University of Nairobi Collaborative Centre for Research and Training in STIs/HIV/SRH

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A team from KAVI-Institute of Clinical Research attending University of Nairobi Collaborative Centre for Research and Training in STIs/HIV/SRH at Mayfair Court Southern Sun, Nairobi.

 

Every year in Kenya, there are 71,034 new infections among people aged 15 and above – about one hundred and ninety five each day. According to a 2016 county profile produced by the National AIDS and STI Control Programme (NASCOP) and the National AIDS Control Council (NACC), 1.6 million people in Kenya are living with HIV.

Despite the declining rate of infection (prevalence has almost halved since 1996, when it peaked at 10.5%, to 5.9% in 2015) and improved HIV treatment and care (the number of people on antiretroviral treatment [ART] is the greatest it has been), almost one third of deaths among adults in Kenya are still caused by the burden of HIV and AIDS.

NACC through the Kenya AIDS Strategic Framework 2014/15-2018/19 declared four strategic objectives over this 5-year period:

  1. Reduce new HIV infections by 75%
  2. Reduce AIDS-related mortality by 25%
  3. Reduce HIV-related stigma and discrimination by 50%
  4. Increase domestic financing of the HIV response to 50%

Against this backdrop, one hundred and twenty participants gathered at the Mayfair Court Southern Sun Hotel in Westlands Nairobi on Monday the 23rd of January 2017. With varied expertise among them, they convened to attend the first day of a week-long annual meeting of the University of Nairobi Collaborative Centre for Research and Training in Sexually Transmitted Infections (STIs), HIV and Sexual and Reproductive Health (SRH).

The meeting – which is co-organised by the University of Manitoba in Canada – registered representatives from numerous institutions. These included the Kenya Medical Research Institute (KEMRI) – Wellcome Trust, Kenyatta National Hospital (KNH), the Sex Worker Outreach Program (SWOP), Centers for Disease Control and Prevention (CDC), AMREF Health Africa, the International Centre for Reproductive Health (ICRH) and CDC-KEMRI. Several universities such as Moi, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Toronto, Makerere, Washington and British Columbia also had delegations.

The meeting was officially opened by Professor Peter Mbithi, the UoN Vice Chancellor, with brief welcome notes from Prof. Isaac Kibwage, the Principal of the UoN College of Health Sciences and Mr. John Kearsey, the External Vice President of the University of Manitoba.

We were aptly guided through discussions by thought-provoking and informative presenters, on HIV testing and linkage to care; key populations; vaccine studies; and laboratory science.

KAVI-ICR also made a contribution to the discourse, with four presentations from its members on the day. Borna Nyaoke, a clinical physician, provided an overview of KAVI-ICR’s progress in HIV preventive technology, with the institute studying the impact of different vaccine delivery systems, and told of a new HIV vaccine trial launched in South Africa in November 2016. “It is based on a vaccine tested in Thailand, which showed 31% efficacy. We are anticipating the results greatly, which we expect to be released in 2020,” Dr. Nyaoke said.

Community liaison officer, Jane Ng’ang’a, discussed good participatory practice (GPP), which are guidelines developed by AVAC and UNAIDS to provide a framework with which to engage the stakeholders involved in HIV vaccine trials. “Recruitment is not community engagement”, Ms. Ng’ang’a emphasised. KAVI-ICR’s use of GPP is expected to mitigate many challenges faced during the cycle of a clinical trial such as misconceptions about trial participation.

Regarding HIV laboratory science, Brian Onsembe, a technologist, described the methods and importance of identifying specific HIV peptides which bind to primary antibodies. “Although the sample size is small, these are very encouraging results,” he said. The use of these HIV peptides in a vaccine candidate would make it highly targeted, eliciting a sufficient enough immune response to confer significant protection against HIV.

As part of KAVI-ICR’s diversification of research activities, a small team has begun studies on stem cells. Patrick Mwaura, a laboratory technologist, is part of this team. Reporting that stem cell transplantation therapy has the potential for use in HIV prevention, Mr. Mwaura said once the gene responsible against HIV protection is isolated, – a feat currently underway – one can “get white blood cells resistant to the disease, all from the self-renewing stem cells”. KAVI-ICR eventually plans to open a stem cell and regenerative therapy centre.

The day closed with a cocktail reception, where anticipation for the rest of the week was evident. Sessions over the next three days were:

Tuesday 24th – Men who have sex with men (MSM); HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP); adolescents, adolescent girls and young women

Wednesday 25th – Immunology and resistance to disease; sexually transmitted infections; other infectious diseases (this included tuberculosis, worm infection, Zika and hepatitis B); voluntary male circumcision

Thursday 26th – epidemiology; injection drug users; maternal reproductive health and prevention of mother-to-child transmission; emerging technologies

Presentations delivered during these three days regarding studies involving KAVI-ICR were on: comparison of plasma cells in the intestinal mucosa compartment and the periphery (Tian Sun); prevalence of chlamydia and gonorrhoea among HIV-negative women in Nairobi (Timothy Kotikot); the impact of bacterial vaginosis treatment on HIV susceptibility (Vineet Joag); and alcohol use and sexual risk behaviours among MSMs and female sex workers in Nairobi (Mary Gichuho).

Discussion on Friday 27th – the last day of the meeting – centred on paediatric HIV and HIV treatment and care.

Some highlights from the sessions: the use of weekly SMS reminders to patients to improve ART adherence resulted in a 32% improvement, with a reply costing the patient only 1 KSh per week; initiation of ART in infancy is linked to improved cognitive outcomes in children compared to those with a late start on ART; a patient’s genomic data could be used to tailor their treatment, thus reducing rates of treatment cessation due to gene-therapy conflict; point mutations in a patient’s DNA can be used to predict virological failure, and thus adjust treatment accordingly; mean corpuscular volume (MCV) – the volume of red blood cells – can be used as a marker for clinical outcomes with Zidovudine (AZT) treatment, as an increase in MCV is correlated with therapeutic effectiveness.

A summary of the meeting was given, noting that this year’s attendance was better than ever before, with more than 100 participants each day.

Representing the University of Toronto, Prof. Rupert Kaul – who has an interest in the relationship between mucosal immunology and HIV transmission – noted “the shift in focus from viral and basic science research” during the mid-1980’s when the meetings first begun, to “implementation science with the aim to improve care in HIV” currently. “I have been here twenty times, and that – I think – is a testament to the people in this room, [as] this meeting is a reflection of the fantastic work being done,” he said.

In closing, Prof. Ruth Nduati, a renowned specialist in the prevention of mother-to-child transmission, spoke on behalf of the UoN Dean of the School of Medicine. “This forum demonstrates the transfer of skills from one generation to the next,” she asserted. Warning that funding for HIV research may change due to the current uncertain political climate both locally and globally, Prof. Nduati nevertheless called on researchers young and old alike, to “keep our eyes on the goal, and not get distracted by what is going on around us”, always keeping in mind the importance of research.

This collaborative meeting speaks to the unceasing dedication of people with diverse knowledge and skills continuing on the journey to better sexual and reproductive health in Kenya and beyond, using evidence to inform solutions and drive change.

 

By Joy Muthure

JMuthure@kaviuon.org

Contacts

KAVI Institute of Clinical Research (KAVI-ICR)

College of Health Sciences

University of Nairobi

P.O. Box 19676 - 00202

Nairobi,

Kenya.

 

Telephone: +254-20-2717694/2725404

 

Mobile: +254-722-207417

 

Fax: +254-20-2714613

 

E-mail: kavi@kaviuon.org

 

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