South Africa has the biggest human immunodeficiency virus (HIV) epidemic in the world with more than 6.3 million individuals living with HIV. Many HIV-positive individuals (50 – 75%) will develop an eye disease at some point during the course of their illness, which can lead to visual impairment and blindness. On top of that, HIV-positive individuals tend to have amore severe eye disease that recurs more often compared to HIV-negative individuals. Needless to say that visually impaired individuals, as well as their families, face serious social and economic challenges that affect their lives forever. In answer to this call Anova started up the Mopani Eye Project.
The Mopani Eye Project, which forms part of Anova’s Khutso Kurhula project, aims to improve ophthalmological expertise, skills and health systems in a rural South African context. To achieve this, a parallel approach is implemented whereby clinical research is combined with health systems strengthening support at primary healthcare as well as hospital level. The ‘Eye Team’ comprises of three medical doctors (Dr Schaftenaar, Dr Railton and Prof Peters), an ophthalmology technical advisor (Ms Maluleke) and an ophthalmology support nurse (Ms Khosa). This provides a great mix of ophthalmological, infectious disease, microbiological, epidemiological and public health expertise to reach impact.
Our clinical research focuses at two infectious eye conditions as well as long-term effects of HIV and antiretroviral therapy (ART) on the eye. To provide for this, Anova Health Institute is partnering in ongoing clinical research with the Department of Viroscience, Erasmus MC and the Rotterdam Eye Hospital (the Netherlands).
First, to prevent visual impairment and blindness caused by the two most important infectious eye diseases in individuals living with HIV (keratitis: inflammation of the cornea and uveitis: inflammation of the uveal tract), information on incidence, prevalence, prevention, and treatment is urgently needed.2 Therefore, our ongoing project focuses on these two diseases and will identify causative pathogens including viruses (e.g. human herpesviruses like herpes simplex virus and cytomegalovirus) and bacteria (e.g.Mycobacterium tuberculosis and Treponema pallidum).
A second project line has started recently and investigates the long-term impact of the HIV-virus itself and ART use on the eye. This project will provide insight in the ambiguous relation between HIV-infection and ART with eye diseases, in order to create prevention and screening programmes for individuals living with HIV. Altogether, our research projects will provide the urgently needed insight in the important but neglected field of eye diseases and HIV in order to improve eye care among individuals living with HIV in South Africa.
Good patient care requires clinical expertise as well as a functional health system. The WHO’s Global action plan for Universal eye health, 2014-2019, calls for the generation of evidence on eye health care as well as developing plan and programs to enhance eye health with activities in line with the WHO’s framework for action for strengthening health systems.3 The U.S President’s Emergency Plan for AIDS relief (PEPFAR) and USAID are the major funders of Anova. In recent years the focus of this funding has moved from emergency roll-out of treatment of HIV, to assisting develop sustainable programmes that integrate a broader array of health demands and challenges which are presented by HIV. In line with this Anova has conducted a baseline survey on the Ophthalmological services in primary care facilities in the Mopani District.
This survey will be rolled out in two other health districts supported by Anova. The objective was to gain insight into the determinants, barriers and challenges of the ophthalmic services. The initial finding of the survey revealed a number of challenges which are currently being addressed through various activities included in the health systems strengthening package on Eye Health.
Areas that the package will address include the following:
- Improving the ophthalmic clinical expertise of Primary health care nurses. A large focus will be on improving the recognition of conditions that affect the eye in HIV. The aim is to integrate basic eye health into primary care.
- Improving resources, both human and ophthalmic equipment, through engagement with the Department of Health in Mopani.
- Improving the monitoring and evaluation of ophthalmic conditions and services through the DHIS.
- Improving the availability and accessibility of ophthalmic drugs at Primary Health care level.
- Improving the referral system for eye care in the District.
- Engaging with various stakeholders within the Department to ensure sustainable eye care services.
- Kestelyn PG and Cunningham ET. HIV/AIDS and blindness. Bull World Health Organ 2001; 79: 208-13.
- Schaftenaar E, van Gorp ECM, Meenken C et al. Ocular infections in sub-Saharan Africa in the context of high HIV prevalence.Trop Med Int Health doi:10.1111/tmi.12350
- Universal eye Health: A global action plan. 2014 -2019. World Health Organization 2013.