Research Highlights

MTN-020/ASPIRE - SAFETY AND EFFICACY OF THE DAPIVIRINE VAGINAL RING

HPRU participated in one of the first women-initiated methods for HIV prevention.

The MTN-020/ASPIRE study evaluated the safety and efficacy of the dapivirine vaginal ring (VR) (25 mg) for the prevention of HIV-1 infection in healthy, sexually active, HIV-negative women. MTN 020/ASPIRE demonstrated that the monthly dapivirine vaginal ring is safe for long term use and can reduce the risk of HIV-1 infection in women when used. Protection was greater in subgroups with evidence of better adherence to ring use. In MTN 020/ASPIRE, the dapivirine ring reduced the risk of HIV infection by 27% overall, and showed a greater level of protection for women over 21 (56%).  IPM 027/The Ring Study showed similar results.

This led to the product to be tested in an “open label” trial (MTN 025), which will assess its use by previous participants in more “real life” situations. We hope that the additional data obtained by the open label HOPE study will lead to licensure of the first women- initiated HIV prevention technology. We anticipate the results in the latter part of 2018. Should we be successful, the study will have implications on policy as well as public health

J.M. Baeten et al. Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women. NEJM DOI: 10.1056/NEJMoa1506110

CONTRIBUTION TO NUMEROUS VACCINE CONCEPTS FOR HIV PREVENTION

HPRU is contributing to the HVTN’s (HIV Vaccine Trials Network) mission “to fully characterize the safety, immunogenicity, and efficacy of HIV vaccine candidates with the goal of developing a safe, effective vaccine as rapidly as possible for prevention of HIV infections globally”; as well as HPTN’s (HIV Prevention Trials Network) mission “dedicated to the discovery and development of new and innovative research strategies to reduce the acquisition and transmission of HIV”. In this regard, the following studies have been undertaken: HVTN 100; HVTN 111; HVTN 702; HVTN 703/HPTN 081; HVTN 705.

INNOVATIVE LONG-ACTING INJECTABLE FOR HIV PREVENTION (HVTN 084)

A Phase 3 Double Blind Safety and Efficacy Study of Long-Acting Injectable Cabotegravir Compared to Daily Oral TDF/FTC for Pre-Exposure Prophylaxis in HIV-Uninfected Women

BEHAVIOURAL RESEARCH

Translating PrEP uptake by adolescents. Developing a Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women

COMBINATION PREPVACC

Innovative trial with combined prevention interventions. To start 2019.

HORMONAL CONTRACEPTION (HC) AND RISK OF HIV ACQUISITION
Observational data suggested that hormonal contraception and in particular Depo-Provera increases the risk of HIV acquisition. We investigated the association between hormonal contraception and risk of HIV seroconversion and prevalence of other STIs. Data from 2236 participants recruited from microbicide trials were analysed to assess the association between HC and HIV. We show that in our setting HC was the most common contraception (46.47%). Use of HC was significantly associated with increased risk for HIV acquisition (HR 1.72: 95% CI 1.19-2.49, P<0.005). HC was also significantly associated with a higher prevalence of C. trachomatis (adjusted OR 2.46, 95%CI 1.52-3.97, P<0.001). HC are highly effective and well tolerated family planning methods. However, evidence suggests it may increase risk of HIV acquisition and it is recommended that women are counselled on importance of dual protection such as with male condoms in high HIV prevalence settings. This study was used as evidence for the WHO guiding document on HC and HIV prevention. Women should be encouraged to use other long acting contraception such as IUCD and contraceptive transdermal patches (such as Evra®). The NDOH has embarked on a drive to introduce these in Family Planning Clinics in South Africa. I developed the concept and co-wrote the manuscript.

Handan Wand and Gita Ramjee. The effects of injectable hormonal contraceptives on HIV seroconversion and on sexually transmitted infections. AIDS 2012. 26:375-380

 
Recognition

  1. Prof Ramjee was recognized as the EDCTP Outstanding Female Scientist in Africa, in Lisbon, Portugal (18 September 2018). “The EDCTP prizes recognise outstanding individuals and research teams from Africa and Europe who have made significant contributions to health research. In addition to their scientific excellence, the awardees have made major contributions to the EDCTP objectives of strengthening clinical research capacity in Africa and supporting South-South and North-South networking.”

  2. Prof Ramjee - SAMRC Scientific Merit Awards: Gold Scientific Achievement Award, October 2017

  3. Prof Ramjee was acknowledged for her expertise in HIV prevention research when she received a Lifetime Achievement Award at the 2012 International Microbicide Conference in Sydney, Australia. This award affirmed her contribution to the field as recognized by international peers. 

  4. In 2013, Prof. Ramjee was appointed as one of three selected Programme Co-Chairs for the 20th International AIDS Conference (Melbourne, Australia, 20-25 July 2014).

  5. HPRU received a new 7-year grant from the NIH in 2013. This is the third cycle of funding received by the unit through a very competitive global grant application and review process. A total of approximately R545 million was received from the NIH for HPRU’s Clinical Trials Unit (CTU).

  6. HPRU was a recipient of a Service of Excellent Award, from the KZN Department of Health (DoH) in 2014.  Professor S. Abdool-Karim, the former MRC President, was invited to receive this award on behalf of the MRC. The award was granted on the basis of the excellent, long standing collaboration between HPRU and the KZN DoH. HPRU is deeply honoured to have received this recognition from the Provincial Minister of Health Dr. Sibongiseni Dhlomo.

 

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