South Africa HIV/AIDS & TB

Yale School of Medicine and TFCARES (Tugela Ferry Care and Research) Collaboration with Philanjalo NGO / Church of Scotland District Hospital and the KwaZulu Natal Department of Health

Church of Scotland District Hospital

KwaZulu Natal province in South Africa has one of the highest rates of HIV infection in the world. Closely linked to this HIV epidemic is one of the world’s most severe TB epidemics. Yale first began work directed at the integration of TB and HIV treatment and care in KwaZuluNatal in 2000. In 2005, while investigating the advantages of integrated TB and HIV care in Tugela Ferry deep in rural KwaZuluNatal, Yale School of Medicine clinician and researcher, Gerald Friedland, along with collaborators at Albert Einstein College of Medicine, uncovered the largest global cluster of cases of extensively drug resistant (XDR) TB, a form of TB with few treatment options and high mortality.

Since then, drug resistant TB has been recognized as a global epidemic, which threatens both TB and HIV programs and populations. Since 2002, Yale and collaborating institutions have provided clinical support and an array of research activities, capacity building and technical assistance to improve prevention, diagnosis and treatment of HIV and TB and confront the convergent epidemics of HIV, TB and XDR TB.

Organizational Structure

The Yale program in Tugela Ferry, KwaZuluNatal, has been situated within the AIDS Program in the Section of Infectious Diseases and the Department of Medicine Office of Global Health. The Yale associated Tugela Ferry Care and Research Collaboration (TFCARES) was organized in 2006 and is currently incorporated as an umbrella organization supporting efforts in KwaZuluNatal directed at confronting the entwined epidemics of HIV and drug susceptible and resistant TB.

Participating institutions include the Yale school of Medicine, Albert Einstein College of Medicine, Philanjalo (a local HIV and TB oriented NGO), the KwaZuluNatal Department of Health, the Nelson R Mandela School of Medicine and the University of KwaZuluNatal.

As an international collaboration of healthcare professionals and researchers, Yale and TFCARES is committed to clinically relevant, ethical research, educational capacity building and high-quality, compassionate and comprehensive care and treatment for adults and children with and at risk for HIV/AIDS and tuberculosis in Sub-Saharan Africa.

emptyPhilanjalo, the primary local South African partner, serves as host organization for clinical and research activities and for all visitors. Philanjalo has developed and operates a 32-bed inpatient step-down facility for care of HIV & TB patients, supplies community based HIV and TB focused health care services, and employs all staff associated with research endeavors. Through the collaboration with Philanjalo, COSH and the provincial KwaZuluNatal government, Yale and TFCARES has provided senior and junior faculty, medicine and pediatric residents through the Johnson and Johnson Scholars Program, medical students through the School of Medicine and nurse midwife students through the School of Nursing.

The clinical care, educational, research, capacity building and technical assistance activities have been funded by charitable foundations and government agencies including, The Irene Diamond Fund, The Doris Duke Charitable Foundation, The Johnson and Johnson Foundation, The Gilead Foundation, The KwaZuluNatal Department of Health, PEPFAR (through Columbia University ICAP), The National Institutes of Health and the Howard Hughes Medical Institute.

Since initiating HIV and TB integration and the identifying of XDR TB in Tugela Ferry in 2005, Yale and TF CARES have made substantial progress in improving and strengthening TB and HIV care and in confronting the intertwined epidemics. But the challenges are great and remain to be met.