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Wits RHI’s comprehensive approach to fighting HIV is informed by innovative research ranging from testing multi-purpose prevention technologies, exploring structural drivers, to improving approaches to care and treatment through health systems strengthening, optimising treatment, and developing appropriate models of care for key populations and marginalised groups.
We respond to emerging trends in the field of HIV.
HIV Prevention
Wits RHI’s work largely focuses on women and girls, and we continue to contribute to global evidence and cutting-edge research as part of an international effort in response to the HIV epidemic.
Our prevention research portfolio includes studies considered among the most important for advancing the field of HIV prevention. Many of these trials focus on assessing ARV-based microbicides and include studies designed to evaluate microbicides along with other promising HIV prevention approaches, such as the daily use of ARVs as pre-exposure prophylaxis (PrEP).
Our work includes:
HIV care and treatment optimisation
Wits RHI has been working in the field of HIV since the late 1990’s. Initially focussing on HIV prevention, we have expanded from development of new products for HIV prevention such as self-testing and multipurpose prevention technologies (MPTs), to include the evaluation of upstream interventions aimed at addressing the structural drivers of HIV, and implementation science projects that explore the introduction of these new approaches into the health system.
Our work includes:
Accelerating Program Achievements to Control the Epidemic (APACE)
The ADVANCE Programme led by Wits RHI, is the world’s largest set of studies on ARV treatment optimisation. Results coming from this study facilitated the introduction of new ARVs in South Africa. These ARVs are cheaper and have fewer side effects than the drugs that are currently available.
Clinical trials have shown that treatment regimens including dolutegravir work faster, have fewer side effects and demonstrate greater potency against drug resistance than standard HIV drugs used in Africa and other poor countries. Dolutegravir is a highly effective antiretroviral, which is well tolerated by patients and has fewer side effects. Patients are therefore more likely to be adherent and more likely to be virally suppressed – which means that they are not likely to transmit the virus to others.
“ADVANCE Study” – Study launched to test new and safer HIV drugsCare and treatment in adults
Wits RHI’s research portfolio is contributing to global evidence and cutting-edge research as part of an international response to the HIV epidemic. Despite outstanding achievements in which over three million people are accessing ART in South Africa, there are still an estimated one million in need of ART and an additional three million who are in need of care and support services. Increased access to ART and better TB diagnostics has renewed focus on complex case management.
Referral systems are being stressed by the large number of people being screened and initiated on ART, as well as the surge of multi-drug resistant (MDR)/extremely drug resistant (XDR) patients.
Wits RHI offers technical support to the DoH on DR TB and clinical support and mentoring at decentralised DR treatment sites within The City of Johannesburg Region F.
Our work includes:
Coalition to Accelerate and Support Prevention Research (CASPR)
Care and treatment in adolescents
Wits RHI works with the National Department of Health and other key partners to ensure that HIV/AIDS care and treatment services are high quality, cost effective, and reach HIV-positive populations. Our clinicians, public health advisors, and health scientists provide ongoing technical expertise and identify, evaluate and replicate innovative interventions that are low-cost, high impact approaches to service delivery.
We also link HIV services to other healthcare services in order to strengthen the country’s healthcare system.
Our work includes:
Care and treatment in children
HIV and TB in children remains a challenge. Children have limited options with regards to HIV and TB medication, and disease progression is often different to that of adults. According to the Elizabeth Glaser Pediatric AIDS Foundation, children with HIV are 20 times more likely to contract TB and UNAIDS estimates that 700 children worldwide become infected each day, and that almost half of them will die before their second birthday without ARV therapy.
Diagnosis of infant HIV and subsequent initiation onto ART is thus imperative to prevent disease progression and mortality. This is one of the major objectives of the Wits RHI paediatric team, which is working to strengthen health systems to better identify and care for children living with HIV and TB. Technical assistance, training and mentorship are provided to facilities in the districts where we operate, to increase their capacity to treat HIV-infected children and adolescents holistically.
Our work includes:
Wits RHI’s paediatric clinical research team is located at the Wits RHI Shandukani Research Centre in Hillbrow. Shandukani conducts research with the aim of decreasing the mortality and morbidity associated with HIV disease and infectious diseases in children, adolescents and pregnant women.
The team conducts clinical and network trials of new drugs and evaluates treatment regimens to guide the care and management of HIV-positive infants, children, and adolescents, with a particular interest in TB/HIV co-infected children. This is done in partnership with the International Maternal Paediatric Adolescent Aids Clinical Trials Group (IMPAACT). Shandukani provides secondary level and specialised health services for women, adolescents and children, and includes a 24-hour midwife-led obstetric unit.
All men and women have the right to quality reproductive health care and access to services such as family planning. In countries where resources are constrained and health systems are overburdened by diseases such as HIV and TB, it remains a challenge to develop reproductive health care strategies that are able to reach populations in need.
Evidence is needed from high quality studies to design and implement these strategies; a gap that Wits RHI is addressing through its research.
Since inception, we have focused on all aspects of sexual and reproductive health (SRH), including, in actively supporting the conceptualisation, drafting and implementation of the contraceptive policy; providing comprehensive training to public health professionals across the country in SRH; and, more recently, providing support to developing approaches to family planning and conception in the context of a generalised HIV epidemic.
We have a robust and expanding portfolio of work in women’s health which spans pre-conception and antenatal care, delivery and infancy. Our studies test new solutions aimed at encouraging women to attend antenatal care early with the benefits of early HIV diagnosis and antiretroviral initiation to prevent HIV transmission to infants, receive quality services and care throughout their pregnancies and deliver healthy babies.
Our work includes:
Optimised Postpartum PMTCT Testing for Infants and their Mothers (OPPTIM)
In 2017, we received funding support from Unitaid to implement an SRH access project that will provide PrEP to 6,640 adolescent girls and young women aged 15 to 24 in priority areas of South Africa.
This three-year project will be integrated into the National Department of Health’s She Conquers campaign, which works with adolescent women and young girls to reduce HIV incidence, gender-based violence, teenage pregnancy, school drop-out rates and youth unemployment, with a focus on prioritized districts.
Unitaid PrEP ProjectVaccines are one of the most powerful, cost-effective public health interventions, responsible for saving millions of lives and catalysing economic growth. Yet, in 2013, WHO estimated that a lack of access to established vaccines contributed to approximately two million childhood deaths worldwide.
Vaccine preventable diseases (VPDs) are a relatively new, but increasingly important focus area for Wits RHI. We are currently conducting tuberculosis (TB) vaccine studies in infants, and are planning to implement a Respiratory Syncytial Virus (RSV) vaccine trial in pregnant women. Wits RHI has published on human papillomavirus (HPV) vaccine implementation and programme feasibility, and has evaluated the National Department of Health’s national HPV vaccine programme. We are developing an adolescent/pre-adolescent platform for vaccines, and maternal infant pair cohorts.
We have also had extensive involvement with international vaccine research partners and global policy. In 2015, we became a lead partner in the African Local Initiative for Vaccinology Expertise (ALIVE); a Wits University project to create a flagship vaccine and immunisation institution. Professor Helen Rees, together with Professor Shabir Madhi of the Respiratory and Meningeal Pathogen Research Unit, is spearheading the initiative, which is supported by a group of eminent South African vaccine researchers and other academics from fields such as implementation science, public health, health economics and social science. ALIVE is being run in conjunction with the National Research Foundation and was launched in May 2016.
Our Work includes:
