Could early treatment with antiretroviral (ARV) therapy help the body fight off HIV? African researchers believe studies they are conducting show promise for a more effective treatment and possible prevention or elimination of HIV at a lower cost.
Control, elimination and eradication are the three strategies for disease prevention and control.
In research currently going on at the HIV Pathogenesis Programme (HPP) at the University of KwaZulu-Natal (UKZN), Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE) researchers are investigating whether ARVs treatment started within days of exposure to HIV could rid the body of the virus. This works with the same principle of prophylaxis following incidental or accidental exposure to the HIV.
SANTHE is a network of multidisciplinary experts empowering African scientists in pioneering basic, clinical and translational research to inform vaccine development and HIV prevention, treatment and cure strategies.Focusing on the epicentre of the epidemic, South Africa, where 7.1 million people are living with HIV, SANTHE is collaborating with leading academic institutions, non-profits and community groups worldwide on translational research, efficacy studies in animal models and community perspectives of HIV.
The consortium of researchers from Botswana, Kenya, Rwanda, South Africa and Zambia, is one of the 11 awardees of the US$100 million DELTAS Africa programme supporting the Africa-led development of world-class researchers and scientific leaders in Africa being implemented by The African Academy of Sciences (The AAS) through its programmatic platform, the Alliance for Accelerating Excellence in Science in Africa (AESA), with the support of Wellcome Trust and the UK Department for International Development (DfID).
“In one of the studies, we are trying to come up with a strategy for people to live without ARVs after treatment and to ensure HIV does not become a progressive infection. In the research we are conducting, we are treating young women in South Africa with ARVs once they are exposed to the risk.
The participants in the study are tested twice a week, so we can immediately detect if they are infected. These individuals might be easier to cure,” says Thumbi Ndung’u, SANTHE programme leader and HPP scientific director.SANTHE is collaborating in the study with the Females Rising through Education Support and Health (FRESH), a community-based programme that has since 2012 reached out to young women at risk from HIV based in Durban, South Africa. Findings from the study will have a major impact on HIV cure strategies and will help African governments and health officials plan for interventions, drawing on lessons from cutting-edge research in the country with the biggest HIV epidemic in the world.
The basic research science on biological samples from FRESH participants and performed at HPP under Ndung’u’s leadership is based on statistics indicating that young women are very high risk and bear the disproportionate burden of the HIV epidemic. Over two-thirds of 24-year-old women in South Africa are infected with HIV.
The programme enrols local women who are HIV negative. Their blood samples are frequently tested (every two weeks) at the HPP to see if anyone has recently contracted the virus. If they have, they are started on ARV therapy; and, in turn, provide further samples for the study. Most of the young women in FRESH are disadvantaged and a lot of them are out of school, but through the programme they can get economic opportunities, or even go back to school.
There are some interesting preliminary findings from the study. For example, HIV usually depletes a person’s CD4 cells – but not so in these women, if they are treated early. The team is exploring whether this has long-term benefits.Ndung’u’s colleague, Krista Dong, who leads the FRESH study, is collaborating with the SANTHE scientists on a two-pronged prevention strategy clinical trial - enrolling the highest risk group at the epicentre of the HIV epidemic and treating early to provide an opportunity to conduct pure research.
“Thumbi Ndung’u and our teams at HPP and FRESH will be implementing a clinical trial focused on “cure” or ‘post-treatment control”, enrolling young women whose HIV infection was detected during their enrolment in the FRESH study,” says Dong adding: “This is a novel treatment that will be given to HIV-infected individuals, that involves a combination of two or three broadly neutralizing antibodies (‘BNAbs’ pronounced bee’-nabs), plus an immunomodulatory agent.”
A FRESH Cohort HIV study has discovered that Black women in South Africa have a different composition of bacteria - a diverse bacteria-microbiome in their vaginal tract - that makes them more vulnerable to HIV infection. Data from the study reveal that most of the women use the injectable hormonal contraceptive, which puts them at a higher risk of HIV infection.
The research seeks to understand those factors (the bacterial conditions that puts the women at a higher risk of infection), in the clinical trial that will launch a novel product to alter the composition of the bacteria in the vaginal tract. It seeks to know how the immune system fails to protect women infected via the membranes at the site in the female genital tract where they are first exposed. “The idea of using immunotherapy, for example chemicals (monoclonal antibodies), is to kill HIV in those infected with HIV and also stimulate a new immune response, to have the body generate, make cells that can fight the infection. We don’t know whether this will work, but we feel there is a possibility,” states Ndung’u.
With the first marker for infection, immediate treatment will lead to reducing the virus, blunting the peak-time; the most likely of a cure strategy, Dong explains. The cure study will begin in 2020 following the 2019 Lactin V new investigation product the researchers have developed to alter the bacteria in the vaginal tract.Since the young women in the FRESH Cohort Acute HIV study are tested so frequently, HIV infection is picked up within days of exposure and they are started on “immediate” treatment.
This means that the ARVs stop viral replication very early, before the levels get very high in the blood and before they establish large repositories or “reservoirs” of virus that cannot be eliminated by drugs alone.
Because ARV treatment is started very early and limits the size of the viral load, this may present one of the best opportunities to use a novel treatment to eradicate the virus from the body or to help the body to control the virus without drugs (post-treatment control).
Early treatment research has confirmed that the earlier you start treatment for HIV, the better. Early treatment suppresses the virus in the blood, which prevents further damage to the immune system. Although the immune system is unable to control (suppress) the virus without ARVs, except in rare individuals, once a person stops ARVs, the virus begins to replicate and high levels in the blood return.
In the study, the goal of early treatment is not only to prevent damage to the immune system, but also to limit establishment of the viral load and create a unique cohort of individuals in whom novel cure strategies can be tested.The SANTHE/FRESH study will significantly contribute to HIV research and demonstrates that African researchers are conducting cutting edge science in Africa that complement global efforts in stemming the spread and eliminating the disease that has ravaged the continent.
Government has finally presented to parliament the much-awaited Bill calling for the establishment of Botswana Teachers Professional Council (BTPC). While all speakers concede that such a body is needed, the Bill has however been a subject of debate for a long time.
At times the Union stopped government from tabling it because teaching fraternity had concerns with is framing. In fact the idea of a teaching council came through Botswana Teachers Union about two decades ago, but did not see the light of day among the powers that be. This is despite that the council stands to assist in the effectiveness of a teacher, which requires motivation, discipline, patience, articulation, responsibility, and innovation. It also depends on continuous professional development. The teaching profession has been characterised by lack of educational standards for entry and acceptable standards of professional competence as well as lack of an agreed code of conduct resulting in declining academic performance in basic education. The decision by the ministry is seen as a way of improving teaching standards and work ethics, which are central themes as stated in both the 1994 Revised National Policy on Education and the 1977 Education for Kagisano.
In 2015, the then Ministry of Education and Skills Development (MoESD) was forced to defer the tabling of the Bill during the July parliament session following objections by Trade Unions. The ministry had to wait for unions to submit their concerns and queries first. MoESD followed that by holding a consultative meeting in which unions and, or stakeholders presented their input on the bill to government. Among the issues the unions raised were reservations on some of the key issues including the definition of the word ‘lecturers’ in the teaching situation. Unions requested for more time to engage with other stakeholders and to form an independent board that will be able to make decisions that will not prejudice its members and that in their view the minister had powers to appoint the council board.
Talking to Botswna Guardian on condition of anonymity this week, an elated education expert said the formation of Botswana Professional Teaching Council has been on the ministry’s agenda for a very long time. Progress since the idea was mooted has been painfully slow. It would appear the issue gathered momentum following the release of the Education and Training Sector Strategic Plan (ETSSP). “I don’t think there is anything new as for reasons necessitating the establishment of the Teaching Council. The reasons are to establish a body that regulates profession and registers and licences teachers and ensures adherence to a set code of conduct among other things,” said the disinterested observer. It is hoped the body will instil the highest standard of professionalism, clean up the teaching profession by way of eliminating elements that may not have the right work ethics.
“In my view the council heralds a new dawn in the teaching profession. The council comes against the background of declining academic achievement levels and the need to restore excellence in our public schools... “It might have come at the right time to galvanise teachers to prioritise teaching and learning while taking appropriate action against deadwoods while taking measures to ensure the professional development of underachievers and weeding out those who are beyond redemption.” Due to the escalating rate of unemployment the teaching profession over time attracted job seekers who did not have the heart and passion for teaching and this unfortunate development could have contributed to a culture of underachievement that the ministry faces and registration could eliminate people who do not deserve a place in the profession, said the observer.
When presenting the Bill the Minister of Basic Education, Bagalatia Arone said the object of the Bill is to provide for the regulation of the teaching profession, for the establishment of the Council, enrolment and regulation of the teaching profession at pre-primary, primary and secondary levels in Botswana. He said a number of people are employed to teach whilst they do not have teaching qualifications or work ethics necessary to achieve effective teaching and learning. These compromise the quality of teaching and learning in Botswana. Supporting the Bill, Vice President and Leader of the House, Slumber Tsogwane said the teaching profession should not be seen to be remaining behind other professions.
“It is unfortunate, I am just rising to show concern because we discuss these Bills at the General Assembly and we expect Members of Parliament to attend so that things can be clarified, elaborated and if we have questions, we can raise them there. It seems some Members of Parliament are interested in debating the Bills here, yet they do not want to engage and interrogate them further at the General Assembly. This is a very unfortunate situation because the General Assembly is meant to help us to develop more ideas and more understanding of the Bills that we pass here, instead of coming here and presenting a totally different picture or thinking away from the Bill itself.
“So, we need to attend the General Assembly as MPs so that we can interrogate and engage our Ministers more meaningfully than to come here and seek clarifications, points of order, this and that. I am pleading with you so that we can have a better understanding of some of the laws that we pass here. This is a very good Bill Minister. Your Assistant Minister did a sterling job at the General Assembly. We really appreciate that this is long overdue. We need to have professionals and people we can trust with our students”. MP for Nkange, Edwin Batshu said teachers should be appreciated as pillars of education, and the implementation of Public Service Act brought many challenging issues around the teaching profession, such as hours of work which treated teachers the same way as with other public servants.
MP for Serowe South, Dr Pelonomi Venson-Moitoi, said that there was need to have regulating body for all professions. She welcomed the Bill describing it as progressive for the teaching profession. “With this Bill, teachers will be identified and also be restricted to follow rules and regulations as per the council.” She also said the regulating body would also provide for qualified and professional local teachers. She said there are many foreign teachers, some of them expelled and their licenses revoked by the regulatory bodies in their countries. “It is necessary that this Bill provides for registration of teachers and for the establishment of the disciplinary committee and other inquiries,” she said.
New HIV infections in Botswana could be reduced substantially by offering entire communities voluntary HIV testing, and immediately referring those who test positive for HIV treatment, results from Ya Tsie study have revealed. The encouraging results of the Ya Tsie or Botswana Combination Prevention Project study conducted from 2013 to 2018 were published in the New England Journal of Medicine on the 18 July 2019.
The study found that voluntary HIV testing, and immediately referring those who test positive for HIV treatment in line with local guidelines decreased new HIV infections in Botswana by at least 30 percent within the intervention communities. The community-randomised study involving about 180,000 people sought to discover the effectiveness of the ‘universal test and treat’ and safe male circumcision strategies in reducing new HIV infections. It was led by researchers from the Botswana Harvard AIDS Institute Partnership (BHP), Harvard T.H. Chan School of Public Health, The Centers for Disease Control (CDC) in Botswana and Atlanta, and the Ministry of Health and Wellness in Botswana.
In 2017, around 344 000 people were living with HIV in Botswana. Hailed as a model state in the battle against HIV/AIDS, the country still records an estimated 10 000 new infections every year. Furthermore, the national HIV/AIDS prevalence rate is at 17.6 percent and 25 percent for adults, which makes it the second highest in the world.
Steep reductions in incidence are therefore needed to curb the HIV/AIDS epidemic, in the country and the southern Africa region where the prevalence is higher than anywhere else in the world. Out of the 30 communities involved in the study, 15 were randomised to an HIV prevention package while the other 15 communities received the local standard of care for HIV management. The intervention group received door-to-door voluntary counselling and HIV testing, linkage to care for those who tested positive and the opportunity to immediately begin treatment for the virus, and a suite of proven HIV prevention measures for those who tested negative.
The standard group also received the same services except treatment was provided according to national guidelines. By the end of the study period, investigators found that in the intervention group, the proportion of persons living with HIV, suppressed viral load increased from 70 percent to 88 percent while those in the standard care group increased from 75 percent to 83 per cent. The population level of viral suppression in the intervention group is among the highest to be reported globally. Incidence of HIV infection in the intervention group was 30 percent lower than incidence in the standard care group.
Among the package of methods tried during the intervention however, male circumcision uptake was relatively low and was hence likely the least significant, according to the researchers. The successful HIV testing campaigns, in homes and mobile venues, along with support for linkage to care both contributed to the very high ART initiation and viral suppression achieved. According to the researchers, this in turn likely led to the nearly one-third reduction in the rate of new HIV infections in the intervention communities.
“Using approaches that are feasible in most settings, we achieved levels of HIV diagnosis, treatment, and viral suppression that are among the highest levels reported globally,” said the Principal Investigator and CEO of the Botswana Harvard AIDS Institute Partnership, Dr Joseph Moeketsi Makhema. “These high rates of treatment coverage are a testimony to the long standing commitment that Botswana has shown to tackling HIV. We also believe that our approaches and findings are highly relevant for other countries,” he said.
According to Dr Makhema, the study has provided aspiration that sustained over time, counselling, testing and effective early antiretroviral therapy will help in achieving the UNAIDS target of 90 percent reduction in the rate of new HIV infections by 2030 globally.