Dr Joseph Enegela (Senior Technical Advisor on a CDC/USG funded comprehensive HIV/AIDS treatment program (IPSAN) with Pro-Health International Nigeria)    

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ICASA 2013 has come and gone and for sure it was a major success just like the organizers planned it. It may not have had 7000 delegates downgraded from the earlier 10,000 planned but I must say it was well attended.

Personally, I think the venue and organization was appropriate and well done. I never got lost, answers to directional inquiries were just a glance away: the “Ask Me” young men and women were everywhere; such that I had a comical feeling they were there to make up the numbers. The plenary and session topics were ideal and the contents of both plenary and abstract presentations where rich in their conceptualization. The speakers at plenary were just the right persons and knew their content very well. I can say from my experience of international conferences that the plenary sessions at ICASA 2013 were well attended: I recall conferences where plenary sessions after day one were sparingly attended. Registration was also relatively easy.

On the other hand, I felt from personal observation and discussions with friends that there was quite a number of NO SHOWS, both for the poster and the oral abstract presentations. While I cannot blame the organizers for this, there may be ways of mitigating this ahead of the next ICASA or other conferences for that matter. The location of the poster viewing hall was the only sour point in the venue arrangement. You needed to be looking for it to get to it, you couldn’t just walk past it to be attracted as was the case of the exhibition halls. The posters themselves were another significant source of worry for me and from my observation, at least 60% of the posters were very poor in their formatting. Some posters had 3 to 4 different text fonts; some were written in all caps, many were just texts and no graphical representations while others resembled full text manuscripts. The formatting is always a significant motivation for one to read through or want to stand by your poster to listen to you.

The Agenda then. Every major conference always has an agenda and for ICASA 2013 it was “Now more than Ever, getting to zero” – Zero discrimination, Zero deaths, Zero new infections. My personal perception was the obvious push for stopping discrimination against key populations. Truth remains that they are generally discriminated against in most African countries. While cultural and community peculiarities have always come to play in these discussions, I believe the push to decriminalize as against legalizing may be easier to sell in many African countries and communities. As a physician, I would want to reach this special population in order to offer them every service I offer any other person but stigma and discrimination won’t allow me to do this, so I support advocacy to give them more access to care and zero discrimination.  The second agenda I see gaining support is viral load monitoring of patients. Viral load monitoring has continued to be a contentious issue, not only for physicians in the primary care but both country programs and funders alike. Despite the clear advantage  (see here, here or here) of addition of viral load monitoring over CD4 cell and clinical monitoring , many commentators especially country programs and funders have continued to refer us to studies like the ones in Plos  or the Lancet Global Health that didn’t demonstrate any mortality benefit in the use of the former over the latter. Funding always takes center stage (rightly so), but we must remember that increased demand invariably drives down prices, that the new WHO criteria for initiation of ART now brings to question the usefulness of CD4 monitoring and program and patients costs associated with clinical and immunologic monitoring such as costs applied to OI drugs and overall quality of life of patients; lost man hours due to opportunistic infections, costs applied to frequent transportation to clinics for OI management etc. Except we are able prove that these short term program costs of instituting VL monitoring (until the costs of investigations drops; which they will) greatly outweigh the costs described above, we should continue to push for VL monitoring for all patients.

Taking a peep from behind my curtain I would suggests a few things to future conference organizers to help solve those I have raised. First, as it concerns attendance at conferences; all conference secretariats should demand proof of transportation (air or bus ticket) and accommodation from presenters at most two weeks prior to conference start date. As it concerns poster format, the media committee/center should be open for activities at least 4 weeks prior to the conference start date and screen all pdf versions of every poster for conformity before conference date. I agree the quality of the poster is the presenters’ prerogative, however it will reflect on the overall quality of the conference.

My final word, international funding agencies attending these conferences should not only showcase their country specific successes but also demand an increase in local funding from such countries. In addition, conference organizers should continually advocate for attendance by high level Government personnel.

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