Moving beyond HIV
The Infectious Disease Institute (IDI) was established to build capacity to treat HIV/AIDS, and over the last ten years much has been accomplished. Now 70% of patients receive antiretroviral therapy (ART)1, and IDI has built capacity beyond its own four walls at its Outreach Clinics both in Greater Kampala and in six districts in Mid-Western Uganda and eight regional referral hospitals.
As the field of HIV research has matured, innovation is moving away from core first line treatment into newer areas including prevention of HIV transmission through male circumcision, prophylactic ART, and gels, all areas in which IDI conducts research.
However, as treatment for HIV improves and patients can live healthy, productive lives, complacency can creep in and an increase in risky behavior can undo the advances that have been made in reducing new HIV infections. Overall HIV prevalence in Uganda has been reduced from a high of 18.5% in 1992 to a stable 6.7% in 2011 through a concerted national response driven by strong policy2. However recent data2 show a worrying trend of a slight increase from 2006 to 2011 in HIV prevalence in young Ugandans aged 15 – 24, contrasting strongly with a decline in prevalence among the 25 - 34 age group. Are young Ugandans getting the message? IDI has set up a special weekly clinic for young HIV positive adults to foster peer-to-peer advice and communication about the risks.
IDI has matured into a specialized center of excellence for HIV treatment, and research today focuses on optimizing second line therapy; treating lethal complications of HIV including TB, malaria, cryptococcal meningitis and Kaposi’s Sarcoma; and studying drug-drug interactions. Every Tuesday morning before the IDI clinic opens, staff gather for a “Switch Meeting” to discuss individual patient cases that are failing first line therapy to reach consensus on optimal second line treatment. This week’s topic was patients who fast for religious reasons, both Christian and Muslim, and the impact this can have on adherence (compliance), the timely taking of ART medication. IDI is also running studies to understand the impact of taking anti-retroviral therapy (ART) with or without food in order to be able to provide patients with the best advice.
Ultimately as more advances are made, the field of HIV research and funding for HIV are narrowing. To sustain its research pipeline, IDI must look to broadening its focus to address other areas of public health concern in Uganda. A major part of my project will be to interview Principal Investigators and to mine clinical trial registries to scan the horizon for new, emerging and relevant areas of research for IDI.