SAMRC S RESPONSE TO HIV & TB: WALKING THE TALK: MOVING TO CONTROL

Transcription

1 SAMRC S RESPONSE TO HIV & TB: WALKING THE TALK: MOVING TO CONTROL Glenda Gray President & CEO SAMRC 1 SA AIDS 2017 Durban 15 June 2017 Partner logo

2 LEADERSHIP IN A TIME OF UNCERTAINTY 2

3 BASELINE BUDGET ALLOCATION Leadership in a time of uncertainty?

4 ROLE OF SCIENCE IN MOVING TO CONTROL SAMRC s mandate The importance of science in controlling the epidemic SAMRC s funding of HIV and TB Strategic scientific collaborations 4

5 SAMRC S ROLE The SAMRC is the custodian for medical research in South Africa The biggest African funder of medical science Centrality of scientific excellence Prioritised intramural research to maximise impact on SDGs Funds research based on locally development priorities Focusing efforts to develop scientific capacity and transformation of the pipeline of researchers 5

6 SOUTH AFRICAN BURDEN OF DISEASE BURDEN

7 SAMRC GRANTS: : TB & HIV R R R R R R R R Sum of 2012/13 Sum of 2013/14 Sum of 2014/15 Sum of 2015/16 R 0

8 POWER of SCIENCE and its role in SAVING LIVES 8

9 GLOBAL AIDS DEATHS GLOBAL HIV/AIDS DEATHS

10 GLOBAL SCIENCE GROWTH

11 SCIENTIFIC IMPACT IN MEDICINE Scientific research leads to new knowledge, technologies and clinical treatment New paradigms Direct impact on society Basic Science

12 TRENDS IN DEATH: ARV roll-out SA SAMRC: 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

13 TRENDS IN CHILDHOOD MORTALITY PMTCT Under-5 mortality rate (U5MR) and infant mortality rate (IMR) increased to a peak in 2003 and declined till 2011 Levels have stagnated at 40 and 28 deaths per livebirths for the U5MR and IMR respectively Neonatal mortality rates (NMR) have declined to 11 per livebirths SAMRC RAPID MORTALITY SURVEILLANCE REPORT 2014

14 TRENDS IN LIFE EXPECTANCY AT BIRTH, year increase in average life expectancy since the low in 2005 By 2014: Total: 62.9 years Male: 60.0 years Female: 65.8 years RAPID MORTALITY SURVEILLANCE REPORT 2014

15 TRENDS IN PMTCT Reducing Early MTCT Trend Any PMTCT 2011 MTCT amongst mothers with unknown HIV+ status approx4 times higher Undiagnosed HIV positive mum 2011 Any PMTCT % SA national target Undiagnosed HIV positive mum 2012 Source: Goga A, Dinh TH, Jackson DJ, Lombard C. Journal of Global Health in press;

16 STRATEGIC HEALTH INNOVATION PLATFORM Capacity development & global participation Other strategic projects Product development HIV vaccines Partner logo

17 SHIP HIV PORTFOLIO Prevention Treatment Diagnostics Platforms Novel HIV vaccine candidates Env-CD4 complex subunit vaccines BNAbs, adjuvants and immunogens Vaccine-mediated effects in breakthrough HIV infections HVTN 097 Immunology Assays (P5) Silver-based microbicides Gene-directed targeting of HIV reservoirs Low dose duranovir clinical study Radio-immunotherapy Genital Inflammation Test for HIV prevention Seq2Res for highthroughput HIV drug resistance genotyping HIVSmart! Self-test implementation study Projects span: basic science / exploratory research product development clinical research value chain development community engagement capacity development NHP Facility support Animal models for HIV vaccine development Plant production of monoclonal antibodies WSU HIV CRU Support Crosscutting LTNPs and ECs for HIV cure ECHO study HIV serosurvey in emergency units in Eastern Cape Stakeholder engagement on HIV prevention Research Capacity Development: HIV vaccine clinical trial capacity development PrEP for Pregnant women Partner logo

18 SHIP TB PORTFOLIO Drugs Diagnostics - TB drug discovery consortium - Bioinformatics for TB biomarker discovery - TB CHAMP - TB PROTEC - SERS - PoC urinary TB biomarkers device - Rapid PCR diagnostic Vaccines - Blood signature of TB infection - TB HART - T cell responses associated with protective TB immunity - Systems immunology of vaccine induced protection against recurrent TB disease

19 FLAGSHIP HIV & TB PROJECTS

20 TUBERCULOSIS

21 TB FLAGSHIP PROJECTS TB transmission: host, bacterium & environment UCT TB control Improving TB diagnosis & RX through basic, applied and health systems research SAMRC Developing oxidant and redox drug combinations for TB NWU Evalutating new treatment regimens for MDRTB (NeXT study) SMU/UCT 21

22 FLAGSHIP HIV PROJECTS Alcohol reduction interventions to promote ART adherence SAMRC Impact of rape in women on HIV acquisition SAMRC Causes and Consequences of HIV transmission and drug resistance UKZN Addressing structural issues 22

23 SAMRC NIH COLLABORATION Joint MRC-NIH Summit on HIV/AIDS, TB and HIV related Malignancies - 17 & 18 June 2013 in Durban ZAR investment

24 Strategic Collaborations with NIH, BMGF, HVTN and PPPs in the pursuit of an HIV vaccine

25 The Need for a Vaccine Has Not Changed HIV epidemic continues to surge even in countries with longstanding ART In eastern and southern Africa, in 2015 there were 19 million people living with HIV, 960,000 new infections and 470,000 AIDS-related deaths (UNAIDS) Under status quo, 49 million new infections predicted worldwide (Medlock et al., PNAS, 2017)

26 Corey & Gray, PNAS 2017

27 The Two Major Scientific Questions Facing the HIV Vaccine Field: Can non-neutralizing antibodies be potent enough to achieve desirable vaccine efficacy (VE >50%) for at least 2 years? Can this be achieved by designing better recombinant proteins and adjuvants? By eliciting better T helper responses to drive higher and more durable antibody production? Is neutralization, as we currently measure it, associated with vaccine protection and will this protection be of a sufficient magnitude to overshadow other vaccine design approaches?

28 3 strategies to advance immunization Efficacy Studies P5 Clade C approach using ALVAC & gp120/mf59 (HVTN 702) Multi-clade approach using rad26/mva/gp140 trimer (HVTN 705) Neutralising antibody approach using VRC01 (HVTN 703) AN INVESTMENT OF > USD 250 MILLION

29 HIV VACCINES

30 What we need to control the epidemic? New classes of Drugs Point of care viral load & Immunologic al monitoring FDCs, long acting ARVS & child friendly formulation s HIV Vaccines & other immune based strategie s Microbicid e developm ent & long acting ARVS for PrEP Immunolog ical & Drug Based Strategies aimed at the latent reservoir Innovations in the management of HIV that will impact on community viral load and infectiousness: prevention of secondary transmission Innovations in the Prevention of Sexual Acquisition that will be required when secondary transmission is not averted HIV Cure: the ultimate control of the HIV epidemic will be in the elimination of viremia in those infected Gray, G et al Plos Biol, 2016

31 ACKNOWLEDGEMENTS NDOH DST NIAID HVTN NIH CDC & USAID BMGF PPP SAMRC STAFF & SCIENTISTS PARTICIPANTS WHO VOLUNTEER FOR SCIENCE 31 Partner logo