Research at Hope Cape Town
HOPE Cape Town has realised the real benefits of partnering with academic institutions and experts in the field. We collaborate with Stellenbosch University on a number of levels, including doing research projects that aim to answer practical questions concerning the care of HIV positive children and their families.
The HOPE doctors have been involved in a wide variety of research projects over the years. We have recently completed two research projects, both in collaboration with academic staff from Stellenbosch University. The first project looked at the reasons why HIV positive children fail treatment at the Delft Community Health Centre. The project included file review, as well as interviews with staff, caregivers and children. A poster of this research was presented at the SA HIV Clinician’s Society conference in 2014, and a journal article has been submitted to the African Journal of AIDS Research and is awaiting peer review. The other project assimilated all of our resistance testing data (collected between 2011 and 2015) and analysed it to record the different resistance mutations and their frequency of occurrence. This project was done in partnership with the Virology Department in the Faculty of Medicine and Health Sciences. The results were presented at the Stellenbosch University Academic Day in 2014.
The HOPE doctors are currently working on a case history series project, which will document the histories of the children who started HIV treatment with HOPE funding, before treatment was available in the public sector. Many of these children are now adults, and their stories provide fascinating insight into the benefits and challenges of long-term treatment of HIV.
HOPE Cape Town has also supported the work of senior researchers at Tygerberg Hospital. Their projects are summarised below:
Dr Etienne Nel (Paediatric Gastroenterologist): A Prospective Evaluation of Feeding Disorders in HIV Infected Children
Although swallowing disorders occur in almost 80% of HIV-infected adults, the prevalence in children is unknown. These disorders are associated with loss in quality of life, decreased drug adherence, aspiration pneumonia, and malnutrition. The purpose of this study is to describe the prevalence, etiology, nature and morbidity of feeding and swallowing disorders in a sample of HIV-infected infants and children in the era of anti-retroviral treatment (ART). A secondary outcome was to assess the prevalence of functional gastrointestinal disorders in HIV-infected children.
Two-hundred-and nineteen children were enrolled in the study. The prevalence of swallowing disorders was 15%. This is lower than the 45% prevalence reported prior to the introduction of ART. Severity of feeding difficulties was associated with the developmental delay. Infections and structural abnormalities of the pharynx and esophagus were rare. Functional gastrointestinal complaints were rare, an unexpected finding in a group of children with chronic disease.
Dr Pricilla Springer (Paediatric Neurologist): Neurodevelopmental outcomes of HIV exposed un-infected infants
This is a neurodevelopmental study nested in the Mother and Infant Health study, a longitudinal study researching the innate immune abnormalities of HIV-exposed but uninfected infants (HEU). Successful Prevention of Mother to Child transmission programmes have led to a significant reduction in the number of HIV-infected new-borns. Consequently an increasing proportion of South African infants (estimated at 30%) although HIV negative, have an HIV- infected mother. There are biological and environmental risk factors associated with having an HIV-infected mother which have the potential to affect infant cognition and behaviour.
The purpose of this research is to determine whether there is a difference in the neurodevelopmental outcome of HEU infants compared with a well-matched control group of HIV-unexposed infants (HUU). Ninety six children have been tested in infancy (11-14 months) and are now being reassessed as toddlers (30-42 months) using the Bayley scales of infant mental development.
A secondary objective of the study is to improve early detection of developmental delay. Finding suitable screening tools which are culture neutral and applicable in a low resource environment will allow early detection and prompt referral. In this way appropriate intervention could be instituted early to prevent or limit neurodevelopmental delay.