Anova recognises the importance of eye disease in South Africa, especially in the context of HIV infection.

We have built high-level clinical, epidemiological and public health expertise in this neglected field. HIV-infected individuals have a higher risk of ocular disease than those without HIV infection. If these are left untreated and result in visual impairment, there can be a devastating impact on the individual’s life as well as for that of the dependent family. Anova is contributing to reducing the burden of eye disease in South Africa, especially among HIV-infected individuals, by raising awareness of such conditions, strengthening the healthcare system through technical support, and conducting high-quality research.

The Mopani Eye Project

The Mopani Eye Project forms part of Anova’s Khutso Kurhula project in Mopani District, is an important part of this programme. It aims to improve ophthalmological expertise, skills and health systems in a rural South African context. To achieve this, a parallel approach has been implemented whereby clinical research is combined with health systems, strengthening efforts to support healthcare at the primary and hospital level.

This team comprises of three medical doctors with different clinical expertise and backgrounds, an ophthalmology technical advisor and an ophthalmology support nurse. Together this team provides a great mix of ophthalmological, infectious disease, microbiological, epidemiological and public health expertise to enable making an impact.

We focus on two important infectious eye diseases in individuals living with HIV in the rural Mopani District: keratitis – the inflammation of the cornea, and uveitis – the inflammation of the uveal tract. To prevent visual impairment and possible blindness caused by these diseases, information on the incidence, prevalence, prevention and treatment is urgently needed. We found that most cases of keratitis were caused by viruses of the herpesviridae group, especially among HIV-infected patients. Antiviral treatment is not routinely available for these patients and this requires urgent attention. The aetiology of uveitis among our patients is diverse and includes various viruses (e.g. varicella-zoster virus), Mycobacterium tuberculosis, and Treponema pallidus (the causative agent of syphilis). Referral of patients presenting with uveitis to adequate level of care for diagnostic testing and treatment is important.

Another project  investigates the long-term impact of the HI-virus itself and ART use on the eye. This project aims to provide insight in the ambiguous relationship between HIV-infection and ART with regards to eye diseases, to create prevention and screening programmes for individuals living with HIV.

We show that a large spectrum of eye disease is more common among HIV-infected individuals on ART, affecting all anatomic segments of the eye. Conditions that are much more prevalent and of particular importance are blepharitis, cataract formation and HIV-retinopathy. Regular eye screening of HIV-infected individuals is warranted to identify early complications to reduce visual impairment.

Anova has developed a specific module on eye disease in HIV-infected individuals as part of the NIMART training. The unique expertise available in the organisation provides a valuable resource for other settings. A portfolio of training modules and practical resources has been developed to strengthen eye care at primary healthcare and hospital level settings in sub-Saharan Africa. By working together, we can impact positively on the burden of eye disease and reduce future visual impairment among HIV-infected individuals in Africa.