in the article cited below: