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Univ. Manitoba/ Univ. Nairobi - 34 years of ground-breaking research – HIV Prevention works!

Univ. Manitoba/ Univ. Nairobi - 34 years of ground-breaking research – HIV Prevention works!. E. Ngugi J. Kimani L. Gelmon March 10, 2014. The Collaboration began as a single research project in 1980 and grew rapidly. 1980 - chancroid in female sex workers

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Univ. Manitoba/ Univ. Nairobi - 34 years of ground-breaking research – HIV Prevention works!

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  1. Univ. Manitoba/ Univ. Nairobi - 34 years of ground-breaking research – HIV Prevention works! E. Ngugi J. Kimani L. Gelmon March 10, 2014

  2. The Collaboration began as a single research project in 1980 and grew rapidly • 1980 - chancroid in female sex workers • 1981-85 - STIs being studied included gonorrhea, chlamydia & syphilis; Majengo Sex Workers Cohort established • Support from IDRC – chancroid & gonorrhea studies • 1985 - Construction of Majengo and Pumwani Clinics which are still in use

  3. There are as many as 50-60 clients per day at Majengo

  4. The clinic at Pumwani Maternity Hospital – originally for mothers and children, but now open to all

  5. With the discovery of HIV in the cohort in 1984-85 research expanded to include HIV/AIDS • 1985-92 – studies on natural history & risk factors for HIV - much of the basic knowledge about HIV in Africa arose from these studies. • Development of interventions – development of STI syndromic management guidelines & advocacy in STD Control programme. • 1990 – discovery of HIV resistance among some sex workers • 1990 – 2000 – studies on HIV resistance  vaccine candidate trials (unfortunately not successful)

  6. Ground-Breaking Findings on the HIV Epidemic from the Univ. Manitoba - Univ. Nairobi Program in Kenya • Existence of a largely heterosexually-transmitted HIV epidemic in Africa & elsewhere • Importance of other STIs in facilitating HIV transmission • HIV transmission occurs through breastfeeding • Some forms of hormonal contraception facilitate HIV transmission • Male circumcision protects men against HIV acquisition • Some highly-exposed individuals can acquire immunity to HIV infection • Importance of focused HIV preventive interventions for FSWs and clients in reducing HIV transmission in the general community

  7. Long-term Canadian support for operational research and implementation • 1985-2000 – IDRC – mother-to-child transmission study • 1989-2006 – CIDA - Strengthening STD Control in Kenya (Moses, Ngugi) – established the basic methodology of community-based interventions with sex workers: use of peers, coordinated program of services, outreach strategies, etc. • 1997-2006 – CIDA – Regional AIDS Training Network (Gelmon, Bwayo) – established a regional network of institutions delivering short-course skills-upgrading (RATN became an independent NGO in 2003 & CIDA support continues) • 1990 – present – basic science research funding from assorted Cdn & international funding bodies.

  8. Other Canadian-supported UoM research projects • 2002-2007 – CIHR - Kisumu Male Circumcision randomised controlled trial (UoM, UoN & Univ Illinois) – directly led to WHO policy change on male circumcision • 2007-2011 – CIHR - The Cell phone intervention – showed that weekly text messaging improved treatment adherence • 2011-2013 - IDRC – PMTCT Cell phone trial – attempted to use same methodology as the cell phone trial to improve antenatal testing & care. • 2011 - CIDA – Muskoka project – to improve reproductive health outcomes in Taita-Taveta.

  9. Funding from CIDA and CFI helped to build new offices and labs in 1995 and 2005

  10. Since 2005 with support from American CDC-PEPFAR program, ARV treatment & care is being delivered to our SW populations • 2008 – the Sex Worker Outreach Program (SWOP) clinic established in downtown Nairobi • 2014 – Nine SWOP clinics & drop-in centres in Nairobi serving an estimated 30-40,000 sex workers • The SWOP clinics provide a comprehensive HIV prevention, care & treatment package for both male & female sex workers • Since 2010 – Univ. Manitoba – HIV prevention & care services to key populations in Nairobi prov. • Since 2010 – Univ. Nairobi – prevention & care services to key populations in Central/Eastern prov.

  11. Prevention works!!! - Impact of 25 yrs of UoM/UoN Programs at Majengo Sex Workers Clinic

  12. 1999-2006 the lessons learned in Kenya were transferred to India through the CIDA-funded India-Canadian HIV Prevention Project (ICHAP) • The lessons learned in India through massive scaling-up in the ICHAP & Avahan (Gates) projects have now been brought back to Kenya & applied nationally • Univ. Manitoba is implementing a Technical Support Unit for key populations in the Ministry of Health. • Univ. Manitoba conducted a national mapping & enumeration of key populations (SWs, MSMs. IDUs) in 2011. • UoM and UoN personnel sit on national technical working groups & advisory bodies – an active role in policy formulation & program planning. • Non-Canadian support from Gates Fdn, World Bank, UNAIDS & others

  13. Lessons learned • The collaboration has often been compared to a long-term marriage – there are good times, some bad times, and sometimes outside counselling is needed!! But the relationship continues because both partners recognise the value of the partnership and are committed to sustain it. • The collaboration has not just been about research. It is also about capacity-building in both directions: dozens of Kenyans have received training in Europe and Canada/USA and hundreds of Canadian graduates and undergraduates have received clinical training or carried out research in Kenya. Alumni of the Kenya program are now on faculty at med schools in Canada, USA & Europe and working for intl. health organisations.

  14. Lessons learned 2 • The collaboration has resulted in the establishment of new institutes and centres in the UoN: • Kenya AIDS Vaccine Initiative (KAVI) • Centre for HIV Prevention • UoN Institute for Tropical and Infectious Diseases (UNITID) • UoN Level 3 Enhanced Laboratories

  15. There continues to arise new research questions which inform the work to come • Reaching hard-to-reach populations – how to increase rates of testing and care-seeking • Greater involvement of men in HIV prevention. • Pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) in key populations – demonstration projects • Development of more efficient and effective prevention and treatment packages in an era of diminishing resources – allocative efficiency and cost-effectiveness studies. • Solving the mysteries of HIV resistance

  16. Asanteni sana – thank you very much

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