On Thursday 30 March, Dr Anne Wensing, virologist at Utrecht University Medical Center, received the ZonMw Parel Award from ZonMw director Véronique Timmerhuis for the ITREMA project. This successful cooperation project between the Netherlands and South Africa has led to improvements in HIV-treatment in South Africa, including in rural areas.

Of the 7.7 million people with HIV in South Africa, 5.5 million receive antiretroviral therapy (ART). The treatment is effective in a large majority of patients, thanks to a system of local coaches who encourage patients to take their medicines. But treatment may fail, causing the viral load to rise again. This may indicate the virus has become resistant, but it can also mean that the patient is not taking the medication as prescribed. Demonstrating resistance is expensive. The ITREMA study investigated whether an inexpensive medicine test could help improve care in rural South Africa.

Medication test

ITREMA was conducted at a health centre in Limpopo province, where people living with HIV regularly come for check-ups. At each check-up, blood is drawn to determine the viral load. If it is too high, a medicine test is done. If it turns out that the problem is caused by poor medication adherence, the patient will be given more intensive guidance by the local coach. If the drug test shows that the patient does take the medication properly, a resistance test is done. The patient is then given appropriate medication to regain control of the resistant HIV. The ITREMA study showed that this approach can be implemented well and is effective. An additional study examined blood samples from 100,000 South Africans living with HIV. This showed that it is more effective to aim for the same low viral load as in Western countries. The likelihood of increasing viral load can thus be drastically reduced.

Cooperation

The ITREMA project was one of the fruits of an ongoing intensive collaboration between the Ndlovu Care Group in Limpopo province, the University of Witwatersrand in Johannesburg, UMC Utrecht, Utrecht University and the Radboudumc. ITREMA is funded by ZonMw and NWO-WOTRO and supported by the AIDS Fund and the African HIV Care & Cure (AHC²) Foundation. Additionally ITREMA received the a ZonMw Dissemination and Implementation Impulse (VIMP) and a WOTRO Impact & Innovation Grant (I&IG). Learn more about ITREMA at www.itrema.org. The Ndlovu Care Group was founded by Apeldoorn physician Hugo Tempelman.

ZonMw Parel

The ZonMw Parel (Dutch for 'pearl') is an award presented several times a year to ZonMw projects that may serve as an example and inspiration for the hundreds of projects that receive grants from ZonMw every year.