EXPERTS TO REPORT ON ADVANCES IN THE SEARCH FOR THE ULTIMATE HIV PREVENTION TOOL - A VACCINE - AT AIDS VACCINE 2013

Progress, Partnership and Perseverance is the Theme of the Leading Global Conference on HIV Vaccine Research

(NEW YORK, NEW YORK and BARCELONA, SPAIN) - More than 450 research studies outlining the latest advances and obstacles in the search for an AIDS vaccine will be presented and debated at AIDS Vaccine 2013, the world's only scientific meeting dedicated exclusively to HIV vaccine research. The conference, which runs Monday, 7 October through Thursday, 10 October, will bring more than 1,000 of the world's leading vaccine researchers, funders and policy makers to the International Convention Center in Barcelona, Spain for four days of exchange, debate and direction-setting for the field.

AIDS Vaccine 2013 is organized by the Global HIV Vaccine Enterprise and by this year's local conference hosts, the HIVACAT Program for HIV Vaccine Research,based in Barcelona.

A vaccine that could help to stop the global HIV/AIDS epidemic is one of the most-sought-after goals of modern scientific research, and among the most complex scientific challenges ever undertaken.  Researchers meeting at AIDS Vaccine 2013 will report on several recent advances in the field, including:

• Progress in the study of several candidate vaccines being tested globally;
• Updates on strategies to better understand and increase the modest protection observed in the RV144 trial, the first study to reduce HIV infection risk through vaccination; This HIV vaccine clinical trial started in Thailand in 2003 and the first results were presented in 2009, showing modest protection from HIV infection;
• Advances in efforts to engineer immunogens capable of inducing the neutralizing antibodies that could form the basis of future vaccine candidates; and
• Novel vaccination strategies being investigated in non-human primates.

AIDS Vaccine 2013 opens as the field is also working to learn the lessons from studies such as HVTN 505, a phase 2b clinical trial stopped earlier this year when the vaccine tested was found to be ineffective.  Researchers are studying the lessons of this and other trials to determine how to better predict complex immune responses that can help ensure protection against HIV infection.

"Progress, partnership and perseverance are the themes of this conference, and all three will be on display at AIDS Vaccine 2013," said Bill Snow, director of the Global HIV Vaccine Enterprise.  "As we meet in Barcelona, huge strides are being made in efforts to understand and replicate the development of broadly neutralizing antibodies, which could be the basis for powerful new vaccine candidates.  We are also seeing a flowering of cross-disciplinary and cross-institutional collaborations in vaccine research, as well as surprising new findings from individual labs and sophisticated animal studies."

“Transforming advances in the lab into vaccine candidates for clinical trials will be high on the list of priorities for researchers, funders and policy makers meeting in Barcelona,” noted conference co-chair, Bonaventura Clotet, M.D. of the Institute for AIDS Research IrsiCaixa and codirector of the HIVACAT Program for HIV Vaccine Research.  

“Our ultimate challenge is to develop a vaccine that is not only safe and effective against HIV, but also practical in real world settings.”

"AIDS Vaccine 2013 will feature more than 450 research presentations selected from a record number of abstracts," said conference co-chair, Josep M. Gatell, M.D., Ph.D., of the Hospital Clínic-IDIBAPS, University of Barcelona and codirector of the HIVACAT Program for HIV Vaccine Research.  

"The vibrancy of the field is demonstrated not only by the volume of outstanding research to be presented, but also by the fact that more than 50 percent of conference presentations will highlight the research of the young and early-career investigators, whose energy and new ideas represent the future of HIV vaccine science."

Among the additions to this year's conference program are a symposium session on therapeutic vaccines, and an additional plenary session with updates on the latest HIV vaccine clinical trial results, including HVTN 505. 

  

The conference opening session, on Monday 7 October, will elaborate on the Progress, Partnership and Perseverance theme with presentations from Anthony Fauci of the U.S. National Institutes of Health, the world's largest funder of AIDS vaccine research; vaccine development pioneer Stanley Plotkin; AIDS vaccine study, HVTN 505, Principal Investigator Magda Sobiesczcyk; Ntando Yola of the Networking HIV/AIDS Community of South Africa (NACOSA), a South African civil society network; Bill Snow of the Global HIV Vaccine Enterprise, a collaborative of the world's leading HIV vaccine researchers and funders; HIVACAT codirectors Josep M. Gatell and Bonaventura Clotet; Catalonia Minister of Health, Boi Ruiz i Garcia; and Enric Banda, director of Science, Research and the Environment of the vaccine research funder "la Caixa" Foundation.

"AIDS Vaccine 2013 presents a critical opportunity to highlight Spain's commitment to HIV vaccine research," said Christian Brander, Ph.D., scientific director of the HIVACAT Program and ICREA Research Professor at IrsiCaixa. 

 "Advances in HIV prevention, including the use of antiretroviral drugs to reduce transmission and infection, expanded access to voluntary medical male circumcision and promising research on microbicides to prevent infection in women and men are all contributing to important decreases in new infections.  At the same time, a safe and effective vaccine remains the key missing piece in efforts to drive down new HIV infections

worldwide and control the pandemic."

The growing interconnection among various biomedical approaches to HIV prevention has brought leaders in different research fields together to establish a new, unified HIV prevention research conference beginning in 2014.  Building on the tradition of the annual HIV vaccine and microbicide research meetings, the new biennial conference, HIV Research for Prevention: Vaccine, Microbicide and ARV-based Prevention Science (HIV R4P) (Cape Town, South Africa, 28-31 October 2014), will bring together the full spectrum of biomedical HIV prevention research.

"HIV R4P will promote the cross-fertilization of research and synergies in HIV prevention strategies that can lead to significant, ongoing reductions in the global epidemic," said Robin Shattock, professor of Mucosal Infection and Immunity, Imperial College, London. 

"The new HIV R4P conference will help ensure that all of the potential synergies in research and implementation between different prevention approaches, including vaccine research, are fully explored in a format that will draw global attention to the promise of both new and established approaches to HIV prevention."

Facebook and Twitter
Conference participants will keep up with what is happening at AIDS Vaccine 2013 and share their updates with the broader community through Facebook @HIVEnterprise and Twitter, #AIDSVax2013, as well as through the Twitter accounts of two of HIVACAT's leading institutions: @IrsiCaixa and @IDIBAPS_EN

 

 

Mulago hospital in crisis of nurses, senior consultants

Patients, care takers, visitors, staff and non staff jostle for corridor space within Mulago Hospital impatient to get to their next destination. Time at Uganda’s largest referral hospital waits for no man because every day, more than 1000 patients are pouring in.

The emergency paediatric unit alone receives 200 patients daily whereas the Uganda Heart Institute (UHI) receives about 100 patients daily. The labour suite (5C) receives between 80 and 100 expectant mothers and of these, 35 need caesarean section. When I visited the ward, some women were sited on laid out lesus on the floor because the wards 20 beds were full. 

Women waiting to deliver at Mulago's labour suite

“There is a lot of advocacy ending in nothing because congestion and limited monitoring are still big challenges in the suite. There is need to address human resource challenges, skills and equipment,” Dr Eva Nakabembe, a gynaecologist said.

Dr Eva checks the health of a pregnant woman

Meanwhile, three to 10 children are received daily at the Mwana Mugimu clinic depending on the season.

The overwhelming number of patients is a great challenge to the hospital which is in need of 946 approved nurses. Dr Byarugaba Baterana, the hospital’s executive director says there are only 882 nurses currently.

In the Emergency pediatric unit, there are only four nurses per duty instead of the required eight.

“At night, there needs to be at least five nurses on duty but there are usually three and yet they have to handle 80 patients,” Dr Opika Opoka, the head of the unit told the observer in an interview.

The crisis is similar to what is in the Mwana Mugimu clinic where there are only 11 qualified nurses of the needed 25.

“There is a lot of work to do such as preparing therapeutic foods and feeding the children every two hours which cannot be done by only 11 nurses,” Sr. Julian Eyotaru, the incharge of Mwana Mugimu said.

At the Uganda Cancer Institute (UCI), more than double of the 52 nurses currently available is needed. This is because of the large number of in and outpatients the institute receives. Dr Jackson Orem, the director of the institute says that at any one time, the institute handles about 4000 patients.

Last year alone, UCI saw more than 34000 visits.

Human resource challenges;

Dr Byarugaba says there is need for government to recruit new senior consultants and increase their salary. Mulago hospital has only 30 and 15 more are needed.

“Although they are among the highly paid civil servants earning about Shs 2.1m, this is not commensurate with the number of years spent in school. They need at least Shs. 15m,” he said in an interview.

He adds that nurses should be paid at least Shs 530,000 a month.

The hospital has an approved structure of 2166 positions of which 1877 are currently occupied. It is only the medical officers that are full. Two senior medical officers and 283 health workers are lacking and more neurosurgeons, biomedical engineers and pharmacists are needed.

Dr John Omagino the head of the Uganda Heart Institute (UHI) attributes the shortage of human resource at the institute to the existing narrow structure.

“The structure does not allow for a mix of diverse skills and yet to carry out any operation, one needs these,” he says.

There is 192 staff (30 percent) at the institute currently and yet this is still below the bar. Dr Omagino says that the institute management is in the process of contracting other staff to bring the numbers to at least 60 percent

A child and his mother at the Mwana Mugimu clinic where he is being treated for malnutrition

He adds that there is need for government to recognize different specialities by approving them on the structure and their associated terms in order to enable management to attract retain and plan a decent exit. To have these, he urges on the need to build training capacity.

“As a country, we do not have facilities for training these specialists and are instead, we are sending them out at a very high cost. What we need is to build local capacity,” Dr Omagino urged.

Although UCI has 10 operating specialists currently compared to five that were there in previous years, Dr Orem says that it needs more than 100 specialists.

Dr Byarugaba attributes the challenges of inadequate human resource to the fact that Mulago Hospital is over centralized.

“The hospital is non-autonomous and because of over centralization, the appointed structure has no existent directorates with appointed heads,” he said.

Byarugaba adds that the hospital’s relationship with Makerere University is also not defined.

New developments;

Despite these challenges, new developments to upgrade the hospital have been made and others are underway. For example 40 CCTV cameras and electronic display boards have been installed within the hospital to beef up security.

Planned projects include construction of 100 units of staff houses and construction of a fully fledged women’s hospital.

Health Centre turned into furniture store

Past the moving faces of kobs, lions, warthogs and elephants scattered throughout Queen Elizabeth National park in Kasese District, one cannot miss a signpost showing Kahendero landing site.

The narrow winding road leading there is just one of the many indicators of a community disconnected from the world. The other is Kahendero Health Centre II. Located 10KM off Kasese main road, it stands out as a two roomed building bolted with dark grey padlocks. There is nothing to warn a visitor that that the five year old health centre is now a furniture store.

Kahendero Health Centre II on the outside

It has been this way since its construction in 2008 according to the fishing community here.  

“Can you imagine we even close it with padlocks because it is now a store for people’s building materials and furniture!” ranted Musa Lukwago the chairman of the beach management unit of Kahendero village. 

The meant to be consulation room is now a store for furniture and plastic chairs

On the inside, stains of yellow paint severely scratched off the walls hint at the centre’s first beauty. Cobwebs cover the corners of the doors leading to the meant to be consultancy and treatment rooms. Dust swirled around the room as I made my way inside jumping over plastic blue chairs and iron sheets. The meant to be medicine cabin lay shattered on the floor and a loser look revealed unused garden forks and hoes.

The only hospital bed available carries wood plunks. Residents testify that the centre cost Shs 12m to construct.

For the over 4000 people living in this site, access to medicine and medical care is a far cry.

“When we become sick, we either have to go to Kagondo, Kilembe or Kasese hospitals that are about 13, 14 and 11 kilometres away. Many are reluctant to seek medical help because of limited transport,” Rehema Hakim, a village health team volunteer said.

She adds that Antiretroviral and anti-malarial drugs are most needed in this community because of the high prevalence levels of HIV/Aids and malaria. According to her statistics as of press time, 101 women and 60 men are living with HIV. A 2012 study conducted by the Uganda Fisheries and Fish conservation Association (UFFCA) revealed that HIV prevalence among fishing communities around Lake George and Edward increased to 22% compared to 19% in 2011.

Transactional sex was reported to be very common and the payment methods took various forms including fish for sex, shoes and alcohol and the overall mean age for the first sexual debut was 13 years. This prevalence is higher among the females because of multiple sexual partners-with one respondent mentioning 12 partners and only 13% of the 468 respondents used a condom every time they are going to have sex.

“Some of the reasons given for non condom use include lack of time, compromised sexual pleasure for both parties, no receptacle for disposal and their non acceptability in ritual sex,” the report findings read.

Hakim however says the complacency of Aids being another disease has settled in among the population so much so that some; especially men do not want to get treatment.

Three men have succumbed to HIV since the beginning of this year.

The treatment room being used as a store for wood plunks and iron sheets

“Lack of access to services and traditional social support networks in fishing villages means that people living with HIV who are too ill to work have to keep at their homes. This has implications for the spread of HIV and increases the number of people experiencing the impact of Aids,” Seremos Kamuturaki, the executive director of UFFCA said.

He urges government to establish a functional, well equipped and staffed health facility in Kahendero village. Another appeal is for government to economically empower the communities with other means of livelihood to avoid problems related to transactional sex.