key: cord-1010260-28ccteaw authors: Airewele, Efeose A.; Sunpath, Henry; Moosa, Mahomed-Yunus S.; Gandhi, Rajesh T. title: Importance of global communication to combat global pandemics: Lessons from the HIV Online Provider Education programme date: 2021-08-31 journal: South Afr J HIV Med DOI: 10.4102/sajhivmed.v22i1.1281 sha: 9c9ed0183b94a0eefed7d775b77d84d7d5c0d421 doc_id: 1010260 cord_uid: 28ccteaw In many ways, the coronavirus disease 2019 (COVID-19) pandemic mirrors the challenges, lessons and opportunities of the HIV pandemic. In this article, we argue that global pandemics such as COVID-19 and HIV require a global response. We highlight the HIV Online Provider Education (HOPE) programme as an example of the importance of global communication when combating a pandemic. From both the COVID-19 and HIV pandemics, we have learned that to optimise health worldwide, it is necessary to have effective and efficient means of swiftly sharing experiences, expertise, best practices and guidelines. To prepare for the next public health emergency, clinicians and researchers must put in place and promote effective programmes for global communication. Similar to the COVID-19 pandemic, when the first patient with AIDS was identified in the early 1980s, there was widespread fear of a new, unknown virus. Because of uncertainties about how HIV was spread, people were shunned and stigmatised. In addition, people with HIV then -and now -often belonged to the most vulnerable and marginalised communities. The parallels between HIV and COVID-19 treatments are also telling. As with COVID-19, early treatments for HIV were largely ineffective and often harmful. By 1987, the United States (US) Food and Drug Administration had approved the first antiretroviral medication, zidovudine, but it soon became evident that single-drug therapy had serious limitations. Since then, significant progress has been made in developing well-tolerated, highly effective combination antiretroviral treatments (ART), resulting in dramatic reductions in both morbidity and mortality. Despite the similarities, there are also vast differences between COVID-19 and HIV. The former is primarily a respiratory viral infection transmitted by droplets and through the airborne route, with the majority of patients recovering spontaneously. The latter is a sexually transmitted and blood-borne viral disease that causes immunodeficiency and opportunistic conditions and is usually fatal if not treated. The former has had an unprecedented impact on the global economy, in part because of its rapid trajectory necessitating widespread lockdowns. Nevertheless, the parallels summarised above, and the global nature of both pandemics, highlight the critical need for global communication in our response. In many ways, the coronavirus disease 2019 (COVID-19) pandemic mirrors the challenges, lessons and opportunities of the HIV pandemic. In this article, we argue that global pandemics such as COVID-19 and HIV require a global response. We highlight the HIV Online Provider Education (HOPE) programme as an example of the importance of global communication when combating a pandemic. From both the COVID-19 and HIV pandemics, we have learned that to optimise health worldwide, it is necessary to have effective and efficient means of swiftly sharing experiences, expertise, best practices and guidelines. To prepare for the next public health emergency, clinicians and researchers must put in place and promote effective programmes for global communication. The HOPE programme focuses on topics relevant to the care of people with HIV in resource-limited settings. Through regular internet-based conferences, the HOPE programme serves as an opportunity for continuing education and the sharing of best practices in HIV medicine for clinicians worldwide. In addition to a programme focused on physicians, a parallel conference was designed specifically for nurses. 4 During the early years of the HOPE programme, clinicians in the US had more experience treating patients with ART. Because of this, HOPE conferences were primarily case based and followed the 'mentoring the mentor' model to support South African, Zimbabwean, US, Haitian, Dominican and Indian clinicians. It was realised early on that clinicians learned best when clinical problems were constructed around a real-life clinical case, and this led to a case-based as opposed to a didactic approach to teaching. Initially, because of the toxicities of the available antiretroviral medications, much of the focus was on managing the complications arising from treatment. In particular, the unavoidable reliance on antiretroviral agents such as stavudine and didanosine led to a rise in complex metabolic complications such as lactic acidosis, pancreatitis, lipodystrophy and peripheral neuropathy. 5 Through the HOPE programme, clinicians gained familiarity with the adverse events commonly associated with ART and developed confidence in identifying and managing these conditions using locally available resources. Physicians in the US offered advice based on years of clinical experience with similar toxicities and often influenced discussions and policies in South Africa. The HOPE conferences and inperson conferences like AWACC also served as opportunities for clinicians to advocate for access to better-tolerated and less toxic medications, like tenofovir. Eliminating stavudine and didanosine from the ART formulary in South Africa took approximately 6 years, during which time physicians worked collaboratively to develop guidelines to manage toxicities. In addition to toxicities, antiretroviral drug resistance emerged as a significant threat to the impact of these medications in reducing morbidity and mortality. A 2008 study from two clinics in Durban, South Africa, demonstrated that > 83% of patients with virological failure had a least one major resistance mutation, and, of particular concern, mutations resulting in resistance to at least two classes of drugs were present in more than half of those tested. 6 The HOPE conference served as a critical forum for clinicians to discuss and develop management strategies for patients with drugresistant HIV. Again, these discussions influenced policies related to the management of virological failure. Attending the HOPE conferences in real time served as an opportunity for the immediate exchange of knowledge while simultaneously facilitating networking with physicians around the world. Through the HOPE programme, physicians in the US and South Africa have been able to connect and engage in collaborative research. The potential to serve as a networking platform was an unexpected beneficial outcome of the real-time nature of the HOPE conferences. For those unable to join the conferences live, recordings, references and slide presentations have been made available at no cost on the HOPE website after each conference. What has been the utilisation of and response to HOPE? When HOPE first started, 2000-3000 users logged in annually. In recent years, this number has increased at least threefold to around 9000 attendees per year. Since tracking began in 2012, almost 20 000 users have viewed the conferences, with almost 95 000 conference page views. About 60% of those accessing conferences are medical doctors, 20% are nurses, 10% are nurse practitioners and 10% are medical students. In terms of geographic distribution, visitors are most frequently from the US, South Africa, Dominican Republic, Canada and Argentina. Surveys of HOPE conference attendees reveal that 95% of the participants report the content is relevant to their practice and that a similar proportion report that there is an appropriate mix of didactic and interactive material. In its early years, attendees asked for additional content relevant to nurses, which led to the development of a parallel HOPE nurses' conference. The cost of the programme has mainly been the time and effort of the organisers who arrange the speakers and discussants, as well as the project coordinator for the programme, whose time and effort has been supported by the Harvard University Center for AIDS Research as a component of its training mission. The HOPE conference itself is free of charge for all participants. Over time, as South African clinicians gained experience in the care of patients with HIV, they themselves evolved into experts in their own right, and the HOPE programme shifted focus to summarising the latest in HIV research and innovation. These conferences now serve as an important platform to keep providers in the US, South Africa and other parts of the globe up to date with the latest advances in the field. Of late, the HOPE programme has pivoted to incorporating content geared towards confronting the latest global pandemic, COVID-19. One such recent conference described the impact of the B.1.351 (beta) variant of SARS-CoV-2, which was instrumental in alerting US clinicians to the challenges ahead. Through the HOPE programme, we can see how global communication positively impacts health education internationally. By expanding and developing other programmes like HOPE, clinicians can position themselves to mount an effective global response to health threats like HIV and COVID-19. Interactive online clinical discussions are one of many ways in which the global medical community can bridge the gap in medical education to promote better health outcomes for people everywhere. To reach the Joint United Nations Programme on HIV/AIDS targets for 2030, it is of the utmost importance that collaborative educational initiatives that started at the turn of this century expand and continue. http://www.sajhivmed.org.za Open Access R.T.G. received grant funding from the Harvard University Center for AIDS Research (NIH P30 AI060354) and the AIDS Clinical Trials Group (NIH/NIAID 2 UMAI069412-09). Data sharing is not applicable to this article as no new data were created or analysed in this study. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of Desperate times call for temperate measures: Practicing infectious diseases during a novel pandemic Trials and therapeutics: Important lessons from the COVID-19 pandemic. Harvard Health Pol Rev [serial online HIV Online Provider Education (HOPE): The Internet as a tool for training in HIV medicine Antiretroviral therapyassociated toxicities in the resource-poor world: The challenge of a limited formulary Prevalence of HIV-1 drug resistance after failure of a first highly active antiretroviral therapy regimen in The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors. This article followed all ethical standards for research without direct contact with human or animal subjects.