Building Long-term Capacity for HIV/AIDS in Africa: S-S and Regional Strategies

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1 Building Long-term Capacity for HIV/AIDS in Africa: S-S and Regional Strategies Quarraisha Abdool Karim, PhD Director: CU-SA Fogarty AITRP Institute of Medicine (IOM) Envisioning a Strategy to Prepare for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests April in Pretoria, South Africa.

2 Life in the 21 st Century

3 Going to battle with sticks and stones

4 Need to diversify prevention research portfolio Tenofovir Truvada

5 Strengthening the Science Base in 58 countries SSA - the Challenge! Majority with no Medical Schools or Schools of Public Health Limited research infrastructure Limited science base Nurse driven health services Getting to S-S a long, but not insurmountable journey Institute of Medicine (IOM) Envisioning a Strategy to Prepare for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests April in Pretoria, South Africa.

6 The CU-SA Fogarty AITRP: A Tale of Evolving Politics, Epidemics & Science:

7 Building capacity - Evolving politics, evolving challenges and evolving responses Apartheid democracy Respectful partnerships CU and SA, SADC AITRP 3 cycles changing leadership Building capacity people and institutions high end, research, create opportunities Translational and operational Grants, Units, Centres, CIPRA MDGs LE, MMR, IMR HIV&TB Generate and share knowledge Increase $ for research

8 CU-SA Fogarty AITRP South Africa pre-1990: no schools of public health and 5 foreign trained epidemiologists Limited capacity to respond to HIV/TB 2010 : highest number of NIH grants outside US strong internationally recognised scientific leadership critical mass of scientists across disciplines major centres of excellence across the country Strong partnerships and collaborative relationships Regional and S-S resource Not sufficient to turn epidemic around! Limited local investments in capacity building Fragility of institutions Balance between multi-centre studies vs locally relevant research Institute of Medicine (IOM) Envisioning a Strategy to Prepare for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests April in Pretoria, South Africa.

9 CU-SA Fogarty AITRP: HIV & TB Training in US and SA Basic science, epidemiology, ethics and social sciences 125 long-term traineeships 84 (67%) are women 85 (68%) from previously disadvantaged communities 40 long-term USA Trainees: 21 obtained MS (Epi) degrees, 3 MPHs 2 obtained MS (Biostatistics) degrees, 1 MS (Health Sciences) 2 currently in training 11 PhDs 186 Short-term traineeships range of labs across USA Institute of Medicine (IOM) Envisioning a Strategy to Prepare for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests April in Pretoria, South Africa.

10 CU-SA Fogarty AITRP: (2) > 99% Retention Rate Leveraging Additional Funds for Training FIC Supplements LifeLab, KRITH, CIPRA Ongoing training and capacity building through local workshops 46 co-sponsored conferences and workshops in South Africa Training in Swaziland, Lesotho and Namibia > 7000 local participants > 1000 publications in high impact journals Numerous NIH grants Numerous Centres, Institutes and Units Leadership role at highest levels locally and globally

11 CU-SA Fogarty AITRP : North-South CU-SA Fogarty AITRP established in epidemiologists in South Africa (all trained outside South Africa) and no Schools of Public Health Challenges faced by CU-SA Fogarty AITRP: Apartheid isolation Few international funding opportunities to SA scientists Lack of public health research training opportunities in SA Rapidly growing HIV epidemic HIV prevalence < 5% Steering Committee CU & SA SPHs Local PI appointment at CU Respectful partnership Regional resource Trainees from Lesotho, Swaziland, Namibia, Botswana 25 South African institutions National and Provincial Health Departments, MRC, Research Centres and Universities

12 CU-SA Fogarty AITRP : N-S, S-N Program s role in successful NIH applications involving trainees: HIVNET units; HPTN unit and HVTN unit; 2 CIPRA program awards;2 PACTG satellite units; 2 AACTG satellite units; 3 social science partnership research awards; ICOHRTA planning award UKZN alone - about $20million in NIH grants during this period Sub-contracts with US institutions Steering Committee expansion beyond SPH and CU in SA and US Generating & Participating in RCTs GRIPP? HIV Epidemic continues to grow AIDS denialism

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14 HIV prevention trial landscape in 2006 Microbicide Barrier Behaviour Treatment pmtct Vaccine Population Council Carraguard HVTN 204 HPTN 035: Pro 2000 & Buffergel CDC Truvada PrEP trial: Heterosexual HVTN 503 trial PAVE 100 trial HPTN 039 HSV-2 Susceptibility UCSF MIRA Diaphragm NIMH Project Accept trial: Community based VCT MDP 301 Pro % and 5% Trial CAPRISA 004: Tenofovir gel trial HPTN Estimated trial completion date

15 CU-SA Fogarty AITRP : N-S, S-N, S-S Substantial increase in # of Institutes, Centres, Units but fragile Increasing opportunities for training in SA degree courses and practical experience Local and international students (US and RCS) China, Saudi Arabia, India, Uganda, Ethiopia, SC includes two previous trainees CIPRAs - strong base for locally important research; Network research Epidemic grows, denialism, Availability of ARVS

16 CU-SA Fogarty AITRP : N-S, S-N, S-S Strengthen Institutes, Centres, Units Strengthen training in South Select high level training in US Expand S-S collaboration SC expansion to > representation from south + previous trainees End of HIV denialism demand for implementation science HIV & TB epidemics intertwined

17 Why S-S Collaboration is important Develops local research capacity Not just for HIV, but also for other emerging health threats Helps to reduce the Brain Drain Building research infrastructure helps reduce brain drain Contributes to better understanding of the HIV epidemic and its nuances in a broader range of settings

18 CU-SA Fogarty AITRP (2) Base for building other training programs FICRS Implementation science Expansion to other Infectious and noninfectious diseases eg KS Institutional bases for S-S collaboration and training opportunities Balance between local vs international training Leverage for other training resources Institute of Medicine (IOM) Envisioning a Strategy to Prepare for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests April in Pretoria, South Africa.

19 Goal Build next generation of scientific leadership globally Strengthen institutional capacity for training and research Support existing faculty Build critical mass Career paths Rewards for focus on priority research Be responsive to changing needs Institute of Medicine (IOM) Envisioning a Strategy to Prepare for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests April in Pretoria, South Africa.