Understanding the HIV challenge in South Africa

The quest to reduce the HIV burden in Sub-Saharan Africa (SSA) involves a multi-faceted and multi-disciplinary approach. While detailed understanding of the pathogenesis, virology, immunology and epidemiology as it relates to HIV/AIDS is crucial, ways to curb the disease require constant attention and innovation, as do the socio-economic implications. Working in partnership is critical, given the complexity of the virus, and the extent of its impact at a young age. The final aim is to progress towards a 90-90-90 goal1: 90% of people living with HIV know their status; 90% of those who know their status are on antiretroviral therapy (ART); and 90% of those on ART achieve viral suppression by 2020.

The final aim is to progress towards a 90-90-90 goal1: 90% of people living with HIV know their status; 90% of those who know their status are on antiretroviral therapy (ART); and 90% of those on ART achieve viral suppression by 2020.”

“Understanding the HIV challenge in South Africa,” a new report from Clarivate Analytics, provides an overview of HIV incidence and prevalence in SSA countries, with a focus on South Africa. Disease projections provide an estimate of the growing number of new HIV infections and of people living with HIV/AIDS. HIV-caused deaths and disability in South Africa were defined using comparators on the global burden of diseases (GBD) regional classifications, and an overview of South Africa’s health service utilization.

Across SSA, HIV control has involved the successful use of ARVs that were studied for efficacy in numerous clinical trials. A profile of the clinical studies undertaken in the various SSA countries was tabulated, and is excerpted here, followed by a visualization of the various public-private partnerships active in sponsoring HIV trials, and the drug pipeline interventions studied.

Clinical trials in Sub-Saharan Africa

HIV treatment has been facilitated by the appropriate planning of clinical trials in both children and adults. The top 20 countries with the highest number of HIV clinical trials in SSA are reported in Figure 1. More than 657 clinical trials were reported, with 348 HIV studies reported for South Africa, followed by 144 in Uganda, 76 in Kenya and 69 in Tanzania. Nigeria reported 14 clinical studies.

 

Figure 1: Top 20 countries with the most HIV clinical trials in Sub-Saharan Africa. Source: Cortellis Clinical Trials Intelligence, Clarivate Analytics, May 31, 2018.

 

Public-private partnerships

In SSA, public-private partnerships are exemplified by the National Institute of Allergy and Infectious

Figure 2: Top 20 sponsors for HIV clinical trials conducted in SA. Source: Cortellis Clinical Trials Intelligence, Clarivate Analytics, May 31, 2018.

 

Diseases (NIAID)-funded HIV Vaccine Trials Network (HVTN). The network is sponsoring several clinical trial sites, such as the HIV vaccine efficacy trials termed as the Imbokodo and the phase IIb/III HVTN 702 study. Imbokodo is a new phase IIb proof-of-concept study, enrolling 2,600 HIV-negative women, age 18-35 years; the first participants have already received vaccinations at various clinical research sites in South Africa, while regulatory processes are underway to conduct the study in Malawi, Mozambique, Zambia and Zimbabwe.

The prime boost vaccine strategy being tested in Imbokodo includes utilizing “mosaic” immunogens – vaccine components inserted in an Adenovirus type 26 vaccine platform designed to induce immune responses against a wide variety of global HIV strains – combined with a protein vaccine boost. Results from Imbokodo are expected in 2021.

Results from the ongoing phase IIb/III HVTN 702 study, which launched late last year and is enrolling HIV-negative men and women in South Africa, are expected in late 2020.2

South Africa has been involved in up to 49 HIV trials sponsored by the NIAID. The University of Witwatersrand, University of Cape Town and the University of KwaZulu-Natal have sponsored 10, nine and four HIV clinical trials, respectively, in the country. (See Figure 2.)

This article was excerpted from the author’s full “Understanding the HIV challenge in South Africa” report. The paper analyzes HIV incidence and prevalence data, via the Incidence and Prevalence Database from Clarivate Analytics, as well as mortality and morbidity data, health services utilization in South Africa, and a look at HIV-AIDS-related clinical trials in the region. The full paper is available here.

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References:

  1. https://interactive.pri.org/2017/08/awl-hiv/index.html
  2. https://www.niaid.nih.gov/news-events/first-new-hiv-vaccine-efficacy-study-seven-years-has-begun

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