HIV vaccine: Scientists call for patience as research continues

Days after the most awaited HIV vaccine clinical trials was stopped, researchers say that there is still hope to get another a vaccine which will prevent HIV infection.
“The recent withdrawal a HIV vaccine, HVTN 702, clinical trial is not the end of finding an effective preventive HIV,” two scientists recently told us at a science media café called by the Media for Environment, Science, Health and Agriculture (MESHA).

Dr. Kundai Chinyenze, Executive Medical Director, International Aids Vaccine Initiative (IAVI), clarified that the HVTN 702 vaccine, also known as Uhambo, was stopped due to its inefficiency in preventing HIV infection.
As journalists, we had somehow become enchanted by this news which we had received a few days earlier. We did actually think that scientists were still on it but were not very sure what researches were going on around us.
In her address to us, together with her colleague, Prof Omu Anzala of KAVI and University of Nairobi,
Dr. Chinyenze dispelled any fears in us in regards to the stopped vaccine clarifying that the study posed no safety concerns to the volunteers who were under trial.
She said that even though HTVN 702 study had failed and disappointed not only researchers but also donors and the community who had hopes in its success, there are a number of other HIV vaccines under trial and scientists are still working tirelessly towards developing vaccines in a bid to find a solution in curbing the infectious disease.
“As much as it is disappointing to have lost money and time, the HVTN 702 was just one among many other HIV vaccine trials that scientists have been working on and so this does not mean that it is the end of vaccine trials,” added Dr. Chinyenze. She observed that there are novel vaccines that have different mechanisms of action that are in earlier phases of testing.
Prof. Omu Anzala of KAVI and the Institute of Clinical Research (ICR) based at the University of Nairobi mentioned that they have learnt a lot following the failed vaccine in South Africa and that here in Kenya, they at KAVI in collaboration with partners in USA and Canada are working on Antibody Mediated Prevention (AMP) study and HVTN 706, also known as Mosaic.
“We scientists are still in pursuit of a safe and globally effective preventive HIV vaccine and other global efforts underway include HVTN 703 and HVTN 704 and HVTN 705 also known as Imbokodo, whose results are expected later this year 2020,” Prof. Anzala said, adding that there is no need to give up on ever finding an AIDS vaccine.
He however lamented over decline in funding towards research on HIV but was quick to state that this will not stop any efforts they are putting forward in finding a safe and effective safe vaccine.
“As we await an effective vaccine, we must understand the epidemic and establish a tool which will help in finding out who are getting infected and reach out to them,” he observed.

“People who are at risk of HIV infection should make use of PrEP and everyone should embrace test and treat as prevention measures to avoid new infections and spread of the virus – patients who are already positive must adhere to treatment,” said Prof Anzala.
That national Institute of off Allergy and Infectious diseases (NIAID) on February 3, 2020 stopped administration of HVTN 702 vaccine after Independent Data and Safety Monitoring Board (DSMB) found that it was not effective.
The HVTN 702 study funded at USD 130 million was launched in 2016 and it enrolled 5,407 HIV negative volunteers at 14 sites across South Africa. The volunteers randomly received six injections of the investigational vaccine or placebo for over 18 months.



Researcher: Include more women in health research

A researcher at Kisumu’s Kenya Medical Research Institute has challenged the media to include more women voices in their stories.
While speaking at the MESHA 14th Media Science Cafe held alongside the Third Kenya Science Journalists Congress 2019 in Mombasa last week, the expert
told the media to stop angling women issues negatively to the detriment of the fight against HIV and for improving reproductive health outcomes.

Dr Maricianah Onono added that at this age, it is self-defeating for the media to continue vilifying unmarried adolescents 18 years and under who
take contraceptives and instead they should put women at the centre while reporting on HIV and Family Planning.

Women, she noted, are often underrepresented in clinical trials on HIV infections, something the media should highlight so that designers of research studies bring more women on board at the planning stages. This comment was made as a follow up to a recent drug known as Descovoy which will be licensed as a PrEP that can only be used by men and transgenders. Despite women being with higher risk of getting HIV, they were not included in the study done by Gilead.

The expert said that only 8.3% of participants enrolled in HIV cure studies are women. This she observed, calls for women to be at the table to plan trials to ensure more women are enrolled in the studies.

Dr Onono went on to observe that there is need to mobilize stakeholders within and beyond the health sector to help create awareness on HIV prevalence.
Finally, the researcher told journalists to report continuously about the need to include women and especially adolescent and young girls in HIV and Family Planning research.



Study: Traditional healers key to end mental health stigma

Traditional and primary health providers should be incorporated in policies to help reduce huge stigma that has been negatively affecting mental health patients in Kenya.

Previous studies on traditional healers’ involvement in the management of mental illness in Kenya found that most Kenyans trust the informal providers more to tackle mental health issues than hospitals, despite the former not having capacity for cure.

While most traditional health practitioners were willing to collaborate with hospitals to refer patients, their input is always ignored.

Ms Judy Baariu, the Mental Health Assistant Research Officer under Difu Simo project at the facility says traditional healers can play a big role

in identifying and referring mental health patients to health facilities.

Difu Simo, is derived from Giriama language that meaning breaking free.

The project involves engaging in public awareness campaign and participation in schools and meetings (barazas) to help improve knowledge and end stigma associated with mental illnesses.

Encouraging dialogue between health care providers and traditional healers would go a long way in ensuring optimization of care for mental illnesses as traditional healers can play a big role in identifying patients with mental illnesses and referring them to seek health care. This is because most patients may prefer them more mostly fueled by cultural beliefs and myths about causes of mental illnesses,” Ms Baariu said.

At KEMRI Wellcome Trust’s Neurology and Epilepsy Clinic in Kilifi town, mental health patients get free treatment drawn from across coastal counties as explained by Gilbert Katana, a clinical officer.

“Most patients first stop are traditional healers and prayers as they believe mental health sickness and epilepsy are caused by witchcraft, ghosts and jealous neighbours which is not the case,” Katana said.

The two were speaking to journalists drawn from the Media for Environment, Science, Health and Agriculture (Mesha) who visited the facility as part of the delegation attending the Third Kenya Science Journalists Congress in Mombasa.

A research ‘Priority mental, neurological and substance use disorders in rural Kenya: Traditional health practitioners’ and primary health care workers’ perspectives,’ by Mary Bitta and others done at the facility in Kilifi area, support the experts views. The research was done between February and April 2018.

“Optimizing treatment and care for people with mental health requires utilization of all available resources within a health care system,” the report stated after analyzing eight focus groups of primary, traditional health practitioners and faith healers.

The World Health Organization’s Mental Health Gap Action Program (mhGAP) noted that over 75 per cent of people with mental sickness live in low and middle-income countries where the informal group forms major step of care givers.

“Most patients seek services when their condition is severe after taking longer at traditional healer ,” Katana said.

Makao, a 56-year-old traditional healer said most of them are willing to refer patients to hospitals.

“I will give you my medication for 3 days and if there is no improvement on the fourth day, then you have to go to hospital,” Makao said.

Mental illness is a manageable condition and can be treated on time when symptoms are detected early and traditional healers are incorporated on time, the research states.

“When you get unprovoked seizure several times within 24 hours or suffer from depression the best cure is seeking medical help. Most extreme cases of suicide can be treated on time,” added Katana.



Drug under test brings hope for sickle cell in Africa

A drug, known as hydroxyurea, currently under clinical trials in four African countries may be the panacea for prolonging lives of sickle cell patients, an expert has said.

According to Mr George Muchama of KEMRI-Wellcome Trust programme at Kilifi Referral Hospital in Kenya’s Kilifi County the drug has been on trial in Kenya, Uganda, Democratic Republic of Congo and Angola for the past four years. The clinical trials are expected to be concluded in 14 years’ time. Specifically, the clinical trials seek to investigate the safety of hydroxyurea as a supportive treatment in children with sickle cell disease.

Scientists, he said, are hopeful that if successful, lives of persons with sickle cell will be prolonged under good management and patient care with the help of the drug.

They added that the success of the study will also lead to a larger trial that will inform national management policies for all children born with sickle cell anaemia in Africa, Kenya included.

Even though the drug has been effective in other parts of the world like Europe, no trials of hydroxyurea have been conducted in Africa where the safety and effectiveness of the drug remain unknown.

Muchama said the situation might be different in Africa and therefore the clinical trials are aimed at assessing the effectiveness of the drugs and also its safety among users in the continent. Reports from the trials team indicate that the drug which makes the body to produce foetal heamoglobin which neutralizes sickle cell has shown substantial progress in the management of the condition.

So far, 150 children at the referral facility have shown some signs of improvement, an indication that the drug is likely to work in the region.

He said they are optimistic that the drug will be effective at the end of the trials; something he said will be a breakthrough in the fight against the disease in the region.

The sickle cell disease specialist however said the affordability of the drug may stifle its uptake by the patients especially those from poor families. One single tablet of the drugs cost Ksh.40 (USD0.4) and those with sickle cell diseases should use at least two tablets daily at a cost of Ksh Ksh.80 (USD0.8).

Even though the trials show positive progress, Mr. Muchama said preventing inheritance of the disease remains a key challenge.

He said every couple getting married should undergo a test to determine whether both of them have sickle cell disease, and in cases where they are found to have it, seek for advice before they sire a child together.

Mr. Muchama said a child can only get sickle cell if both parents have the sickle genes and one partner has the sickle cell gene with the other partners is a carrier a condition known as Thelassemania trait.

Currently, stem cell transplant remains the only cure for sickle cell disease. However experts say it can easily lead to death besides being very expensive. The entire treatment costs approximately Ksh.10 million (USD100,000). Chances of the patient surviving are also limited.

Currently, nearly 90 percent of sickle cell patients succumb to the disease before they celebrate their fifth birthday in sub-Saharan Africa, according to a report by the World Health Organization.

The WHO survey done in collaboration with Kenya’s Masinde Muliro University in 2018 reveals that Western Kenya and Coastal regions account for 30 percent and 20 percent cases of sickle cell disease respectively.

How Hydroxyurea works

Sickle cell anemia is a disease in which abnormal hemoglobin protein causes the body to produce sickle- or crescent-shaped red blood cells. These cells have short lives compared to healthy, round red blood cells. The presence of sickle cells is linked to anemia — a condition where the blood cannot carry enough oxygen to the rest of the body.

Hydroxyurea is a medicine that is used to treat certain types of cancer as well as to reduce the frequency of pain crises and the need for blood transfusions in patients with sickle cell anemia. Until recently, it was the only treatment option approved by the U.S. Food and Drug Administration (FDA) for the treatment of sickle cell anemia. In July 2017, the FDA also approved Endari to treat the disease.

Hydroxyurea works by increasing the level of a special type of hemoglobin called hemoglobin F (HbF) in the body. HbF is found at high levels in early stages of development. Compared to the adult form of hemoglobin, HbF is more effective in binding and carrying oxygen around the body. The increase of HbF production stimulated by hydroxyurea prevents the symptoms of anemia from developing.



ECHO answers unresolved questions but opens Pandora’s box

In culmination of what has been a sore point of speculation for nearly three decades, it is now a matter of scientific evidence that women using the injectable contraceptive Depo-Provera, commonly known as Depo, are not more likely to acquire HIV than their counterparts using implant or the copper-T coil for contraception.

This finding is particularly important for countries in sub-Saharan African countries where Depo, a progestin-only injectable, is widely used and HIV rates are high.

The Evidence for Contraceptive Options and HIV Outcomes (ECHO) study, whose results were released on June 13, 2019 in Durban-South Africa, has provided solid evidence on how the three contraceptive methods stack up in relation to a woman’s risk of HIV acquisition.

 “The ECHO study was conducted because of conflicting data. Some observational studies had indicated that using certain hormonal contraceptive methods increased the risk of HIV acquisition. Other studies did not show any such correlation,” said Imeldah Wakhungu, ECHO study coordinator for the Kisumu site.

In 2017, the World Health Organization released a most telling pointer of how dominant these contradictions were by releasing guidelines summarizing that women at risk of HIV can use progestin-only injectable but that they should be informed of possible risk.

The significance of the ECHO study in putting to rest these fears that have dominated public health spaces for years cannot be overestimated. And what cannot be under-estimated is the Pandora’s box that the study has opened.

“ECHO provides the highest quality evidence because women need to know whether certain contraceptives place them at increased risk of acquiring HIV,” said Dr Nelly Mugo during the release of the results.

She explained that three contraceptives in the ECHO study are currently prioritized and are widely used for their efficacy and safety. Ultimately, the study sought to answer one primary public health question and three secondary ones.

“ECHO compared the risk of HIV acquisition by pitting three comparable contraceptives against each other.

Efficacy, safety and continuation or discontinuation were closely monitored,” Dr Mugo explained.

This study started in December 2015 and participants’ follow-up concluded in October 2018.

In the end, the study found that HIV incidence was very high across all three methods and that there was no substantial statistical difference in HIV acquisition across all three methods.

Of note, 397 women out of 7,829 who participated in the study aged 16 through 35 years acquired HIV during study follow up over a period of 18 months.

“This is significant because the women were not profiled for individual risk of HIV acquisition and were offered HIV prevention services including PrEP throughout the study,”

noted Dr Mugo.

The door has been opened for speculations that HIV interventions in Kenya, South Africa, Eswatini and Zambia where the 12 ECHO study sites were set up have failed to stop infections among young women.

Overall, fears are now rife that years of HIV control measures have not borne fruit where they are needed the most and there is a need to reevaluate where women’s risk for HIV exposure lies.

Other HIV experts have raised concerns that the study does not fully answer some key public health questions because it settled on an age group that has been documented for its vulnerability to HIV acquisition.

This vulnerability is based on age, gender and economic status.

Furthermore, this is the age group that is most active sexually.

At the landmark 2018 HIV Prevention, Care and Treatment Scientific Conference where hundreds of participants gathered in Nairobi for over four days, in September 2018, it is the failure to prevent new HIV infections among young women 15 to 24 years that particularly stood out.

At the time, Anthony Chazara, LVCT Health and Youth Programme made a statement that completely resonates with the ECHO study.

“When you talk about new HIV infections, these are people who are negative today and HIV positive tomorrow.

Young people account for about half of these new HIV infections and this is a worrying statistic,” he said.

Adding that: “More than half of all new HIV infections occur among adolescents and young people aged 15 to 24 years which is a sharp rise from 29 percent in 2013.”

In just 18 months, a study that started with 7,829 women testing negative for HIV culminated with 397 testing positive.

It is therefore a matter of scientific fact that young women continue to be disproportionally affected by HIV and that this is not limited to countries where the 12 ECHO sites were set up but across Africa.

Throughout Africa, research shows that HIV infections among young women are double or triple those of their male peers.

In Kenya alone, young women are almost twice as likely to acquire HIV compared to young men.

According to National AIDS and STI Control Programme (NASCOP), due to their vulnerability to HIV, young women 15 to 24 years account for 33 percent of the total number of new HIV infections.

In comparison, NASCOP statistics show that young men account for an estimated 16 percent of the new HIV infections.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, biological factors, limited access to health care, education and jobs, and health systems that do not address the needs of young people.

There is also the question of deepseated attitudes that young women have as well as their own perceptions of HIV risk. Surveys have shown that young women are still more fearful of an unplanned pregnancy than HIV.

These fears were astoundingly confirmed by the ECHO study which was summarily characterized by high sexually transmitted infections, high incidences of HIV, low condom uptake and notably low pregnancy rates. Reported pregnancies were mainly among women who had at some point discontinued assigned methods.


Millions to suffer from drug resistance globally by 2050

About 700,000 people die annually due to drug resistance globally and the number is expected to increase to 10 million people annually by 2050, a health expert has warned.

A Kenya health ministry official in charge of Antimicrobial Resistance (AMR), Dr Evelyn Wesangula said cases of resistance have become more common not just in Kenya but in the sub-Saharan Africa region.

The World Health Organisation (WHO) warns that the prospect of the world entering a ‘post-antibiotic era’, where common infections can no longer be cured, is real.

Speaking during a MESHA conference held on Thursday at Ngong Hills Hotel, Dr Wesangula said increased cases of drug resistance is posing a threat to the significant gains made in the fight against diseases, a health expert has warned.

While there are many causes of antimicrobial resistance, Dr Wesangula singled out both over use and underuse of the antibiotics as some issues which led to this public health concern.

She said the free-for all access of drugs in pharmacies, drugstores and market places, unregulated prescription in health facilities and from animals to humans as among causes for resistance.

Dr Wesangula said apart from long hospitalisation due to drugs resistance many lives are lost– a situation which should compel governments to act.

“It is a problem with a wide range of consequences. Those who have resistance will face long hospitalisation or will have to try different medicines which is costly.

“This also has an implication on their personal economy and development. If you come to think of sub-saharan region, we have a higher disease burden hence resistance to antibiotics must be a serious cause for worry.” she explained.

According to WHO, AMR occurs when micro-organisms (bacteria, fungi and viruses) change when they are exposed to drugs such as antibiotics leading to prolonged untreated illnesses.

Dr. Wesangula, there is need to intensify efforts such as enforcement of the law to have adhered to prescription procedures for antibiotics.

Like, Kenya, Malawi has similar challenges such as free – for – all access to antibiotics due to weak enforcement mechanisms of the law.

But National Coordinator for AMR in the Ministry of Health in Malawi, Dr Watipaso Kasambara said one strategy they have employed is raising public awareness on the gravity of drug resistance as well as equipping medical staff with appropriate knowledge so as to manage prescription of antibiotics in hospitals among other  interventions.

“Creation of a special unit to look at AMR is one effort by the Malawi government which demonstrates commitment in dealing with the problem at hand,” according to Dr Kasambara.



Young women’s HIV burden worries experts

As curtains fell on what has been a landmark scientific conference on the prevention, care and treatment of HIV, it was clear that there are many strides made in the right direction.

Notably, the national adult HIV prevalence has been on a steady decline in the last seven years.

According to the National AIDS and STI Control Programme (NASCOP), “annual new infections are less than a third of what they were in 1993” when the epidemic was at its strongest.

There are now better antiretroviral regimens that are accessible and consequently, more people on treatment inspiring experts to declare that the country may well be on its last mile towards achieving the 95-95-95 dream.

This is essentially a fast track plan to halt the spread of HIV by 2020 and to eventually end the epidemic by 2030.

Initially dubbed the 90-90-90 Aids eradication strategy, the goal is to have 90 percent of people living with HIV tested, 90 percent of those diagnosed with HIV put on treatment and 90 percent of those on treatment achieving durable viral suppression.

Based on advances in the treatment and care of HIV, experts are now aiming for 95-95-95.

Nonetheless, experts are alarmed that this success story has been clouded by failure to prevent new infections among young women 15 to 24 years.

“When you talk about new HIV infections, these are people who are negative today and HIV positive tomorrow.

Young people account for about half of these new HIV infections and this is a worrying statistic,” said Anthony Chazara, LVCT Health and Youth Programme.

Dr Lillian Njagi from Kenyatta National Hospital concurs: “More than half of all new HIV infections occurred among adolescents and young people aged 15 to 24 years which is a sharp rise from 29 percent in 2013.”

According to NASCOP’s latest estimates, 1.5 million people were living with HIV with youths accounting for 280,000 of these numbers.

Speaking at the conference, Dr Njagi was particularly concerned that young women continue to be disproportionally affected by HIV.

Across Africa, HIV infections among young women are double or triple those of their male peers. “In Kenya, young women are almost twice as likely to acquire HIV compared to young men,” she emphasized.

Due to their vulnerability to HIV, young women 15 to 24 years account for 33 percent of the total number of new HIV infections. In comparison, NASCOP statistics show that young men account for an estimated 16 percent of the new HIV infections.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, lack of access to education and jobs, and health systems that do not address the needs of young people. During the entire period of the conference, experts belaboured the fact that the face of HIV has significantly changed.

People living with HIV are no longer as sickly as they used to be. It is therefore now possible for a HIV positive individual with a very high viral load and therefore highly infectious to appear healthy.

This has shaped the attitudes that young women have as well as their own perceptions of being at risk of infections.

Surveys have shown that young women are still more fearful of an unplanned pregnancy than HIV. But there are other factors that have served as obstacles to the prevention of HIV among young women. Experts said

that biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus.

Experts were also quick to clarify that besides sex, the age of the male partner is a defining factor. “The trends are showing that HIV prevalence is high among women aged 15 to 24 and among men aged 35 to 45. This is because of the intergenerational relationships,” Chazara expounded.

The age of the young woman herself is also a factor. Women who had their first sexual encounter before the age of 15 years faced twice the risk of getting infected with HIV.

Importantly, experts belabored the point that interventions are in the pipeline to address the needs of young people in the prevention, care and treatment of HIV.

According to Dr Irene Mukui of NASCOP, “There is a lot of discussion and focus on the youth to figure out how to prevent new HIV infections, to ensure those infected are on treatment and that they have good treatment outcomes once they start taking antiretroviral drugs (ARVs).” With experts drumming support on increasing awareness and knowledge of HIV prevention among young people, these efforts are bearing fruits.

Nonetheless, more young men than women have demonstrated adequate knowledge of HIV prevention.

In the Kenya Health and Demographic Survey (KDHS) 2008, an estimated 48 percent of young women and 55 percent of young men “demonstrated adequate knowledge of HIV prevention compared to 73 percent of young women and 82 percent of young men in 2014.”

There is still no consensus on teaching young people about HIV and sexual health. This remains a debatable controversial issue with the most recent KDHS 2014 finding that an estimated 40 percent of adults were “against educating young people about condoms” for fear that it might be taken as encouragement for them to have sex.

Such fears and controversies notwithstanding, the figures have spoken and raised the alarm. Without urgent and young people tailored interventions, the HIV prevalence among young people will become the epidemic.



15 years and counting: Researcher’s relentless charge against HIV

Despite the difference in opinion about the statistics on HIV/AIDS in Nyanza, the concern of scientists in the region is much focused on how best to treat and reduce new HIV infections.

Mr. Arthur Ogendo, a Senior Research Officer working for Kenya Medical Research Institute Centre (KEMRI/CDC) in Kisumu, Kenya gives an insight on how they are rolling out the fight against HIV/AIDS even as the search for cure continues. Mr Ogendo has for the last 15 years, dedicated his life to researching on how his own people from Nyanza can participate in eliminating HIV from the face of the earth using people based solutions.

Our member, Christine Ochogo of Radio Nam Lolwe, recently met the ever smiling researcher in Kisumu during our eighth media science café and fielded the following questions to him.

Tell us about yourself.

I am Arthur Ogendo, a senior Research Officer at KEMRI/CDC Kisumu, The organization hosts various research on areas of Malaria, TB, HIV and other infectious diseases. I am a public health specialist currently working in the epidemiology and health research.

Kindly tell us more about the researches you have participated in on HIV.

KEMRI and CDC established a HIV Research Branch in 2000. The branch started with two major studies, one conducted in Asembo, Siaya County and another in Kisumu County both in western Kenya.

The research in Asembo was a Baseline cross sectional survey (BCS) that took a look at HIV infection prevalence and the one in Kisumu was known as Kisumu Breast feeding Study (KiBS) that majored on how to prevent transmission of HIV virus through breast feeding amongst women who are lactating before and after delivery.

What are the finding on the two studies?

In Asembo, the research revealed that there was high prevalence of HIV Infection of 15% as at 2003.

However, this has since reduced due to concerted efforts on behavioral and medical methods being initiated in the region.

In Kisumu the research informed Prevention of Mother to Child Transmission (PMTCT) Policy that mothers can be put on triple ARV for PMTCT was safe tolerable and efficacious . ART was administered to mothers before they deliver and continue with the drugs after delivery to protect the child from being infected with HIV virus through breastfeeding.

What other studies have KEMRI/ CDC conducted in relation to HIV?

Between 2010 and 2013, we did a study that looked at whether early initiation of ARVs treatment would reduce the risk of HIV transmission among HIV sero discordant couples. The study was sponsored by US national Institute of Health (NIH).

Participants were placed onto into two groups, one being on survivors whose CD4 cell count was at above 550 per ml and those whose CD4 count was at 250 per ml or below as per the national guidelines on ART initiation at that time (2010).

We found out that those who started Antiretroviral Therapy (ART) early when their CD4 cell count was high, had more health benefits and the risk of cross infecting their partners reduces by 96%. This was considered a scientific breakthrough.

This has now informed the WHO and Government of Kenya’s health ministry to adopt a ‘test and treat’ policy where infected individuals begin ART treatment immediately irrespective of their CD4 count, to reduce the risk of HIV transmission.

What about the study on vaccines and drugs?

We are coming up with a number of interventions to help in prevention and further spread of HIV/AIDS which include Voluntary Male Circumcision, use of vaginal ring, pills (Truvada), a pilot vaccine, implants among others.

Currently we are conducting a study on antibody mediated prevention (AMP) study. Vaccines are intended to induce immune responses (antibodies) in the body system but sometimes this is a slow process and may not be effective againstthe HIV virus. Antibodies are proteins produced by the body to fight germs in the blood. Therefore we are looking whether infusing antibodies directly into attacking the white blood cells. This

study is targeting about 80 participants who we will be followed up for four to five years.

We in CDC/KEMRI are also focusing on long-term pre- exposure prophylaxis (PrEP) for the population of young women. We are looking at superiority between Cabotegravir and Truvada as a PrEP. Carbotegravir drug has been proven to be effective among HIV-negative older women and it was time to investigate its efficacy in young women who are sexually active.

What are some of the challenges you face in the fight against HIV?

Research is very expensive and we as scientists have been relying a lot on donor funding which is now decreasing.

We are now advocating for the County governments to consider allocating more funding to HIV programs to avoid over reliance on donors who are proving to be unreliable due to changing times and priorities.

What role do you think the media can play in the fight against HIV?

The media plays an important role in dissemination of information and we scientist work best in collaboration with them to pass to the masses information on our progress in HIV research.

Why do scientists fear the media?

Scientists are sensitive to misfacts as reported by the media. We are accountable to our partners and collaborators fear being misquoted or misreported on our research be it on HIV or any other subject.

This calls for consistent and responsible journalism to avoid interfering with the progress made so far as well as avoid misrepresentation of scientific facts. We abhor the media to consult with us when not sure as they do articles because fact checking helps readers and listeners to get the correct information.

What is your patting shot?

Everybody is at risk of contracting HIV and the fight against the virus need concerted efforts from all people despite the County or region or country one comes from.

The society needs to be informed more about HIV on prevention and proper management in a bid to have a HIV free generation to come.

Scientists are still searching for a vaccine that may one day prevent infection of HIV/ AIDS infection and they are hopeful that the vaccine will soon be available. In the meantime, everybody has the responsibility to prevent HIV transmission but embracing behavior change and seeking treatment as necessary.

The perception and impression that those who hail from counties or regions where HIV prevalence is low are at less risk of contracting the virus is a misconception.



Stigma and side-effects slowing PrEP adoption

The idea of providing an antiretroviral (ARV) medication as pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV infection by persons at high risk is now well established.

However, the full public health impact will be realized only when PrEP is implemented effectively at scale.

The UNAIDS has projected delivery of PrEP to 3 million persons by 2020 while the National AIDS & STI Control Program (NASCOP) projected upto 500,000 persons on PrEP by 2022 according to the national Framework for Implementation of PrEP in Kenya issued in 2017.

By George Juma I

Data from UNAIDS 2013 show that over 7000 young women get new HIV infections contract globally every week.

Despite having oral PrEP and other researches being conducted to get more forms of the vaccine which can satisfy the taste of users ,the oral vaccine has not been utilized maximally because of arrays of factors including peer pressure, inaccessibility of PrEPS to users among others.

Josephine Nyaboke (not real name) a PrEP user champion in Migori County says issues regarding the packaging of Prep, peer pressure among other remains some of the major challenges she is facing when championing for PrEP use among the youths and the adolescent. She said other side effect of PrEP on usersat the early stages of use has also made many of her clients to abandon the pill.

Nyaboke who currently has 47 clients introduce to the vaccine that she monitors every month to ensure that the drugs adherence level is met also said that delay in the issuance of PrEP at the health facilities has discouraged many of her clients.

The perception of many has been that the PrEP is only used by Key population which includes sex workers, discordant, truck drivers and men sleeping with men, however this is not the cases.

Nyaboke said she started using PrEP in 2017 after having felt at risk of contracting HIV due to the long distance relationship she is in adding that her boyfriend and the parents accepted her proposal.

During this year’s AIDS 2018 Conference in Amsterdam four weeks ago, PrEP was arguably the dominant subject with far more sessions devoted to it than any other topic and will probably also dominate the HIV Research for Prevention (HIVR4P) Conference in Madrid from October 21 – 25,This is a global scientific meeting dedicated exclusively to biomedical HIV prevention and research.

Kenya has made significant progress in the reduction of new HIV infections in the past decade through the scale up of comprehensive HIV treatment and prevention programs including PrEP. Despite this progress, over 70,000 Kenyans mostly aged 15-24 get new HIV infections every year. The story is the same across most of sub Saharan Africa where numerous PrEP initiation programs started in the last year. So far, Kenya has initiated PrEP in about 25,000 people at risk – but retention is a big problem.

Scientists suggest there could be several potential barriers to effective PrEP implementation that could derail the program if not addressed urgently. According to Dr. Dismas Oketch from the Kenya Medical Research Institute, there are anecdotal reports about stigma to PrEP use, lack of knowledge of and access to PrEP, skewed expectations from PrEP adopters, side effects as well as shame and hesitation to demand PrEP; which could negatively affect retention and adherence to PrEP.

Speaking to Sayansi in August in Kisumu during a science café organized by MESHA and AVAC, Dr. Oketch further reiterated that there could be some disconnect between what PrEP providers intend for PrEP and what what PrEP users want from PrEP leading to those who were initially enthusiastic about PrEP withdrawing from it. Ideally, PrEP use is not for everyone and should be limited to individuals at risk and during periods of higher risk when other HIV prevention alternatives are not sufficient.

He says the current trend shows that many people are not using PrEP as expected because of various reasons which they scientist continue to investigate. “Side effects and stigma remain the two most important reasons for PrEP discontinuation.” Despite these threats, Dr. Oketch believes “it is far much better individually, principally, socially and economically to prevent HIV than to treat a lifelong infection of HIV/AIDS.” As a result the KEMRI is exploring other alternatives to PrEP delivery than the daily oral pill. This new PrEP pipeline will include long acting injectable PrEP, PrEP implants and PrEP intravaginal rings.

Latest research conducted by non governmental organization, IMPACT Research and Development Organization (IRDO) in Kisumu early this year shows that sixty four percent of potential PrEP users would prefer the injectables.

According to Dr.Kawango Agot is a researcher working with the IRDO, the research which involved commercial sex workers also revealed that 21 percent of potential PrEP users prefer oral tablets while only 15 percent prefer the intravaginal ring.

In the study, Dr.Kawango said the sample group was placed on injectable, pills and ring Preps all placebo for a period of one month each to established the experience and taste of each participant.

Mrs Josephine Odoyo,a researcher with the Kenya Medical Research Institute (KEMRI) at Lumumba centre in Kisumu county, says PrEP users have been giving a lot of feedback regarding the size of the pill, colour and even packaging of the pill.

The feedback they have been receiving from nearly 2000 users of PrEP, have occasioned new researches to see that the drugs is user friendly.



Why we need HIV vaccines like yesterday

More than 20 years ago, just after I had completed my secondary education, I was diagnosed with HIV. At that time, I thought I now had full self responsibility to my life. I had dreams, just like any other young person. This was the worst news I heard at that moment.

My life came to a standstill for awhile. Everything around me was now dictated by my diagnosis. My education, my career and family dreams were shattered and my parents and siblings were affected even more than myself. Ever since then, life has never been normal, It is not normal, It will never be normal for me even if a cure is found.

I have been to hell and back because of HIV on all fronts. Most notable and physical was my onset of treatment. Twice, I have reacted very badly to medication to the point of almost losing my life. At one point, I thought death would be more relieving than the pain and discomfort I was feeling. I am alive today mainly for having had access to competent, quick medical attention and strong family support at that time. In my more than 20 years work in the HIV field, I do not know of any HIV positive individual who has had it easy both socially and medically. I know some that have even died due to drug reactions, stigma and late diagnosis and lack of access to care and support. We musk a lot; because that is what society wants to see or wants us to portray.


Why am I saying all this?

I want to repeat, it is not normal. I do not wish this to happen to our children who have dreams and a full life ahead of them. I would not wish HIV infection to happen even to my worst enemy. It is for these reasons I am joining the prevention advocates. I will do whatever it takes within my ability to speak out and support prevention efforts to stop any single HIV infection where I can. I will support the HIV vaccines initiative because if it succeeds, it will be one of the biggest breakthroughs in the fight against HIV.

It is no longer about me People spoke for us; I am alive today because of the many voices that stood up for us – people living positively with HIV (PLWHIV). My immediate family takes the biggest credit. They read anything and everything they could come across that would enable them to help me and understand me.

But it still has never been normal and it will never be for me. As an existential fact, we are alone. Many a times I am alone, pain, drugs swallowing, loss of appetite….I am alone.

This can, and could have been prevented. I am going to spend the remaining part of my life, advocating for all forms of prevention…. but education and vaccines are going to take centre stage of my advocacy work. For we all know, PREVENTION IS BETTER THAN CURE.

The face of HIV today is young people. As a mother, and as a person who got infected at that tender age, the news about new HIV infections among young people churns my stomach.

I look forward to seeing how advocates are going to be engaged in the HIV vaccine initiatives and I am more than happy and willing to take on this assignment very seriously to let communities know and understand the importance of HIV vaccine and prevention.

Inviolata Mwali Mmbwavi is the National Coordinator International Community of Women Living with HIV Kenya Chapter (ICW-K)