John Donnelly interviews Dr. Gita Ramjee, the director of the South African Medical Research Council’s HIV prevention program.
Dr. Gita Ramjee is a world-renowned scientist specializing in HIV prevention, treatment, and care. Dr. Ramjee is the director of the South African Medical Research Council‘s HIV prevention program and has been involved in the clinical trials of microbicides for over a decade. She has been awarded one of the largest National Institutes of Health’s grants outside of the United States to conduct HIV prevention research. She now is overseeing another microbicide trial called the VOICE trial, which aims to confirm the recent success of CAPRISA 004 trial. The CAPRISA trial was the first proof-of-concept that a microbicide can protect women against HIV. It was supported by the US Agency for International Development.
John Donnelly interviewed Ramjee from South Africa. This is the second of five pieces on the importance of global health research and development that coincides with theGlobal Health Technologies Coalition‘s (GHTC) annual report, and GHTC’s May 3 Hill briefing.
Q: For many years, microbicide trials failed. How difficult was it to keep exploring new prospects for microbicides?
A: I think with every failure there was much disappointment, but there were so many new questions that arose out of each disappointment. Only recently, after 2007, we realized that a product non-specific to HIV was not going to work. So every unsuccessful outcome, there was a new lesson learned. Even if the products were not successful, we learned a lot in terms of how to do the research better.
Q: What do you mean by ‘non-specific’ to HIV?
A: With the earlier, non-specific products, there were some that destroyed the cell membrane of viruses and bacteria, and also destroyed the membrane of the vagina, for example. Now we are moving toward the antiretroviral (ARV) products that are highly specific to HIV.
Q: What are your expectations following the CAPRISA trial in finding a better result in other trials?
A: We are extremely hopeful. CAPRISA was a smaller study. This research needs to be confirmed. We are currently testing both an oral form of ARVs as well as a topical form. We are moving in the same direction now and should receive results in 2013. In addition, there is another South African study planned to confirm CAPRISA results.
Q: How important was US funding in keeping the microbicide research alive?
A: To date, we have received most of the funding from United States and some from the United Kingdom. We wouldn’t have been able to do the work without US-funded scientific research. It also helped us build scientific capacity to do the work. The funding assisted us in providing scientific capacity for young researchers to conduct clinical research. Through the US-funded research, we were able to provide a high standard of care to women participants. This had a huge public health impact.
A lot of times people think research is just research. But they don’t understand there is an enormous amount of public health benefit to it. In our case, many, many women were getting access to a high level of care which they wouldn’t have otherwise.
Q: It cannot be a simple decision for women to participate in these trials. What are the different motivations to do so?
A: It depends on the country. In South Africa, every other woman is at risk of getting infected with HIV. It’s a generalized epidemic. In India, it’s a highly targeted group with HIV, mostly sex workers. So I think for us to conduct large-scale clinical trials in Africa, I hope the motivation for women to participate is primarily because women want to contribute toward finding a solution for HIV prevention, especially for women. I think the motivation is that the next generation of women would be HIV-free. The second thing is that participating in clinical trials is quite lucrative in a way. We give women 150 Rand (about $20) for every visit. I don’t think we can completely ignore the monetary incentive for participants. But based on what we know there is a lot of altruism in wanting to find a product that works for HIV prevention.
Q: How much is South Africa contributing to microbicide research?
A: Most of the research is being funded by the United States. Post-CAPRISA results, there is now a lot of enthusiasm from the local Department of Health and the Departments of Science and Technology and there is a move toward a public-private partnership, together with our US partners. In addition there is some funding from the South African government for the FACTS trial, in which a consortium of South African scientists are trying to come together to confirm the CAPRISA trial, which was initiated and conducted in South Africa.
There is a lot of enthusiasm and not the negativity there had been in the past. Remember, we have a new government now, a new Department of Health, a new Minister, a new Ministry of Health, and that has made a huge difference in support for HIV prevention research. At last the scientists, advocates, and health ministries are working together.