In a media briefing on Tuesday, 8th August, the Council for Medical Schemes (CMS) sought to clarify its process and recommendations over the approved 5% increase to medical aid scheme contributions, levels above which the medical schemes must motivate for. As for low-cost benefit options (LCBO), the CMS indicated that they would only provide a report to the Health Minister by the end of the month. This could prevent medical schemes from applying for new LCBOs in 2023.
Mr Mondi Govuzela, Senior Manager of Benefits Management, explained that the 5% approved increase is based on the Consumer Price Index (CPI) for 2022, which indicated a 4.9% increase. Schemes therefore may raise contributions by 5%, in line with the Reserve Bank’s inflation prediction for 2024. A prudent percentage markup should be incorporated to take into account cost increases and demographic changes, he advised. Before COVID, contribution increases have typically been 2.4–5% above CPI. The years 2020 to 2022 saw contribution increases dip below CPI.
One of the cost drivers that Mr Govuzela noted in the media briefing was supplier pressure stemming from fewer doctors and specialists, who were pushing for higher remunerations. Increased costs elsewhere in the healthcare industry. On the member side, growing rates of chronic diseases, membership ageing and coverage for medical services also added pressure.
LCBO would appear to be a solution for many individuals to access private healthcare for at least some urgent conditions, but the CMS has yet to comply with a Pretoria High Court ruling ordering that they provide a report on their moratorium on granting exemptions to medical schemes to provide LCBO benefits. The case was brought by the Board of Health Funders (BHF).
As to what the CMS’s response to the LCBO ruling was, CMS Registrar Dr Sipho Kabane said that the CMS was preparing a report that would be delivered to the Health Minister “by the end of the month”, but would not be drawn on what it might say. The deadline for registering new benefit options is September 1.
In their circular explaining the decision increase, the CMS acknowledged the persistent macroeconomic headwinds facing medical schemes and their members, with a meagre 1% increase predicted for SA’s GDP next year. “Against the backdrop of the current adverse macroeconomic conditions characterised by multi-year higher interest rates due to stubbornly higher inflation rate, volatile domestic currency and surging energy prices and overall lacklustre economic growth, it is evident that most household budgets will remain constrained for a foreseeable future, leaving most consumers under a precarious financial position. To cushion members of medical schemes against further financial distress and the probable risk of losing their health insurance cover due to affordability constraints, medical schemes are advised to limit their cost increase assumptions for contribution increases for the 2024 benefit year to 5.0%, in line with CPI.”
Acinetobacter baumannii is a notorious hospital pathogen, and there is great pressure to devise novel therapeutic approaches to combat this growing threat. German researchers have now detected an unexpectedly wide diversity of certain cell appendages known as pili in A. baumannii that are associated with pathogenicity. This finding, published in PLOS Genetics, could lead to treatment strategies that are specifically tailored to a particular pathogen.
Each year, over 670 000 people in Europe fall ill because of antibiotic-resistant pathogens, and 33 000 die from the infections. Especially feared are pathogens with resistances against multiple, or even all, known antibiotics. One of these is the bacterium Acinetobacter baumannii, feared today above all as the “hospital superbug”: According to estimates, up to five percent of all hospital-acquired and one tenth of all bacterial infections resulting in death can be attributed to this pathogen alone. This puts A. baumannii right at the top of WHO’s list of pathogens for which there is an urgent need to develop new therapies.
Understanding which characteristics make A. baumannii a pathogen is one of the prerequisites for this. To this end, bioinformaticians led by Professor Ingo Ebersberger of Goethe University Frankfurt and the LOEWE Center for Translational Biodiversity Genomics (LOEWE-TBG) are comparing the genomes and the proteins encoded therein across a wide range of different Acinetobacter strains. Conclusions about which genes contribute to pathogenicity can be drawn above all from the differences between dangerous and harmless strains.
Due to a lack of suitable methods, corresponding studies have so far concentrated on whether a gene is present in a bacterial strain or not. However, this neglects the fact that bacteria can acquire new characteristics by modifying existing genes and thus also the proteins encoded by them. That is why Ebersberger’s team has developed a bioinformatics method to track the modification of proteins along an evolutionary lineage and has now applied this method for the first time to Acinetobacter in collaboration with microbiologists from the Institute for Molecular Biosciences and the Institute of Medical Microbiology and Infection Control at Goethe University Frankfurt.
In the process, the researchers concentrated on hair-like cell appendages, known as type IVa (T4A) pili, which are prevalent in bacteria and that they use to interact with their environment. The fact that they are present in harmless bacteria on the one hand and have even been identified as a key factor for the virulence of some pathogens on the other suggests that the T4A pili have repeatedly acquired new characteristics associated with pathogenicity during evolution.
The research team could show that the protein ComC, which sits on the tip of the T4A pili and is essential for their function, shows conspicuous changes within the group of pathogenic Acinetobacter strains. Even different strains of A. baumannii have different variants of this protein. This leads bioinformatician Ebersberger to compare the T4A pili to a multifunctional garden tool, where the handle is always the same, but the attachments are interchangeable. “In this way, drastic functional modifications can be achieved over short evolutionary time spans,” Ebersberger is convinced. “We assume that bacterial strains that differ in terms of their T4A pili also interact differently with their environment. This might determine, for example, in which corner of the human body the pathogen settles.”
The aim is to use this knowledge of the unexpectedly high diversity within the pathogen to improve the treatment of A. baumannii infections, as Ebersberger explains: “Building on our results, it might be possible to develop personalised therapies that are tailored to a specific strain of the pathogen.” However, the study by Ebersberger and his colleagues also reveals something else: Previous studies on the comparative genomics of A. baumannii have presumably only unveiled the tip of the iceberg. “Our approach has gone a long way towards resolving the search for possible components that characterize pathogens,” says Ebersberger.
Before being diagnosed with bipolar disorder Type 1, Sifiso Mkhasibe says he was often labelled as the “black sheep” of the family and he did not know where to go for help. He was often dismissed as crazy and told that this is a white man’s illness.
“My immediate family did not know how to help or support me,” he says. “I was always labelled the black sheep of my family. I was told that I was crazy, bewitched and that I was just pretending to be sick. I was told to be strong and to get over myself and that this disease is a white man’s illness and black people do not have such things.”
Mkhasibe says his family thought it was a cultural thing and that he had an ancestral calling to become a traditional healer. He did not agree.
The South African Federation of Mental Health (SAFMH) defines stigma as “an attribute, quality, or condition that severely restricts or diminishes a person’s sense of self, damaging their self-worth, social connections, and sense of belonging”.
The challenge of getting help
“It was extremely challenging to get help and support from my family. They played a big role in stigmatising me,” Mkhasibe tells Spotlight.
A delay in accessing mental healthcare services led to Mkhasibe’s condition deteriorating. He says some of his symptoms were racing thoughts, impulsive spending, hearing voices, and insomnia. “I was always high on life with extreme energy levels. Things became worse, whereby I became violent and aggressive. I was eventually admitted to Chris Hani Baragwanath Hospital in 2007 and later transferred to Sterkfontein Psychiatric Hospital in Krugersdorp.”
“I was never informed about my diagnosis. What it was and how to manage it. I had no idea what to do when I was diagnosed. The challenge was that I was not educated about my mental illness,” he says.
Mkhasibe says he was in Sterkfontein Hospital until 2011. By then, he was estranged from his family and moved around a lot staying with cousins, aunts, and his late grandmother.
“I was at Sterkfontein for four years. My family did not want me back home. I moved from one ward to the other during that time. Now I’m close to my sister and mother again but it took a while to mend those bridges.”
He says his experience with the illness prompted him in 2011 after he was discharged from hospital, to start volunteering and creating awareness on mental health conditions. Mkhasibe is now 39 years old and was until recently a project leader for mental health at the SAFMH. He started at the organisation in 2017. On leaving the organisation, he says he has learned a lot but now has a newborn son and wants to spend time with him. Mkhasibe describes himself as a family man. He is married and has two children.
Stigma and seeking care
Ashleigh Craig, a clinical psychologist who runs a Johannesburg-based private practice and has also worked in the public sector, says beliefs around mental health contribute to stigma because there are negative connotations surrounding mental illness.
“People seeking care are often called names such as bewitched or crazy. This prevents people from seeking out care,” says Craig. “This results in people seeking care when their condition is acute and recovery will take much longer. Stigma can often lead to people completely stopping to take treatment.”
Claire Hart, a post-doctoral fellow at Wits University’s Developmental Pathways for Health Research Unit (DPHRU), says the label of any mental illness is often also associated with a mark of social disgrace or stigma. This has been shown in South African communities, where studies revealed high levels of stigmatisation towards individuals with mental disorders. The label of having a “mental illness” is socially stigmatised and constitutes negative external perceptions, which may, in turn, be internalised and negatively impact an individual’s internal sense of self.
“As a result, these individuals may avoid using existing mental health care services in fear of being labelled even when experiencing severe psychological distress. Thus, both having a mental illness and seeking help may be viewed as undesirable,” says Hart.
Under-funded, under-resourced
Hart says fighting stigma requires a two-fold approach that involves education and providing adequate resources. “People with a lived experience can help in terms of fighting mental health stigma and raising awareness. However, mental health is underfunded and there is a shortage of psychologists in the country. To become a registered psychologist, you need a Masters degree and most universities only take six to 12 Masters candidates per year,” says Hart.
Craig says people in the public sector can wait up to four months just to see a psychologist. She says private psychologists are very expensive and in the public sector most mental health services are only available at tertiary hospitals.
According to South Africa’s new National Mental Health Policy Framework and Strategic Plan 2023 – 2030 (the mental health framework,) the country has less than one psychologist for every 100 000 people. This is among the reasons why there are limited mental health services in the public health sector, especially in rural areas.
“At present, mental healthcare in rural areas, preventive and promotive aspects of mental health, and the provision of services to children, adolescents and those with anxiety, mood, and other non-psychotic disorders remain under-resourced and underdeveloped. Furthermore, primary healthcare workers are under considerable strain due to high caseloads and have minimal training in mental health, resulting in patients receiving inadequate mental health care,” says Hart.
The social and economic costs
Data in the mental health framework indicates that about 5% of the total public health budget was allocated to public mental health expenditure in 2016/2017. Provincial public health budget allocations towards mental health showed marked inequality, ranging from 2.1 to 7.7% across provinces.
According to the mental health framework, social costs of mental illness can include disrupted families and social networks, stigma, discrimination, loss of future opportunities, marginalisation, and decreased quality of life.
Mental illnesses such as depression and anxiety have been estimated to cost the economy more than R61.2 billion in lost earnings, according to the mental health framework. It states that at a societal level, lost income associated with mental illness far exceeds public sector expenditure on mental health care. In other words, it costs South Africa more to not treat mental illness than to treat it.
What to do?
Although the mental health framework goes to great lengths to stress the impact of stigma on mental health, its plans to address this are relatively low in detail. According to the framework, all health staff working in health settings will receive basic mental health training, inclusive of anti-stigma training, and ongoing routine supervision and mentoring. Provincial departments of health are meant to look at expanding their mental health workforce.
The framework also sets out to strengthen mental health promotion, prevention and advocacy. “Currently, however, no concerted national programme exists,” the framework states. “In 2024, a national public education programme for mental health will be established, including knowledge of mental health and illness; stigma and discrimination against people with lived experience of mental illness.” This, according to the policy framework, will be steered by the national health department and provincial health departments. Other relevant government departments, including Employment and Labour, Education, and Social Development will, among others, introduce mental health literacy programmes into curriculums or workplace policies and decrease stigma.
But according to Michel’le Donnelly, a project leader for advocacy and awareness at the SAFMH, there is no clear outline for any anti-stigma programming in the mental health policy framework. “As the SAFMH we hold the view that the South African government needs to actively ensure that there is sufficient funding targeted for anti-stigma programming. Monitoring, evaluation, and implementation of these programmes should be done in collaboration with people with lived experience of mental health conditions and NGOs working in the sector. These programmes should include contact-based education as part of governments intended activities because, through evidence and research, this has proven to be a way of ending stigma.”
Mkhasibe agrees that we need more support to make people aware of mental health services and how to fight stigma. ”We need more community engagement in terms of mental health education and awareness. People all over South Africa need to know that mental health is more prevalent than we think. Businesses and organisations need to instil mental health training as a culture in the office,” he says.
“Schools, colleges, and universities should make mental health a priority within education. Awareness campaigns should be done at churches, malls, taxi ranks, airports, and bus stations. Basically, everywhere where people gather,” he says.
Depression and anxiety are thought to increase a person’s risk of developing cancer, but research results have been inconclusive. In an analysis of multiple studies from the Netherlands, the UK, Norway, and Canada, investigators found that depression and anxiety are not linked to higher risks for most types of cancer among this population. The analysis is published in the journal CANCER.
Experts have suspected that depression and anxiety may increase cancer risk by affecting a person’s health-related behaviours or by having biological effects on the body that support cancer development. Some research has supported an association between depression, anxiety, and cancer incidence, while other investigations have found no or negligible associations.
To provide additional insights, Lonneke A. van Tuijl, PhD, of the University Medical Center Groningen, and her colleagues examined data from the international Psychosocial Factors and Cancer Incidence consortium, which includes information from 18 prospective study groups with more than 300 000 adults from the Netherlands, the United Kingdom, Norway, and Canada.
The team found no associations between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers during a follow-up of up to 26 years. The presence of depression or anxiety was linked with a 6% higher risk of developing lung cancer and smoking-related cancers, but this risk was substantially reduced after adjusting for other cancer-related risk factors including smoking, alcohol use, and body mass index. Therefore, this analysis supports the importance of addressing tobacco smoking and other unhealthy behaviours including those that may develop as a result of anxiety or depression.
“Our results may come as a relief to many patients with cancer who believe their diagnosis is attributed to previous anxiety or depression,” said Dr van Tuijl. “However, further research is needed to understand exactly how depression, anxiety, health behaviours, and lung cancer are related.”
The thymus gland, which produces immune T cells before birth and during childhood, is often regarded as non-functional in adults, and is sometimes removed during cardiac surgery for easier access to the heart and major blood vessels. New research led by investigators at Massachusetts General Hospital (MGH) and published in the New England Journal of Medicine has uncovered evidence that the thymus is in fact critical for adult health generally and for preventing cancer and perhaps autoimmune disease.
To determine whether the thymus provides health benefits to adults, the team evaluated the risk of death, cancer, and autoimmune disease among 1146 adults who had thymectomy during surgery and among 1146 demographically matched patients who underwent similar cardiothoracic surgery without thymectomy. The scientists also measured T cell production and blood levels of immune-related molecules in a subgroup of patients.
Five years after surgery, 8.1% of patients who had a thymectomy died compared with 2.8% of those who did not have their thymus removed, equating to a 2.9-times higher risk of death. Also during that time, 7.4% of patients in the thymectomy group developed cancer compared with 3.7% of patients in the control group, for a 2.0-times higher risk.
“By studying people who had their thymus removed, we discovered that the thymus is absolutely required for health. If it isn’t there, people’s risk of dying and risk of cancer is at least double,” says senior author David T. Scadden, MD, director of the Center for Regenerative Medicine at MGH and co-director of the Harvard Stem Cell Institute. “This indicates that the consequences of thymus removal should be carefully considered when contemplating thymectomy.”
In an additional analysis involving all patients in the thymectomy group with more than five years of follow-up, the overall mortality rate was higher in the thymectomy group than in the general U.S. population (9.0% vs 5.2%), as was mortality due to cancer (2.3% vs 1.5%).
Although Scadden and his colleagues found that the risk of autoimmune disease did not differ substantially between the thymectomy and control groups as a whole in their study, they observed a difference when patients who had infection, cancer, or autoimmune disease before surgery were excluded from the analysis. After excluding these individuals, 12.3% of patients in the thymectomy group developed autoimmune disease compared with 7.9% in the control group, for a 1.5-times higher risk.
In the subgroup of patients in whom T cell production and immune-related molecules were measured (22 in the thymectomy group and 19 in the control group, with an average follow-up of 14.2 postoperative years), those who had undergone thymectomy had consistently lower production of new T cells than controls and higher levels of pro-inflammatory molecules in the blood.
Scadden and his team now plan to assess how different levels of thymus function in adults affect individuals’ health. “We can test the relative vigour of the thymus and define whether the level of thymus activity, rather than just whether it is present, is associated with better health,” he says.
Treatment with modern antidepressants may help prevent patients with bipolar disorder from relapsing into a depressive episode, according to an international clinical trial published in the New England Journal of Medicine. The findings challenge current clinical practice guidelines and could change how bipolar depression is managed around the world.
“Treating depression in bipolar disorder is challenging and the depressive episodes can be quite devastating for patients and their families,” said Dr Lakshmi Yatham, professor and head of the department of psychiatry at UBC, and the study’s lead author. “Reducing the risk of relapse is important because it can provide patients with a great deal of stability that ultimately lets them get back to the activities they enjoy and can greatly improve their quality of life.”
Patients with bipolar disorder experience extreme changes in their emotional state that cycle through periods of intense highs (mania or hypomania) and lows (depression). During depressive episodes, patients can experience feelings of sadness, hopelessness and loss of interest or pleasure in activities, in addition to trouble sleeping, changes in appetite and suicidal thoughts.
Antidepressant adjunctive therapy, in which antidepressants are prescribed alongside mood stabilisers and/or second-generation antipsychotic medications, is a commonly used strategy by clinicians to treat depressive episodes. However, the duration of this therapy is hotly debated due to a lack of evidence and concerns that antidepressants may induce mania, mixed states or rapid cycling between mania and depression.
Practice guidelines for the management of bipolar disorder published by the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) currently recommend discontinuing antidepressant treatment eight weeks after remission of depression.
“It’s an area that hasn’t been widely studied and there is not a lot of consensus among experts,” said Dr Yatham. “Some studies have shown that up to 80 percent of patients continue receiving antidepressants for six months or longer.”
Now, results from the world’s first randomised clinical trial assessing the duration of adjunctive antidepressant therapy suggest that extending the treatment period beyond current guidelines may help prevent depressive relapses.
The clinical trial, conducted at sites in Canada, South Korea and India, involved 178 patients with bipolar I disorder who were in remission from a depressive episode following treatment with modern antidepressant drugs (escitalopram or bupropion XL). The patients were randomly assigned to either continue antidepressant treatment for 52 weeks, or begin tapering off antidepressants at six weeks and switch to a placebo at eight weeks.
Over the year-long study, 46% of patients in the placebo group experienced a relapse of a mood event, compared to only 31% in the group that continued antidepressant treatment. While this primary outcome was not found to be statistically significant, the comparison included relapses that occurred during the first six weeks of the study when both groups were receiving the same treatment.
However, in an analysis from week six onward, when treatment between the two groups differed, patients that continued antidepressant treatment were 40% less likely to experience a relapse of any mood event, and 59% less likely to experience a depressive episode relative to the placebo group. There was no significant difference in the rate of manic episodes or the rate of adverse events between groups.
“From the point where the two groups began receiving different treatments, we see a significant benefit for patients who continued treatment with antidepressants,” said Dr Yatham.
Patients with bipolar I disorder experience depressive symptoms three times more frequently than manic symptoms. Previous studies have shown that suicide attempts and suicide deaths are at least 18 times more common during depressive episodes compared to during manic episodes.
“Stabilizing patients and keeping them stable by preventing relapse is critical and can quite literally be lifesaving,” said Dr Yatham. “Future revisions of bipolar guidelines will incorporate the evidence from this study and contribute to changes in clinical practice on how antidepressants will be used to manage patients with bipolar disorder.”
Ten percent of babies born before 32 weeks will develop cerebral palsy resulting from infections that damage white matter, nerve fibres deep in the brain. While it’s known that the white matter loss will lead to neurological deficits, there is currently no treatment to avoid this.
Now, researchers at Duke Health have conducted experiments using neonatal mice and identified a fatty molecule in breast milk that triggers a process in which stem cells in the brain produce cells that create new white matter, reversing the injury.
The study appears in the journal Cell Stem Cell. Corresponding author Eric Benner, MD, PhD, said that further study in a clinical trial is needed, but the finding is promising.
“Developing therapies for children – especially such medically fragile children – is very difficult to do because there are justifiably strict safety concerns,” Benner said. “The fact that this molecule is already found in something that is safe for premature babies – breast milk – is extremely encouraging.
“It’s been known that fats in breast milk benefit a child’s brain development, but there are many types of fats in breast milk,” Benner said. “This work has identified a lipid molecule in breast milk that promotes white matter development. Now, we can begin to develop a therapy that isolates and delivers this lipid in a way that is safe for the unique challenges of these infants.”
Benner is a neonatologist at Duke University and one of the co-founders of Tellus Therapeutics, a Duke spinout company developed with the help of the Duke University Office for Translation & Commercialization to bring this therapy from the bench into the neonatal intensive care unit.
The fatty molecule identified in the study will be administered intravenously to patients in an upcoming clinical trial. This is significant because many of the infants who are part of this vulnerable population also have gastrointestinal issues and cannot safely be given milk or medication by mouth.
The lipid molecule enters the brain and binds with stem cells there, encouraging the stem cells to become or produce a type of cell called oligodendrocytes.
The oligodendrocytes are like a hub that allow for the production of white matter in the central nervous system. This newly produced white matter in pre-term infants prevents the neurological damage that would otherwise impact the child’s ability to move – the hallmarks of cerebral palsy.
“The timing of brain injury is extremely difficult to predict, thus a treatment that could be safely given to all preterm babies at risk would be revolutionary,” said Agnes Chao, MD, a former fellow in the Division of Neonatology and first author of the paper.
“As a neonatologist, I’m so excited that I may be able to offer a treatment to families with babies that are affected by preterm brain injury who would otherwise have no other options,” Chao said.
Boehringer Ingelheim, one of the world’s leading bio-pharmaceutical companies, appointed César Nieto as General Manager and Head of Human Pharma for the Southern Africa region. As part of his responsibilities, Cesar will manage the Southern Africa region which includes South Africa and Sub-Saharan Africa countries.
A qualified physician, César has previously held senior leadership positions with the company in North and Central America, Caribbean, United Arab Emirates, and the company’s headquarters in Germany.
Mohammed Tawil, Regional Managing Director and Head of Human Pharma for Boehringer Ingelheim’s India, Middle East, Turkey and Africa (IMETA) region, said, “César has a proven track record of success in driving growth for Boehringer Ingelheim. His diverse experience will be key to our ability to drive sustainable growth and we are confident that he will help us fulfil our purpose of transforming lives for generations by bringing innovative healthcare solutions to address areas of unmet medical needs in the region.”
Commenting on his appointment, Cesar Nieto said, “Through strong partnerships with our stakeholders and Boehringer Ingelheim team, I’m confident that we can positively impact the patients and communities and contribute to healthcare innovation.”
César was previously the Regional Cardiovascular Therapeutic Area Lead at Boehringer Ingelheim IMETA, where he played a key role in the transformation of the company’s cardiovascular and stroke portfolio. His strategy in this role served as a blueprint for other regions such as Brazil, Mexico, UK and Ireland, and led to an increase in profitability in IMETA.
Boehringer Ingelheim has been in the South African market since 1962 and later grew the network into Namibia and Botswana. Recently, the regional headquarters has extended its representation to the Sub-Sharan African region.
An initiative of Wits University’s MRC/Wits Agincourt Research Unit, the Traditional Healers Project convened two ‘open houses’ at local primary healthcare facilities – Rolle Clinic and Thulamahashe Community Health Centre in rural Bushbuckridge, Mpumalanga – in March 2023.
An ‘open house’ is a community and stakeholder gathering hosted at a public health facility in partnership with the Department of Health.
The aim of these sessions is to build on the relationship that the MRC/Wits Agincourt Research Unit has established between local traditional healers, community members, and healthcare facility staff to support the end of HIV through regular HIV counselling and testing.
Traditional healers in public health
The sessions supplement research that began almost a decade ago, which focuses on the role of traditional healers in healthcare access and delivery.
Specifically, this research aims to determine:
whether traditional healers can conduct HIV counselling and testing (HCT)
whether the patients of traditional healers are willing to undergo HCT that is administered by a traditional healer
whether traditional healers and biomedical healthcare workers can work together to help link patients to HIV/AIDS diagnosis and care.
The open house sessions form part of this research and provide a platform where traditional healers and biomedical healthcare workers can come together and build mutual understanding and trust, with a view to linking those who test positive for HIV with healthcare providers who can then administer lifesaving antiretroviral treatment (ART) and care.
15 traditional healers certified HIV counsellors and testers
The open houses drew an audience of more than 150 participants, including 15 traditional healers, local indunas [tribal chiefs], community healthcare workers (CHWs), community members, and representatives from Right to Care (a local collaborating partner on HIV) and the Department of Health.
Mr Wonderful Mabuza, Project Manager at the MRC/Wits Agincourt Research Unit, oversees the open houses and says that the successes to date have far surpassed expectations:
“It is exciting to be part of the group that is doing this work, knowing that we have a lot of people who visit traditional healers in our communities. It’s groundbreaking to have traditional healers trained to provide HIV counselling and testing – and amazing to see community members respond, with some never having tested previously.”
Gogo Singabeni, one of the 15 traditional healers who has completed the programme, says: “I was very excited to be invited to the HIV training, and that we would be certified in HIV testing and counselling. It’s important to show people proof that I am certified to do HIV testing.”
She adds: “The first day of testing [a patient] was very difficult for me. I was even shaking as I was conducting the test. I started with the first client, although I was shaking, and I managed to complete the process according to how we were trained. After the client left, I drew strength in seeing that I am able to do it.”
Partnerships imperative
Dr Ryan Wagner, Senior Research Fellow at the MRC/Wits Agincourt Research Unit, leads the traditional healers programme known collectively as Ntirhisano (Shangaan for ‘working together’).
He emphasises the importance of the Ntirhisano team, traditional healers, community healthcare workers, and the Department of Health collaborating to strengthen the referral system.
“In order to expand coverage and increase uptake of HIV testing – and thereby contribute to ending new HIV cases – we need to embrace innovative approaches, such as traditional healer-initiated HIV counselling and testing,” says Wagner.
“We have recruited and trained 15 traditional healers in the Thulamahashe/Rolle area who, for the past six months, have been successfully testing their patients for HIV/AIDS. Those who tested positive have been referred to a local clinic or community healthcare worker.”
The Department of Health’s Primary Healthcare Supervisor, Sister Mariah Mkhari, says: “The Department of Health alone cannot do it, but with such collaborations between MRC/Wits and other stakeholders we will be able to conquer HIV. We welcome the initiative, and we hope Wits can expand to other areas in Bushbuckridge and train all traditional healers to test for HIV.”
Combining two types of heart scan techniques could help detect hypertrophic cardiomyopathy (HCM) before symptoms and signs on conventional tests appear, according to a new study led by UCL researchers. To do this, they used two cutting-edge heart scanning techniques: cardiac diffusion tensor imaging (cDTI), which shows the heart’s microstructure and cardiac MRI perfusion (perfusion CMR), which reveals microvascular disease. Their findings, published in Circulation, will help doctors select appropriate treatments.
HCM is a disease which affects around 1 in 500 in the UK, causing thickening of heart muscle and can lead to heart failure and cardiac arrest.
Researchers studied the hearts of three groups: healthy people, people who already had HCM, and people with an HCM-causing genetic mutation but no overt signs of disease.
The scans showed that people with overt signs of HCM have very abnormal organisation of their heart muscle cells and a high rate and severity of microvascular disease compared to healthy volunteers, helping doctors more accurately spot the early signs of HCM.
Crucially, the scans were also able to identify abnormal microstructure and microvascular disease in the people who had a problematic gene but no symptoms or muscle thickening. They found that 28% had defects in their blood supply, compared to healthy volunteers. This meant that doctors were able to more accurately spot the early signs of HCM developing in patient’s hearts.
The first drug to slow HCM progression, mavacamten, has recently been approved for use in Europe and will allow doctors to reduce the severity of the disease once symptoms and muscle thickening have appeared. Genetic therapies are also in development which could prevent symptoms entirely by intercepting HCM development at an early stage.
Perfusion CMR is already being used in some clinics to help differentiate people with HCM from other causes of muscle thickening. The researchers think that these revolutionary new therapies, combined with cDTI and perfusion CMR scans, give doctors the best ever chance of treating people at risk of HCM early enough that the condition never develops.
Dr George Joy, who led the research with Professor James Moon and Dr Luis Lopes (all UCL Institute of Cardiovascular Science), said: “The ability to detect early signs of HCM could be crucial in trials testing treatments aimed at preventing early disease from progressing or correcting genetic mutations. The scans could also enable treatment to start earlier than we previously thought possible.
“We now want to see if we can use the scans to identify which patients without symptoms or heart muscle thickening are most at risk of developing severe HCM and its life-changing complications. The information provided from scans could therefore help doctors make better decisions on how best to care for each patient.”
Dr Luis Lopes (UCL Institute of Cardiovascular Science), senior author of the study, said: “By linking advanced imaging to our cohort of HCM patients (and relatives) with extensive genetic testing, this study detected microstructural abnormalities in vivo in mutation carriers for the first time and was the first to compare these parameters in HCM patients with and without a causal mutation.
“The findings allow us to understand more about the early subclinical manifestations of this serious condition but also provide additional clinical tools for screening, monitoring and hopefully in the near future for therapeutic decision-making.”
