2 nd CHART-CCAS-CMLF Joint Meeting 10 TH CCAS HIV/AIDS INTERNATIONAL WORKSHOP BUILDING ON ACHIEVEMENTS IN QUALITY LABORATORY DIAGNOSTICS, TREATMENT AND CARE FOR THE CARIBBEAN HIV POPULATION NASSAU BAHAMAS AUGUST 25 TH - 29 TH 2013 Highlights 2013 The 2nd CHART-CCAS-CMLF joint meeting / 10th CCAS HIV/AIDS workshop was held at the Breezes Resort, Nassau, Bahamas from the 25 th 29 th August 2013. The workshop comprised 26 plenary session, 19 breakout sessions and 14 country reports. 142 international, regional and local persons from UK, Europe, North America, Canada, South America, and the Caribbean region participated in the meeting. 19 Caribbean countries were represented at this meeting. Mexico was represented for the first time this year. OPENING CEREMONY The Opening Ceremony was hosted by Dr. Ismae Whyms and the local planning committee. There were greetings from members of the organising committee and the local health authorities including Dr. the Hon Perry Gomez Minister of Health, Bahamas. From left to right: Professor Clive Landis President, CCAS; Prof. Thomas Quinn Director, Johns Hopkins Centre for Global Health; Dr. the Hon Perry Gomez Minister of Health, Bahamas; Mr. Herbert Brown Managing Director Public Hospitals Authority, Bahamas; Dr. Valerie Wilson Director, CMLF; Dr. Ismae Whyms Local host and regional CCAS representative, Bahamas.
CCAS DISTINGUISHED LECTURER The CCAS Distinguished Lecture was given by Dr. Thomas Quinn. CCAS Committee Member Shauna Chase presenting Dr. Thomas Quinn with the CCAS Distinguished Lecturer Award. Dr. Thomas Quinn is the Professor of Medicine at the Johns Hopkins School of Medicine, a Professor of International Health, Epidemiology, Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, a Director of the Johns Hopkins Center for Global Health and an Associate Director of International Research, Division of Intramural Research, a Senior Investigator and Head the Section on International HIV/STD Research at the National Institute of Allergy and Infectious Diseases, National Institutes of Health. His investigations have involved the epidemiologic, virologic, immunologic features of HIV infection in Africa, the Caribbean, South America and Asia. He is the current Director of the International Center for Excellence in Research (ICER) in Uganda, and serves on the Board of the Infectious Diseases Institute (IDI). His research interests have involved laboratory investigations that have helped define the biological factors involved in sexual and perinatal transmission of HIV, the natural history and treatment of HIV infections in developing countries, and the identification and phylogenetics of HIV 1 including studies on HIV superinfection. He serves as advisor/ consultant on HIV and STDs to the World Health Organization, Office of the Global AIDS Coordinator (PEPFAR), UNAIDS, and the FDA. He is a member of the Institute of Medicine of the National Academy of Science, and fellow of the American Association for the Advancement of Science. He is also a fellow of the IDSA and a member of the American Association of Physicians. He is an author of over 900 publications on HIV, STDs, and infectious diseases. CELEBRATIONS This year marked the 10 th anniversary of CCAS. We had cake! Con Carino meaning with love is the motto adopted for the 10th year CCAS anniversary celebrations. It encompasses our love and commitment to patient care, as well as our local schools program in Barbados named Science Pebbles which tries to kindle a love of science among youngsters in Primary and Secondary education. 2
NEW FEATURES: There have been some new features added to the meeting this year. 1. A pre and post test of the Immunology mini-symposium. The aim of this was two-fold 1) to garner the base-line knowledge of concepts in Immunology and 2) evaluate the teaching process. For the pre-test, out of 20 questions the percentage of correct answers ranged for 11% to 89%. The post-test is to be completed online. 2. Research in Latin America and the Caribbean. Researchers from the region were encouraged to submit their work for selection by peer-review for oral presentations in a plenary session. This was very well presented and received. The session prompted animated discussion as the audience interacted with the wealth of material presented to them. Researchers also benefitted from the healthy fedback. 3. Debate. A new institution at the workshop was a formal debate entitled: Should adult male circumcision be promoted in the Caribbean on public health grounds?. THE PRO SIDE OF THE DEBATE WAS LED BY DR. CLIVE ANDERSON. Results from multiple clinical field trials indicate compelling evidence that male medical circumcision (MMC), reduces the acquisition of HIV by heterosexual men between 38% and 66% over 24 months. The incidence of adverse events due to circumcision is very low, indicating that MMC is a safe procedure. MMC also offers economic feasibility. Combination of ART and MMC coverage provides approximately the same HIV incidence reduction as treatment as prevention (TasP) protocols. However, the combination of ART and MMC coverage is considerably less expensive than TasP, requiring approximately US$ 5 billion less over the period 2009-2020. There are also other benefits associated with MMC, these include: 28%-34% decrease in acquisition of HSV type 2 and 32% 35% reduction of Human Papilloma Virus (HPV). Syphillis has a 1.5-3.0 fold increased risk in uncircumcised men and invasive penile cancer is 22 times more frequent in uncircumcised men. Male circumcision also significantly benefits HIV and STI infections in female partners due to reduced prevalence in males. Members of the discussion panel for the debate, from left to right Dr. Clive Anderson Clinical coordinator, CHART; Dr. Caroline Allen HIV/AIDS commission, Prof Brendan Bain Director, CHART. THE CON SIDE OF THE DEBATE WAS LED BY PROF BRENDAN BAIN. In 2007, WHO and UNAIDS published recommendations supporting voluntary MMC (as an addition to HIV prevention methods) in 13 priority countries, all in Sub- Saharan Africa with generalized HIV epidemics and low male circumcision prevalence. The WHO/UNAIDS recommendations did not endorse MMC as an approach to HIV prevention in countries such as USA, China or India. In this report, the Caribbean was not even mentioned. The question posed was, do the populations in the Caribbean fit the criteria? 3
Secondly, circumcision alone is not advocated. There are other measures that we can capitalised on, including HIV testing and counselling, screening and treatment of other STIs, pre-operative and post-operative education and the provision of risk-reduction counselling. There is also the concern that there will be a behavioural risk in promoting circumcision among teenage and adult males as it could promote an unintended and unspoken message of I m free to have unprotected sexual intercourse if I am circumcised it s safe, regardless of the context or setting. In addition, the evidence does not show a helpful impact of adult MMC in men who have sex with men and in certain Caribbean countries, there is a disproportionate number of cases of HIV among these men. The debate generated much discussion with well elucidated arguments both for and against the motion. The motion was carried by the pro side with a show of hands among the audience. PROFESSIONALS REPRESENTED: The major professional categories represented were laboratorians, students and clinicians. The large student population was due to a partnership with the clinical programme at the UWI, Bahamas. PROFESSIONAL REPRESENTATION VISITING LECTURERS We had new and returning lecturers. For the first time this year, there was a talk by Dr. Sheila Weitzman from SickKids Hopital, Canada, as we endeavoured to expand beyond HIV diagnostics to blood malignancies. Cross section of the delegates to the conference during a lecture. From left to right: Prof. Maurice O Gorman Chief, Division of Laboratory Medicine, Children s Hospital of Los Angeles; Prof. Brendan Bain Director, CHART; Dr. Sheila Weitzman, Head, Section of leukemia/ lymphoma, SickKids; Prof. Clive Landis, President, CCAS; Prof. Thomas Quinn Director, Johns Hopkins Centre for Global Health. 4
MEETING RATINGS The overall meeting rating was: Overall meeting rating (n=92) % The meeting met your professional needs 97.8 You would recommend the meeting to your colleagues 97.8 You are likely to attend a CHART-CCAS-CMLF meeting again 94.6 Delegates were asked to rate the demonstration of knowledge and the presentation style of the presenters. The scale was: 1 Poor, 2 Mediocre, 3 Average, 4 Good, 5 Excellent IMMUNOLOGY AND THE FRONTIERS OF IMMUNOPHENOTYPING STRENGTHENING LABORATORY NETWORKS IN THE CARIBBEAN L1 L2 L3 L4 L5 L6 L7 Innate and Adaptive Immunity How the normal immune response breaks down in HIV/ AIDS The Natural History and Immune Control of HIV infection Immunology Q and A and Disease Case Histories CD4 enumeration in HIV Leukemia / Lymphoma and Flowcytometry Flowcytometry: Beyond HIV Diagnostics to Blood Malignancies L8 CARPHA A new public health vision for the Caribbean L9 21 st century economic trends and implications for regional laboratory services L10 New Approaches: Treatment as Prevention and Home Testing regional implications DELIVERING REGIONAL LABORATORY NETWORKS L11 services provided by the LRU to the Eastern Caribbean L12 QC and PT programme national implementation as regional models Belize and Suriname L13 Panel Discussion: Progress in developing National Networks: Belize, Suriname, Haiti, Jamaica, Barbados, Trinidad & Tobago 5
RESEARCH IN LATIN AMERICA AND THE CARIBBEAN A1 Scaling up HIV Immune Status Monitoring Through Rapid CD4 Count At 1st Visit in HIV Clinic of Mexico City A2 The HIV Epidemic in Barbados: Trends Amongst Pregnant Women, The PMTCT Intervention and emtct A3 Identifying Effective Sites for The Use of HIV Rapid Testing A4 Frequency of HIV Testing as a Correlate of Laboratory Markers of Clinical Outcome A5 The use of Evidence Based Quality System Improvement Tools for Public Health Laboratories in the Caribbean Region A6 Addressing questions & controversies in considering the relevance of male circumcision as an HIV prevention strategy in the Caribbean L14 Skin manifestations related to HIV infection in adults L15 Tackling Human Papilloma Virus infection in the Caribbean L16 A Step-by-step approach in holistic care of persons with HIV L17 Indications for resistance testing in HIV infection L18 Optimizing drug regimens in Caribbean countries Talk rating / 5 Country Reports 4.2 Break-out sessions Treatment as prevention in practice 4.5 Managing Laboratory data for surveillance 4.2 Strengthening counselling and psychosocial care 4.3 M@E for building network capacity 4.5 Coping with HIV in childhood and adolescence 4.0 6
CME CREDITS The meeting was awarded 22.5 hours of CME credits from the Caribbean College of Family Physicians, a member of the World Organisations of National Colleges and Associations (WONCA). To request your CME credits please contact the CCAS Secretariat by Email ccassecretariat@gmail. com, Telephone 1-246-836-7227. 11TH CCAS HIV/AIDS WORKSHOP: The venue for the 3rd Joint Meeting of the CHART/CCAS/CMLF and the 11th CCAS HIV / AIDS Workshop will be announced by end of November 2013. The dates for this meeting are the 23rd 28th of August 2014. DIAGNOSTIC VENDORS These meetings are impossible without the support from our Diagnostic Vendor Companies and we would like to thank them for their continued support over the years. THANKS TO THE LOCAL HOST COUNTRY ORGANISING COMMITTEE: The CCAS wishes to acknowledge the local organising committee and the local media under the leadership of CCAS Regional Council Member Dr. Ismae Whyms for their outstanding efforts towards hosting this joint meeting and workshop.