University of KwazuluNatal, South Africa

Philanjalo and KwaZuluNatal Department of Health, University of KwazuluNatal

Tugela Ferry is located in the Umzinyathi District of KwaZulu Natal province, a traditional Zulu area and the third poorest district in South Africa. Philanjalo is a local South African NGO founded by Dr. Anthony Moll in 1998 to address the rapidly growing epidemic of HIV/AIDS. Yale joined Philanjalo and the KwaZuluNatal Department of Health (KZN DOH) at the University of KwaZuluNatal in 2002 to strengthen and integrate HIV and tuberculosis (TB) care and treatment. In 2005, the partners uncovered the third epidemic of extensively drug resistant (XDR) TB. These HIV and TB convergent epidemics have been characterized by rapid and high mortality rates, overwhelmed health care systems, ongoing health care and community transmission and epidemic propagation, which are all associated with extreme poverty, weak infrastructures, inadequate prevention strategies, late presentation to care, and limited TB diagnostics and treatment options.

In response, the team worked collaboratively to characterize the convergent epidemics and develop and implement a comprehensive strategy of innovative integrated HIV and TB health care and community-based strategies combined with operational research to strengthen clinical and public health programs, reduce the associated high rates of morbidity and mortality and decrease incidence and transmission of HIV and drug susceptible and drug resistant TB. They have rapidly demonstrated acceptance, feasibility and utility and have successfully advocated for widespread scale-up and dissemination of these strategies, including the first national community-based MDR TB treatment program and first integrated HIV and TB intensive case finding program in rural South Africa. Current priorities include scaling up isoniazid preventive therapy, implementing point of care technologies, integrating community-based screening for HIV and TB with noncommunicable diseases, screening high risk populations, and incorporating new HIV prevention tools.

This site has been very successful in attracting funds from a variety of sources. Expansion of community-based integrated HIV and TB intensive case finding was supported by funding from CDC/PEPFAR, NIH, KwaZuluNatal Department of Health, Gilead, Irene Diamond and Doris Duke Foundations. Development, implementation, and evaluation of isoniazid prophylactic therapy for out of treatment HIV positive community members was supported by a CDC Implementation Science award. Study of community-based implementation of rapid point of care CD4 cell count technology was supported by a National Institute of Allergy and Infectious Disease R21 grant.