20 years of HIV/AIDS research in Uganda
2 February 2010
On the twentieth anniversary of the Medical Research Council’s (MRC) research unit’s presence in Uganda, Director Heiner Grosskurth looks back on the changing landscape of research into HIV/AIDS at the commemorative scientific symposium in Entebbe today. With Uganda often heralded as a model in Africa for fighting the disease, Professor Grosskurth reflects on how Uganda dramatically halved the prevalence of HIV/AIDS over this timeframe and describes the contribution made by medical research.
The first clinical diagnosis of AIDS in Uganda, known locally as the ‘slim disease’ because of its severe wasting effect, occurred in 1982. By the late 1980s, Uganda was immersed in an HIV/AIDS epidemic. It was one of the first countries in Sub Saharan Africa to experience the devastating impact of the disease, which affected up to 30 per cent of the Ugandan population in some areas. It was in this context that the MRC responded to Ugandan calls for research support in 1988.
Integrating with the Uganda Virus Research Institute (UVRI) one year later, the MRC/UVRI Uganda Research Unit on AIDS (MRC/UVRI) has tackled questions about the prevention, spread and treatment of the disease to support the Ugandan Government in its fight to keep the epidemic under control.
Today the multidisciplinary research undertaken at the unit reflects the wide-ranging nature of the problems caused by HIV. Activities range from virology and immunology to social science, clinical studies and intervention trials, all underpinned by strong epidemiological, statistical, laboratory and administrative support. According to a nationwide survey conducted by the National AIDS Control Programme of Uganda, HIV prevalence in Uganda has fallen to approximately 6.2 per cent amongst adults.
Professor Heiner Grosskurth, Director of MRC/UVRI unit, said: “This remarkable 20 year collaboration between the MRC and the Ugandan Government has made a tremendous contribution to the body of knowledge on HIV and AIDS, and to the development of effective strategies in preventing and treating HIV infection. Our work to understand and control the epidemic needs continued support not just from the MRC and the UK and Ugandan Governments but from wider stakeholders and donors. Thousands of Ugandan people are alive today because of the research that goes on here. We are proud to have made a major contribution to public health in Uganda, which would not have been possible without powerful national and international partnerships, outstanding staff and strong community support.”
Sir Leszek Borysiewicz, Chief Executive of the UK Medical Research Council said: “Global health research is at the heart of MRC strategy. We know building sustainable research networks can accelerate progress in international health research. The MRC/UVRI unit in Uganda is a shining example of what can be achieved through collaborative working, taking medical research right through from the lab bench to the patient’s bedside, improving the health and lifespan of millions. It is valuable relationships with the university, Ugandan Government and the healthcare service that has enabled the unit to be such a success.”
The British High Commissioner, Mr Martin Shearman said: "The UK Government has been collaborating closely and highly successfully with the Ugandan Government for the last two decades in the field of HIV/AIDS research, as in many other areas. We are proud of the contributions that scientists from the MRC/UVRI Uganda Research Unit have made over time. While there have been huge advances in the field of HIV prevention and care, the challenge that this health problem poses is still growing for both our countries. In recognition of this challenge, the Government of Uganda and the UK Government renewed their Memorandum of Understanding in 2009 to reaffirm our collaboration and support for at least the next 10 years. We wish the unit of the Medical Research Council at the Uganda Virus Research Institute the very best in its important work.”
The Director of Clinical and Community Health Services at the Ministry of Health, Dr Nathan Kenya-Mugisha said: “Uganda has been highly successful in reducing the spread of the HIV epidemic in the country and in improving the care for people with HIV/AIDS. This success has been the result of the collaborative efforts of the Ministry of Health and many partners who worked together with the Ugandan Government over the last two decades on this important health problem. We are very grateful to the UK Government for its support in the field of medical research through the MRC/UVRI Unit. We congratulate the scientists at MRC/UVRI to the successful completion of their studies, many of which are contributing to policy formulation in the response to HIV/AIDS in Uganda. We also gratefully recognise the major contributions to the health care infrastructure and the delivery of health care that the MRC/UVRI Uganda Unit has made in the areas of its operations. We are looking forward to continuing this collaboration and wish the team a successful continuation of their work”.
Landmark medical research
Agatha is 81 years old and from the Masaka district. She and her family have participated in the MRC General Population Cohort since 1989. Agatha’s family has lost 18 children to AIDS over the past 17 years. When we asked for her permission to share her story, she said: "Yes, please share it so that the world can see how people like me survive despite the problems we face and that we still have hope.”
It is for people such as Agatha and her family and millions of others in Africa that the MRC/UVRI Uganda Research Unit has been conducting research over the last 20 years, looking for solutions in prevention and care. A selection of landmark medical research studies and trials in the history of MRC/UVRI in Uganda include: Tracking the spread of HIV, vaccine trials, cryptococcal disease prophylaxis trial, Development of antiretroviral therapy for Africa (DART) trial and the Jinja ART roll out trial.
Capacity building and support for healthcare and infrastructure
Apart from its mission in research, the unit has been highly successful in its effort to strengthen the capacity for medical research in Uganda, through the training of medical students and young researchers and through its support to partner institutions. Importantly, the Unit has provided health care to thousands of patients and refurbished 8 health centres and a hospital in the Masaka and Wakiso districts.
All this successful work would not have been possible without strong partnerships and collaborative working with a number of Ugandan and international stakeholders.
ENDS
For interview requests and more information on the details of the landmark research, including collaborators, please contact please contact Grace Money, MRC Press office - Tel +44 (0)20 7637 6011 press.office@headoffice.mrc.ac.uk (UK) or David Walugembe +256 712 311 789 dwalugembe@iavi.or.ug (Uganda)
Notes to Editors
For almost 100 years the Medical Research Council has improved the health of people in the UK and around the world by supporting the highest quality science. The MRC invests in world-class scientists. It has produced 29 Nobel Prize winners and sustains a flourishing environment for internationally recognised research. The MRC focuses on making an impact and provides the financial muscle and scientific expertise behind medical breakthroughs, including one of the first antibiotics penicillin, the structure of DNA and the lethal link between smoking and cancer. Today MRC funded scientists tackle research into the major health challenges of the 21st century. www.mrc.ac.uk
The MRC/UVRI Uganda Research unit on AIDS is a Medical Research Council unit which was established following a request in 1988 from the Ugandan Government to the British Government for collaboration on the research of HIV infection and AIDS. The unit, originally named the MRC/UVRI Programme on AIDS in Uganda, is integrated into the Uganda Virus Research Institute (UVRI). The unit is predominantly funded by Medical Research Council and the Department of International Development (DFID) of the United Kingdom. www.mrcuganda.org
The Uganda Virus Research Institute (UVRI), located in Entebbe, was established in 1936. In 1977, it became a Ugandan Government public health research institution. The Government of Uganda now administers and funds the Institute through the Uganda National Health Research Organization (UNHRO) which is an umbrella research body with in the Uganda Ministry of Health. The mission of the institute is to carry out scientific research on communicable diseases, especially viral diseases of public health importance and to advise the government on strategies for their control and prevention. The Institute was the first to isolate more than 20 new arboviruses, including West Nile Virus and Semliki Forest Virus. In recent years the Institute and its partner institutions including the MRC/UVRI Uganda Research Unit on AIDS, have become a world-class centre for the research on HIV infection, and play a large role in coordinating and administering clinical trials, including trials of potential HIV vaccines.
Landmark medical research studies in the history of MRC/UVRI in Uganda
Tracking the spread of HIV
In a surveillance area in South West Uganda, the MRC/UVRI Unit has been documenting the course of the HIV epidemic and its drivers it for 20 years. During the 1990ies, this project demonstrated for the first time that at the population level the number of new infections per year was declining in Uganda. This observation helped to provide the evidence based on which Uganda has been hailed for turning the course of the epidemic. Data from the same project showed recently that the epidemic may be on the rise again; leading to renewed strong efforts by the National AIDS Control Programme to accelerate HIV prevention.
Vaccine trials
In 1999 the MRC/UVRI unit collaborated on the first ever HIV vaccine trial in Africa - the first of many trials to come. Whilst a highly effective AIDS vaccine has still not been identified, MRC/UVRI and its partners have made giant strides in understanding how such a vaccine might be designed.
Cryptococcal disease prophylaxis trial
An MRC/ UVRI trial in Uganda showed the most common disease of the central nervous system in HIV infected African people could be prevented with a pill. Around 10 per cent of HIV positive people in Africa are affected by cryptococcal disease and about half of those people die from it. An MRC trial helped to show that HIV positive people are far less likely to get the deadly disease if they take a regular dose of the medicine Fluconazole, an inexpensive drug which is safe to take.
Developing Antiretroviral Therapy for Africa (DART) trial
MRC/ UVRI researchers from Uganda contributed to a major advance in understanding HIV treatment which could see life-saving drugs extended to more than one million extra people at no additional cost. They found that routine laboratory testing of blood for signs of drug side-effects – long regarded as essential for HIV treatment – is unnecessary. By abandoning routine laboratory testing, which is costly and requires sophisticated equipment only available in hospitals, the money saved could be used to buy and distribute extra anti-retroviral drugs.
JINJA ART Roll Out trial
MRC Ugandan scientists helped to show that vital HIV anti-retroviral (ARV) drugs can be given by trained and supervised lay health workers to patients in their homes, just as effectively as ARV treatment through health centres but significantly cheaper. This could dramatically increase access to these drugs, particularly in areas with limited health clinics and a shortage of doctors and nursing staff.
