Rakai Health Sciences Program (RHSP) Uganda

1988-2011

Population-based Research on HIV, other Infectious Diseases, Reproductive Health and

Service delivery

Current studies and services

Research studies

•RCCS and nested studies

•Circum and related studies

•Acyclovir prophylaxis in HIV-1/HSV-2 co-infected patients

•Rakai Youth Project

•Malaria-Home and facility based surveillance

•Other lab-based studies

Services alongside research

•HIV/AIDS care and treatment •HIV Pre-ARV•HIV antiretroviral therapy•pMTCT

•General Health Care (Mobile & static)

•Male circum roll out and training

• Health Education

• Voluntary HIV testing and counseling

RHSP HIV/AIDS Care Program

• Since June 2004 has provided HIV/AIDS Care to approximately 5600 clients

• Enrollment through RCCS and Walk-in until 2008

• Until January 2011 all clients received CD4 and HIV VL monitoring every 6 months, now performed annually due to budget issues

• Clinical and laboratory data maintained in database at RHSP headquarters

HIV/AIDS Care (ARV) Numbers

  Adults children TotalEver Pre-ART 5364 400 5364

Currently Pre-ART 2503 217 2720

Ever started on ART 2582 176 2758       Currently on ART 2305 163 2468 Lost to follow-up 62 5 67

Dead 215 8 223

Home Based Malaria Surveillance

• Funded by Division of Intramural Research, NIAID/NIH

• Active home based monthly surveillance of 360 households, approximately 1700 individuals in 2 Rakai communities

• Focus on malaria rates among children (6 months-10 years) and adult caregivers

• Initiated April 2011

Home-based Malaria Progress

• Two communities from each of 2 clusters– 2 high and 2 low malaria endemic communities

• Enrollment completed in 40 homes

• 152 Adult and children clients so far enrolled

• Rapid diagnostic testing done on all febrile participants to determine immediate need for treatment, blood smear done on all participants

IeDEA Facility Based Malaria Study

• Objectives• To estimate the proportion of febrile illnesses (body

temperature >=380c) with malaria parasites on a blood smear among all patients presenting to outpatient clinic at Kalisizo hospital

• To estimate the prevalence, presentation, and treatment outcomes of severe malaria amongst HIV-infected and uninfected children aged <5 years admitted to Kalisizo and Bikira hospitals in Rakai district, Uganda.

IeDEA Facility Based Malaria Study

• Retrospective review of all lab records at 2 health facilities to answer first objective

• Prospective enrollment of 3000 children less than 5 years and the same facilities to measure the prevalence of outpatient malaria, presentation and outcomes

• Planned to start enrollment week of May 9th 2011

IeDEA Facility Based Malaria Study Progress

• All IRB approvals (UVRI-SEC, UNCST & WIRB-Indiana) obtained and on file

• 4 Lab techs trained in Kisumu; to re-train in few months

• Protocol discussion & training with facility staff & RHSP

• GCP training for facility based staff in April 2011

• HSP re-training for all staff on IeDEA

• Supplies delivered to facilities

• Enrollment to start Monday May 16th 2011

IeDEA Facility Based Malaria Study Challenges

• Facility based staff transferred frequently – requires training and re-training

• Poor record keeping– Introduced and trained methods of records management

The Rakai Community Cohort is the Rakai Program core

Randomized Trials-STD control for HIV prevention -STD control to improve pregnancy outcomes- Male circ for HIVI prevention in men- Male circ for HIV prevention in women partners - HSV-2 suppression for HIV progression

Operations research-P-MTCT, condoms, ABC, VCT, cervical cancer prevention, ART/HIV care provision, family planning, adolescent health, prevention of intimate partner violence

Observational research (Quantitive / Qualitative)- HIV epi and demographic trends- Risk factors and behaviors - Service uptake and effects (ART, condoms, VCT)- Circumcision- STIs, OIs, malaria - Social (Intimate partner violence, alcohol use)- Ethics research …. And many more

Time trend analyses

Basic science- HIV subtypes, genomics, immunology, microbiology, pathology, histoimmunochemistry,

Molecular epi- HIV transmission dynamics, ART resistance, HSV-2, HHV-8,

Clinical care-OIs, TB-ARVs-STD treatment-General Hlth careC

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Training- Uganda- USA, International