Rifampicin
High-dose rifampicin demonstrates an improvement in TB response rates
* South African scientists and patients involved
 
Nijmegen, Netherlands / Munich, Germany 2 March 2015: At the annual Conference on Retroviruses and Opportunistic Infections (CROI), the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (PanACEA), presented the results of its most recent phase IIb study (MAMS-TB-01). The most exciting finding from the study is that high-dose rifampicin results in faster killing of TB bacilli during treatment, compared to the current standard treatment. 
 
The standard WHO-recommended TB treatment regimen (2 months of daily ethambutol, isoniazid, rifampicin and pyrazinamide followed by 4 months of daily isoniazid and rifampicin (2EHRZ/4HR)) involves taking the drugs daily for 6 months. This can make adherence to treatment hard, and has substantial costs to the health system and patients. Shortening the length of time treatment needs to be taken for, may help to reduce the burden on health systems, the costs of treatment, and make treatment easier for patients. PanACEA MAMS-TB-01 was set up to address this.
 
High-dose (35mg/kg) rifampicin, in combination with standard dose of isoniazid, pyrazinamide and ethambutol, showed a significant shortening of time to culture conversion with a covariate-adjusted hazard ratio of 1.75, 95% confidence interval (1.21-2.55) over the 12 weeks of experimental treatment. For comparison to previous TB trials, covariate-adjusted hazard ratios compared to control over 8 weeks were 1.99, 95% confidence interval (1.21-3.29). It was not possible to culture TB bacilli in sputum by 8 weeks in 56% of patients on the 35mg/kg arm compared to 42% of patients on the standard of care arm. These proportions were 80% and 70% respectively after 12 weeks.
Culture on solid media, which was a secondary endpoint, showed a similar although less marked result.
 
Chief Investigator Martin Boeree (Radboud University Nijmegen) says: “This is the largest reduction in time to culture conversion seen in any previous TB trial, to our knowledge. High doses of rifampicin may be an important component in shorter TB regimens in the future.”
 
The arm containing moxifloxacin with rifampicin 20mg/kg, pyrazinamide and ethambutol showed a borderline significance, hazard ratio 1.42 (95% confidence interval, 0.98-2.05) for improvement over control.
 
In an interim analysis conducted in early 2014, recruitment to both arms that included the new drug SQ109 were terminated, as it was clear that both regimens would not meet the predetermined hazard ratio of 1.8 using liquid culture and thus were unlikely to result in substantially improved regimen. Patients on these arms remained on treatment and in follow-up, and the now available data confirms the interim analysis decision.
 
Preliminary analysis of safety events showed no differences in side-effects in any of the arms as compared to control. 
 
The MAMS-TB-01 trial enrolled 365 patients from 7 sites in Tanzania and South Africa in only 11 months. It used an innovative adaptive clinical trial design that allows several new regimens to be compared to the current standard, and incorporates interim analyses that allow for regimens that show little treatment shortening potential to be excluded from the trial at an early stage.  
 
Data on treatment up to week 26 and post-treatment follow-up will be analyzed and reported together with the results mentioned above in the main publication. 
 
“We would like to thank our main donor, the EDCTP, for its support of this African-European consortium,” said Michael Hoelscher, sponsor representative. “We are pleased to have optimized one potential component of a future treatment-shortening regimen. This is, however, only the beginning of a series of phase I and II studies that will evaluate in a systematic manner at least 5 novel and improved TB drugs. “
 
 
AU Ebola deployment

Johannesburg, 16 February 2015: The African Union Support to Ebola Outbreak in West Africa (ASEOWA), in collaboration with the South African government, is sending 23 South African health workers to Ebola affected countries. The health workers, including 20 nurses and three paramedics are expected to depart Johannesburg for Sierra Leone on Friday, 20 February 2015.

 
The health workers have undergone pre deployment training given by the African Union and Department  of Health officials. On arrival in the affected countries, the health workers will undergo further intensive training for two weeks before embarking on their duties.
 
African Union Commissioner of Social Affairs, Dr Mustapha Sidiki Kaloko commended the South African government for sending health workers, saying that the 835 African medical personnel so far deployed by ASEOWA have impacted positively in reducing both new infections and deaths from Ebola. 
 
“We are very proud that, together with the governments of AU member states, we are finding solutions to African challenges by Africans. By representing South Africa on the mission, you will also be representing the African Union and Africa in general. I am very sure that you will acquit yourselves very well and continue to make a positive impact.”
 
This deployment is the second for South Africa, following an independent deployment on January 23. The first group is stationed at the Goderich Emergency Ebola Treatment Centre on the outskirts of Freetown, Sierra Leone.  Since their arrival, the South Africans have already seen six discharges and lost two patients.  One 36 year old man was a typical patient.  He arrived with a confirmed Ebola diagnosis.  He began treatment and then “crashed” as often happens, but treatment was successful.  He recovered and was released, walking out on his own.  The youngest patient so far has been a four year old boy.  He has been moved from the ICU and is now recovering.
 
The healthcare professionals stay in country for six months of service in AU supported treatment sites and when they return to South Africa they will undergo three weeks of observation before they can resume normal duties. 
 
According to Health Minister Aaron Motsoaledi, “Whilst thankfully Ebola cases are decreasing, the South African effort implemented by Right to Care and supported by the South African government, the private sector and the African Union are able to address Ebola ‘fatigue’. South Africa’s involvement which began last year has been extensive and has included mobilising both a domestic response to prevent the entry of Ebola into South Africa as well as an external health and humanitarian assistance programme to support affected countries. The Department of Health mobilised cash and in-kind contributions amounting to almost R60 million. This has included setting up a diagnostic laboratory which has tested more than 6000 specimens of those suspected of Ebola infection. The laboratory teams rotate every 5 weeks and are also training local personnel. We have also provided 16 000 protection suits and we have sent ambulances, scooters, drugs, generators, autoclaves for sterilisation and food.
 
Minister Motsoaledi concluded, “South Africa can be very proud of our courageous health care workers and all those that have supported the Ebola response, as they assist fellow Africans to win the fight against Ebola.”
 
According to Prof Ian Sanne of Right to Care, “Team South Africa are on duty for long shifts each day; some of the time in full protective clothing and other times working in the laboratory or fulfilling other duties.  They are learning to treat a highly infectious disease effectively.  The knowledge they gain will be useful in knowing how to better treat other crisis outbreaks.”
 
African Union Director of Social Affairs, Dr Olawale Maiyegun summarised the ASEOWA intervention as follows, “The most important and effective intervention with significant impact is the decreasing cases. ASEOWA has made a huge difference. Before their intervention, Ebola was chasing us, thanks to ASEOWA, we are now chasing Ebola. It is just a matter of time, Ebola shall be defeated.” 
 
As part of its obligations to the health workers, ASEOWA will provide the medical professionals with an allowance, full training, insurance and housing and will take care of them should they contract Ebola. One of the major groups in the financial sector in South Africa has committed to paying for transport, flights and transfers for this medical intervention.
 
There are four partners working on South Africa’s response to Ebola under the leadership of the Department of Health. They are Right to Care which has an MoU with the Ministry of Health in Sierra Leone, the Wits Health Consortium which is overseeing and managing funds from the private sector on behalf of the Department of Health and the NICD which has set up labs in Sierra Leone, is providing training and has a number of staff there. 
 
The current deployment is being undertaken under the African Union’s Support to Ebola Outbreak in West Africa (ASEOWA). The African Union will maintain the health workers on the ground till the countries are declared Ebola free.
 
 
Zeenat Dasoo appointed

Zeenat Dasoo appointed to the Right to Care board 
Zeenat Dasoo has been appointed to the board of Right to Care which is chaired by Dr Ali Bacher. Right to Care is a significant non-profit organisation that supports and delivers prevention, care, and treatment services for HIV, TB and Ebola.  
Dasoo is employed at IBM South Africa as the legal counsel for trust and compliance and is a member of IBM South Africa's Social and Ethics board committee. She also serves on the board of Probono.Org, Afrika Tikkun Services and is a ministerial appointee on the Council of the South West Gauteng College, a technical and vocational education and training (TVET) college.
She was an attorney at Cheadle Thompson and Haysom Inc. from 1999 until 2004 and joined Webber Wentzel as a partner from 2004 until 2014 where she practiced in various areas of law including corporate and commercial, health and anti-corruption.  During her tenure at both law firms she also provided legal and governance advice to the NGO sector.
Dasoo’s independence as well as the knowledge and experience she gained as a partner at Webber Wentzel and director of Cheadle Thompson & Haysom Inc, and her role in her current position at IBM will be of great assistance to Right to Care, says chairman Dr Ali Bacher.  

 
About Right to Care

Right to Care is a non-profit organisation (Section 21) that supports and delivers prevention, care, and treatment services for HIV and associated diseases.
 

Through technical assistance, Right to Care supports the Department of Health at national level. Support at provincial level is provided primarily in five provinces: Gauteng, Mpumalanga, Northern Cape, Western Cape, and Free State. In addition, through direct service delivery, Right to Care treats patients for HIV, TB, cervical cancer, and sexually transmitted infections.
 

Support for clinical programmes is delivered through development of clinical best practices, research, training, mentoring, participation in technical committees, provision of facilities and equipment, and secondment of staff, among others services.

Funding and revenue

The chief funding and revenue streams are:

  • The President’s Emergency Plan for AIDS Relief (PEPFAR), managed by USAID
  • Global Fund
  • Private-sector donors
  • Revenue from the private sector for provision of employee wellness services (through Right to Care Health Services)

HIV care and treatment

Right to Care’s Adult HIV and Paediatric HIV programmes support the clinical care and treatment of individuals infected with HIV and associated diseases. Care and treatment is accessible through an integrated model that includes prevention, transition into care, treatment adherence, and nurse initiated and managed ARV treatment (NIMART). Loss-to-follow-up is minimised using innovative approaches, such as automated text messages and patient transfers with electronic records.
 

On-site and didactic training are provided to clinicians in the public and private sectors. In each province, centres of excellence are hubs for mentoring and training and for referrals of complicated cases.
 

In its first ten years of operation, Right to Care initiated over 230 000 patients on ARV therapy.

TB

Right to Care’s TB programme provides integrated TB/HIV services for both drug-sensitive and drug-resistant TB. Components of Right to Care’s TB strategy include use of the ‘‘3 Is’’: Intensified case finding; INH Preventative Therapy (IPT); and Infection control in health facilities.
 

TB symptom screening is done at all healthcare visits. Sputum induction facilities reduce by 10% the number of patients who cannot produce sputum, leading to improved testing rates.
 

Right to Care has spearheaded the use of the Cepheid GeneXpert MDR TB Rif for rapid diagnosis of TB and of drug resistance.
The diagnosis and management of Multidrug and Extensively Drug-Resistant TB is supported, in particular at Sizwe Tropical Diseases Hospital, Johannesburg. On an on-going basis, Right to Care collaborates in TB research studies.

Cervical cancer

At present, our most important weapon against cervical cancer is an effective screening and treatment programme to detect and remove early cervical dysplastic lesions. Right to Care trains medical officers to perform colposcopic biopsies and large loop electrical excisions (LLETZ). These cost-effective procedures have resulted in greatly improved access to treatment.
 

Mobile clinics take screening and treatment services, and other women’s health services, to remote areas.

Prevention

Right to Care’s prevention programmes include treatment as prevention, medical male circumcision (MMC), HIV counselling and testing (HCT), and prevention of mother-to-child transmission (PMTCT).
 

Right to Care advocates treatment as prevention. Among discordant couples, ARV therapy has been shown to reduce by 90% the rate of transmission from one partner to the other.
 

Annually Right to Care conducts over 300 000 HIV tests.
 

Through technical assistance and direct service delivery, Right to Care is supporting the DoH in the delivery of MMC services. MMC is offered as a comprehensive package of services that includes HCT, the provision of condoms, and education for behaviour change. MMC clinics are optimised for high-volumes.
 

Right to Care’s integrated PMTCT and Maternal & Child Health unit provides technical assistance for prevention for mothers, immunisations, reproductive health services, basic antenatal care, and PMTCT at supported sites.

Pharmacy supply chain management

Right to Care’s pharmacy programme supports the DoH at national, provincial, district, and facility levels. Programme staff members play an important role in the development of pharmaceutical policy. Right to Care supports the Medicines Control Council for the registration of medicines and for the regulation of clinical trials. Right to Care supports the site-level implementation of computerised pharmacy dispensing and information management systems. This includes integration of clinical data systems and pharmacy management systems.

Right to Care Health Services

Right to Care Health Services, a wholly owned subsidiary of Right to Care, offers organisations a comprehensive integrated wellness programme. The programme includes health and wellness screening, health risk assessments, management of chronic diseases, psychological counselling, legal and financial counselling, primary and occupational healthcare services, executive wellbeing, absenteeism, and incapacity and disability management. Clients are provided with comprehensive and integrated reports on all aspects of employee healthcare.

Training

Right to Care’s Training Department develops staff knowledge and skills in order to improve the capacity to provide quality HIV care, treatment, and support. Training courses covering a broad range of clinical subjects are offered to healthcare providers of supported sites. Didactic training is follow up with on-site mentoring.
 

Skills programmes are conducted for lay counsellors and for non-clinical staff.

Corporate governance

Right to Care is governed by a board of directors, of whom two-thirds are non-executive directors. The organisation complies with King III standards of corporate governance.
 

Right to Care consistently achieves unqualified audits from its auditing firm, Deloitte and Touche.

 

 
Our Vision & Mission

Our Vision

That every individual will have ready and affordable access to quality evidence-based medical services

Our Mission

To respond to public health needs by supporting and delivering innovative, quality healthcare solutions, based on the latest medical research and established best practices, for the prevention, treatment, and management of infectious and chronic diseases

 
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