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D-CFAR and South Africa

The UR D-CFAR will establish research collaborations with two international partners, at the University of the Witwatersrand and the University of Cape Town in South Africa.

University of Witwatersrand-affiliated Perinatal HIV Research Unit (UW-PHRU) at the Chris Hani Baragwanath Hospital in Soweto (UW-PHRU): The Perinatal HIV Research Unit of the University of the Witwatersrand (UW) is one of Africa’s largest AIDS research centers and a leading research institution in HIV prevention, care and support and is committed to mitigating the impact of the HIV epidemic southern Africa. Established in 1996, it a research unit of the UW and functions as a Division of the Wits Health Consortium (WHC), the contract research arm of the Faculty of Health Sciences The unit is based on the campus of the Chris Hani Baragwanath Hospital (CHBH) in Soweto, South Africa, one of the world’s largest hospitals, within an urban African setting with a population of close to 3 million. Initially focused on the prevention of mother-to-child transmission of HIV, the PHRU has developed over the past ten years under the leadership of Directors James McIntyre and Glenda Gray into a comprehensive and multidisciplinary research center, with a staff of over 350 and a wide range of HIV and AIDS research projects. The work in the PHRU utilizes a variety of research methodologies to optimize the interaction between biomedical, behavioral, sociological, statistical and operational research.  PHRU research has informed the development and implementation of high quality HIV/AIDS programs and interventions. The PHRU has achieved international and local recognition for its research and service work, and initiated NIH-funded research in 1997 through the HIVNET network. The PHRU is the lead institution in the NIH-funded collaborative CIPRA-SA “Safeguard the Household” Program grant, which brings together a consortium of leading HIV-researchers in Johannesburg and Cape Town in an innovative program of work addressing challenges in HIV care. The PHRU is currently affiliated to the HVTN, PACTG, and ACTG and is part of a joint NIMH/HPTN project; it is also involved in four R01 studies, including a study assessing novel TB preventive regimens in HIV-infected adults, into which it has recently completed enrollment of over 1,000 subjects.

Research at the PHRU includes work in the areas of Virology (Dr Efthyhia Vardas), HIV/STI prevention research (Dr Guy de Bruyn), Pediatric HIV Treatment (Dr Avyi Violari, Dr Rikash Jokhan), Adult HIV Treatment (Dr Lerato Mohapi), Health Systems/Models of Care/Operational (Susan Kekana, Dr Tinyiko Khosa), and Opportunistic Infections (Dr Neil Martinson).

University of Cape Town-affiliated Desmond Tutu HIV Centre (UCT-DTHC): The UCT-DTHC is one of the leading HIV research organizations in South Africa and has been in operation as a center for HIV treatment clinical trials since 1991 under the leadership of Professor Robin Wood, when it was the first dedicated HIV clinical unit in South Africa. In 2000 the DTHC became a formal unit within the UCT affiliated with the Department of Medicine, as part of the new Institute of Infectious Disease and Molecular Medicine (IIDMM) at UCT. The Centre is the focal point for HIV/AIDS clinical trials research at the UCT. In the past 5 years the DTHC has grown into a multidisciplinary organization employing more than 100 people, from scientific staff (including 6 clinical researchers, 2 basic scientists, 3 epidemiologists and 2 social scientists) to study personnel (11 study nurses, 13 study counsellors and 5 study doctors) to community outreach workers (19 across 2 research sites). Most recently the DTHC has increased its focus on family-based HIV care and treatment with particular emphasis on pediatric and adolescent HIV. The scientific activities of the DTHC are divided into a series of interlinked activity areas focusing on: (1) HIV/AIDS treatment (including evaluation of antiretroviral drug efficacy and outcomes research), (2) HIV vaccine development (including vaccine preparedness research, and behavioural and immunological research), (3) studies on tuberculosis epidemiology and treatment.

The DTHC holds a number of international research grants, including: sub-programs of the DAIDS CIPRA-SA grant (Dr James McIntyre, PI) from DAIDS; Professor Wood is the local PI for the SMART study of the DAIDS Community Programs for Clinical Research on AIDS (CPCRA; Drs Wafaa El-Sadr and James Neaton, PIs); Dr Bekker and holds a number of grants from the South African AIDS Vaccine Initiative (SAAVI) and the International AIDS Vaccine Initiative (IAVI).

The Nyanga HVTN CRS: The Nyanga district of the Western Cape was rezoned in June 2004 to incorporate Nyanga East, Athlone, and the surrounding areas - a predominantly black, Xhosa-speaking community of over 400,000 people in an area of 16 square kilometres. There are 14 Community Health Centres and clinics, each with a large VCT service) in this new greater Nyanga area staffed by a set of locally based medical officers and nurse practitioners. These clinics provide a variety of primary health care services and include dedicated HIV care clinics; these facilities are the entry point for HIV vaccine trials as the source of HIV testing and initial volunteer contact. The City of Cape Town HIV Testing and Counselling Quarterly Report for April to June 2003 reported an overall seroprevalence of HIV infection of 30% among those tested through the VCT services offered in the public sector.

This densely populated community was identified by the CT-CTU in 2002 as an ideal ‘megasite’ for recruitment into large-scale Phase III HIV vaccine trials. The Nyanga populace features diverse socio-economic conditions including both formal and informal housing. It is located 15 km of Cape Town city centre and is an established community with a strong political history and leadership. Of the population considered to be economically active by age group (ages 15 to 64 years), 42% were unemployed in the 1996 census in the current Nyanga district. The annual household income at that time was about R8,000 (US $1000) in the district and 84% of those over 18 years did not complete Grade 12.

The Nyanga CRS is actively participating in activities supported by three complementary HIV vaccine networks; the HIV vaccine trials network (HVTN), the International AIDS Vaccine Initiative (IAVI) and the South African AIDS Vaccine Initiative (SAAVI).