Scientists caution public expectations on 2016 HIV cure breakthrough research

By Esther Nakkazi

In the year 2016, there was so much excitement about cure research opportunities from the ‘functional cure’ for HIV. However, scientists cautioned the public about high expectations.

Scientists at the National Institutes of Health (NIH) and Emory University in an experiment induced sustained remission of SIV in animals, which if translated to humans could mean that there is a possibility of having people on anti-HIV drugs sustain suppression of the virus and get off of the drugs. 

This is called sustained HIV remission or a ‘functional cure’ which is not a cure but an outcome of a treatment that induces prolonged, undetectable levels of HIV viremia without the daily anti retroviral treatment (ART).

I attended the biennial HIV Research For Prevention conference (HIVR4P 2016) held 17-21 October in Chicago, USA and Anthony Fauci, an immunologist who heads the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and had carried out a landmark research about it explained that some people call it a cure others sustained remission.

Fauci with his team carried out an experiment, which involved infecting monkeys with SIV, the simian form of HIV. The research was published in the Oct. 14 issue of the journal Science.

According to a press release from the National Institutes of Health (NIH), the investigational treatment regimen consisted of 90 days of ART combined with 23 weeks of treatment with a laboratory-derived monkey antibody against a cellular receptor called alpha-4-beta-7 (a4b7) integrin. 

This antibody is similar to the human drug vedolizumab, which is approved by the U.S. Food and Drug Administration (FDA) for treating ulcerative colitis and Crohn’s disease.

The animals’ immune systems suppressed the virus to undetectable levels for as long as 23 months and the regimen led to the near-complete replenishment of key immune cells that SIV had destroyed, something unachievable with antiretroviral therapy (ART) alone.

Way Forward: 

While speaking to the press at the HIVR4P 2016, Fauci said there was so much that they (scientists) do not know, especially the mechanism, but what was loud and clear was the effect. So they decided to start a study in humans. 

The NIAID team will start an FDA approved study with 15-25 people with this profile; HIV infected, 18-65 years old, stable with controlled viremia, CD4 count of 450+, not pregnant and generally with a relatively healthy immune system.

They will get treatment interruptions of combined short-term vedolizumab treatment and ART for 30 weeks. Thereafter, both will be stopped and they will be followed for at least seven months.

The study investigators hope that what happened in the monkeys suppressing SIV replication will be repeated in humans - basically control the virus levels in the absence of ART and the antibody - so the immune system controls the virus in the absence of ART. Preliminary results are expected by the end of 2017 or beginning 2018.

“If we discontinue therapy in the 15 and 4 of them do not rebound that is the best anybody has ever seen,” said Fauci. Most patients immediately rebound after discontinuing therapy.

He also cautioned on public expectations. “Even if it is dramatic in animals we do not want to take a human who is infected and do more harm than good that is why we are starting off with a small phase I study whose primary goal is safety.”

African scientists comments about the 'functional cure' research; 

I interviewed some leading African scientists who attended the HIVR4P 2016 about the 'functional cure' research. Here is what some of said about it.   

'Cautious hopeful'. “It is exciting that we are beginning to get signals. However, these are monkey studies but bring hope. Over the years, we have learnt that people and animals are different so I would say -cautious hopeful, said Nelly R. Mugo, a gynaecologist and a principal research scientist at the Kenya Medical Research Institute (KEMRI).

'Surprising result.' “It is a very surprising result and I think everybody recognises that. I can say we do not really know how it is working, obviously we have some idea but we do not really know the mechanism,” said Lynn Morris the head of the HIV Virology laboratories at the National Institute for Communicable Diseases (NICD) in South Africa.

'It is too early.' “It is exciting because it offers another opportunity. If it is confirmed by other studies it will be quite exciting because people might be able to come off ART. But I think It is very early,” said Thumbi Ndung’u an immunologist and Scientific Director of the HIV Pathogenesis Programme at the University of KwaZulu Natal in South Africa.

Studies in Africa

Many HIV studies are done in Africa and Morris hopes that if a study is done in the US as Fauci promised there will be interest in doing it in South Africa.

In her opinion, from a cure perspective it is going to be a simple study do to. "The point is it is a licensed product so let us not waste time figuring out the mechanism let us just try it. If it works we can figure out if it really prevents rebounding then we can try and figure out how we can do this,” said Morris.

“It is exciting because integrins unlike the virus are the same. The big issue is going to be cost,” said Morris referring to monoclonal antibody therapies which are extremely expensive.

“But cost should never ever be used as a barrier to doing things because if there is a need the cost is a flexible controlled by demand. People should not come with negative things like cost I think the studies have got to be done and if they work people will find a way around the obstacle,” she said.

If the drugs work they will be re-licensed for HIV and it is envisaged that there will be a different pricing structure and there will be mass production. 

Over 37 million people according to UNAIDS need ART. Currently, they are only produced for the niche market for people suffering from inflammatory bowel disease. 

“It is yet another piece of evidence that we are moving closer to a situation where HIV is like cancer where it can be treated and does not come back in a long time,” Thumbi Ndung’u said.

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Ban on sex education in Uganda schools to be lifted

By Esther Nakkazi

By early next year, the ban on sexuality education in Uganda schools will be lifted after a policy to guide the curriculum on what will be taught has been developed.

We all had concerns that the sex education ban was unjustified but recently we talked about it at a Science Café and shockingly authorities in the know said it was a blessing in disguise.

The Science Café was the 14th held by the Health Journalists Network in Uganda at their home in Ntinda and the second one sponsored by United Nations Population Fund (UNFPA) Uganda Its theme was ‘teenage pregnancy’ held on November 30th with oversight from Reach A Hand.

Penninah Kyoyagala Tomusange the national programme officer, Adolescent and youth sexual and Reproductive Health and Rights at UNFPA-Uganda said although we all thought that the ban on sexuality education was a bad thing it was actually a good move by the government. Why?

Apparently, the previous content and packaging was terrible. So right now all stakeholders are meeting to create a package that will have relevant and accurate information for sex education in Ugandan schools.

“Sexuality education is about accurate information,” emphasised Kyoyagala. “No teenager wants to be a dad or Mum.”

Sexuality education is also a life long thing since environments keep changing, sometimes its verbal other times non verbal.

One misinformation that was in the old package was on condom use. So the new curriculum talks about proper condom use but condoms will not be distributed in schools. The students will be informed on where to find them in health facilities.

This is a good move but will it work given the disconnect between health facilities and education centres. The two government entities do not seem to speak to each other at all! Look at the way youth are always begging for youth friendly services in health facilities.

It is only a song well sang but only practiced by a few facilities like the Naguru Teenage Information Health Centre.

We also had Denis Lewis Bukenya the deputy director, Naguru Teenage Information and Health Centre (NTIHC) talk to us at the science Café. He too emphasised the need for accurate information and to regularly sensitize and empower teenagers to make better-informed decisions.

“Provide accurate information so that the decisions teenagers make are accurate,” said Bukenya.

He said the youth need to have ready access to youth friendly sexuality education services so they can get their needs and questions attended to. Bukenya also stressed a need to educate boys who are not only active participants in creating teen pregnancies but are also custodians of the decision making process.

Godfrey Walakira the training and development manager, Straight talk foundation Uganda, was also a speaker at the science cafés and gave astounding statistics. He said research shows 43% of all Uganda teenagers are forced into the first sexual encounter. The early sex debut is also at the young age of 12/13 years in Uganda.

Pregnancy usually leaves stigma around the girl yet many times it is not their fault entirely. Many are defiled and according to the Police crime report 2011, defilement was the most prevalent crime.

Meanwhile, teenage pregnancy is still a big problem in Uganda. Walakira noted that the national average prevalence of teenage pregnancy currently stands at 24% according to the Uganda Demographic Health Survey (UDHS 2011).

Regionally, the rate of teenage pregnancy is highest at 30.6% for Central Uganda, 30.3% for Eastern, 29.7% for Karamoja, 26.4% for West Nile and 25.6% for the North Uganda, Western Uganda is at 22.6 while south western is at 15%.

Walakira stressed the need to handle a number of issues that lead to teenage pregnancies including child marriages whose prevalence stands at 59% for Northern Uganda, 58% for Western region, 52% for Eastern region, 50% West Nile, 41.9% for central region, 37% for southWestern and 21% for Kampala according to the 2011 UDHS.

One way that Uganda can reverse these stats is increase in teenagers’ access to age appropriate sexual reproductive health information, which, can effectively be done through provision of appropriate information to the schools or directly through the communities.

The conclusion therefore at the Science Café was that Uganda should popularise sexuality education in schools. It will delay their sexual debut, probably reduce teen pregnancy but most importantly when the teenagers get accurate sex information they are empowered.

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Dissemination of new innovations for utilisation of Roots, Tubers and Bananas

By Esther Nakkazi

After three years of intensive research, the RTB-ENDURE project will present research findings on expanding the utilisation of Roots, Tubers and Bananas (RTB) in a workshop on Tuesday 6th and Wednesday 7th December 2016 at Crane Hall, Imperial Golf View Hotel, Entebbe.

An exhibition of RTB Technologies and Innovations will also be held alongside the workshop at the Botanical Gardens, which are located close to the hotel.

The project from 2014 to 2016 has added value to the fresh products of roots, tubers, and bananas, expanded their utilisation and reduced on their post-harvest losses among communities in the East African region, said Diego Naziri, a Post-harvest Specialist at International Potato Center (CIP).

Uganda has hosted the $4 million European Union (EU) funded project.

Realising RTB’s full potential as crops and as products in Africa is important as they are food security crops, important sources of income, are less susceptible to price fluctuations in the world food market as compared to grains and legumes.

CGIAR Research Program on Roots, Tubers and Bananas data entails that these are consumed as a staple food and they contribute over 20 percent of caloric requirements and constitute nearly two-thirds of per-capita food production in sub-Saharan Africa.

CGAIR-RTB project also confirms that Post-harvest losses are much higher with this group of crops than with grains, as inherent bulkiness and perishability have traditionally limited them to on-farm and local markets.

However, they are bulky, perishable, with a limiting shelf life and short direct marketing. Africa lacks handling and storage technologies of RTBs and with an underdeveloped potential for value addition.

Naziri says the RTB-ENDURE project has been a research-for-development that has placed research in the context of value chains and the demands and needs of its actors in the production, postharvest handling, processing, marketing, and business organization to make the chain function more efficiently.”

For more about the new innovations on this RTB-ENDURE project please follow #RTB on twitter and more will be highlighted on this blog. 

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Mombasa Tea Auction to go Digital

By Esther Nakkazi

After years of refusing to go digital, East Africa tea traders and growers have accepted to replace the current manual open outcry system, with the computerized electronic auction.

Today, East Africa Tea Trade Association (EATTA) signed a financing agreement with TradeMark East Africa (TMEA) to provide financing provide of US$ 1.5 million that will enable automation of the tea auction in Mombasa.

A statement from TMEA says the automation is expected to reduce the tea trading cycle by about 65% from the current 45 - 60 days to less than one month. Reduced delays will also ensure that farmers receive timely payments negating need to take loans to finance their producer operations.

The Mombasa tea auction is the world’s largest black tea auction and handles about 75% of tea exported through the port of Mombasa covering shipments from the EATTA member countries of Burundi, Kenya, Rwanda, Uganda, DRC, Tanzania, Ethiopia, Malawi, Madagascar and Mozambique.

In 2015, the auction handled more than 350 million kilos of tea, providing a platform through which more than one million farmers in Africa could sell their tea, before shipping it across the world.

The proposed integrated Tea Trading System (iTTS) will encompass the entire tea export processes including pre-auction, auction, post-auction and a Business to Business marketing network says a statement from TMEA.

“This portal will simplify the tea auction with the added benefit of increasing transparency and thus gaining stakeholder confidence in the auction,” said Mr. Nicholas Munyi, EATTA chairperson, at the signing ceremony.

“TMEA is committed to boosting intra- Africa trade and also East Africa’s trade with the world by reducing the barriers to trade. Automation of key trade systems is one way that has enabled us move closer to achieving this vision,” said Frank Matsaert TMEA CEO.

“I am excited to see that tea, a major forex earner for the region, will reach the breakfast tables across the world in an efficient and cost effective way and that the farmers working hard on their farms will regain confidence in the trading process as a result of the transparency and accountability the system will give,” explained Matsaert.

Once fully implemented, the platform, will ensure that, stakeholders of the tea auction including farmers, buyers and sellers, receive real time information on what is happening on the auction bourse.

Further, the automation will reduce delays and paper work, which is synonymous with the manual systems. The tea brokers will benefit from an automated and streamlined trading platform that reduces complex and bureaucratic trading processes and physical movement of documents to various players.

The tea producers both in Kenya and other countries in the region will have real time access to information on the tea sales as well as have lower logistics costs as they will be able to access the information online eliminating the need for travel to Mombasa.

Automation for the Mombsa auction was supposed to be implemented by 2013 using the Indian tea e-auction model, the only country in the world using it. A team from EATTA left for India on a fact-finding mission but found that despite it operating for eight years, the Indians still preferred the manual open outcry system.

The report presented by the team to EATTA said the Indian government imposed the e-auction on them in order to collect more taxes from tea but they were unhappy with it because it was not interactive and it was too commercialized without meeting in the auction room.

So EATTA stakeholders, overwhelmingly, voted against it in a meeting saying the auction, which basically, is a ‘public sales’, would lose its transparency, competition and risk technology failure without a guaranteed power supply at Mombasa.

The traders and growers said using the e-auction would be a health hazard if buyers were to sit uninterrupted through the 8 hours looking at computer screens and the auction would lose its gusto.

It is interesting that these now don’t see it as a health hazard and are willing to move with the times embracing technology.

New research establishes storage temperature for East African highland bananas

By Esther Nakkazi

Margaret Nalujja a trader at Bugolobi market a suburb in Kampala can now earn about 80 percent more from selling East African highland cooking bananas locally known as matooke in Uganda.

“From a cluster of peeled matooke I earn Ush 5,000 while the unpeeled sells for Ush 3,000,” said Nalujja.

Unlike the older generation that has for centuries been preparing matooke through long hours of peeling and steaming in banana leaves most of Nalujja’s clientele who are hotels, bachelors and the young generation want already peeled matooke that they just boil. Supermarkets also prefer it.

Market research under the RTB-ENDURE project has established that Uganda consumers prefer peeled matooke even when it has been under cold storage, said Dr. Enoch Kikulwe, an associate scientist at Biodiversity International of Uganda.

One of the questions that Ugandan farmers also wanted to know under the project was the temperature under which the matooke could be stored without getting spoilt, said Dr. Kikulwe also the team leader of the banana sub-project of RTB-Endure.

“This research has answered this fundamental question for East African highland cooking bananas.”

Scientists have found that both the peeled and unpeeled East African highland cooking bananas can stay for 12 days with no taste or color changes under cold storage of 12-18 degrees centigrade. Most standard fridges offer cold storage of 5-8 degrees centigrade.

Without cold storage the matooke can only stay for 3 days without ripening or rotting.

Bananas occupy 1.3 million hectares nationwide and are grown mainly by subsistence and semi-commercial farmers and it is a staple food for the rural communities. The matooke is a key source of livelihood for over 13 million farmers and a major staple food in Uganda.

A lot of research has been done on increasing the shelf life of other banana varieties like the Cavendish but we did not know what to do with the matooke said Dr. Kephas Nowakunda, the head of the food biosciences and agribusiness research program at the National Agricultural Research Organisation (NARO)

Dr. Nowakunda explained the other benefits of peeled bananas including leaving the waste on the farm to make manure and reducing rubbish.

The RTB-ENDURE research project has focused on innovations for improved postharvest management and expanded use of the cooking banana, cassava, potato and sweetpotato with an aim to improve food availability and income generation for roots, tubers and bananas producing communities.

RTB crops are essential staple foods in developing countries. They have high nutritional value, they generate income, and they contribute to the sustainability of cropping and production systems.

The RTB-ENDURE project is implemented in Uganda by the CGIAR Research Program on Roots, Tubers and Bananas (RTB), led by the International Potato Center (CIP), as part of a larger three year project funded by the European Union with technical support of IFAD.

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A forty-year walk with Ebola – it hasn’t been a 'walk in the park'

By Esther Nakkazi

40 Years ago, around September, the first Ebola blood samples were carried by a Congolese woman in her handbag from Zaire to Belgium on Sabena airlines. Yes, you read that correctly.

Currently, with an Ebola outbreak anywhere, travelers not even remotely near the source have to fill in forms, temperatures have to be taken, suspects quizzed and isolated or even denied access to places. It is the drill.

The fascinating 40-year history of Ebola since the first outbreak in Yambuku, a small village in the DRC, was told at the 8th international symposium on filoviruses in Antwerp, Belgium.

Nothing is the same anymore. Zaire is now the Democratic Republic of Congo, Sabena airlines - then the national carrier for Belgium - closed in 2001, its succeeded by Brussels Airlines.

As you know, this last Ebola outbreak was vastly different from all the ones before. Ebola has become a household name now, 40 years after Yambuku.

Forty years ago, though, Ebola was unknown.

In 1976, in Yambuku, a small village in Mongala Province in northern DR Congo, a young doctor Jean-Jacques Muyembe was ordered by the minister of health to make investigations about a disease that had killed some people.

Muyembe arrived with a medical assistant. The health workers suspected typhoid or yellow fever. Muyembe examined some sick people and collected blood samples without gloves. His hands and fingers were stained with blood but he just washed it off with water and soap. In addition, he collected liver samples from 3 nurses who had died.

When a nurse who he knew was vaccinated from typhoid and yellow fever said she had a fever the alarm bells started to ring. The trio (Muyembe, the medical assistant, and nurse) flew to Kisansha to further investigate the samples.

The disease was nothing they knew. Sadly, the nurse and medical assistant died in the next few days but Muyembe was saved - not by the ‘moon suit’ but by washing his hands with water and soap.

A Congolese woman who was traveling to Belgium on Sabena airlines was asked to drop the samples off at the Institute of Tropical Medicine (ITM) in Antwerp, where Muyembe’s friend was working.

The Ebola samples arrived in Belgium in September 1976. Dr. Guido van der Groen picked them up on his bicycle. They were packed in used containers. He took them for proper storage at ITM.

Here the team tried to identify the virus and found that it was close to the Marburg virus isolated from monkeys in Uganda by the Germans, but clearly, it was not the same. Muyembe was informed about it and warned that it concerned a very dangerous new virus. They then tried to give the new virus a name.

At first, they opted for Yambuku where the index case was discovered but they soon realized that if you use the name of a town it will cause too much stigma. Then they looked for any landmark near Yambuku and found the Ebola river which is why Ebola is now named after a river near Yambuku.

The Ebola forty-year journey has seen 25 outbreaks by now, 30,900 cumulative cases and 12,800 deaths. A new book ‘on the trail of Ebola’ by Dr. Guido van der Groen details this history.

Frontline health workers have been most affected by Ebola over the years, but right now it is a serious public health threat. Many ongoing efforts in terms of policy, diagnostics, and research are being discussed at this symposium.

Clearly, the Ebola journey hasn’t been a ‘walk in the park’.

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Uganda off WHO list of yellow fever risk countries

By Esther Nakkazi

After a month of no evidence of active transmission, Uganda has now been declared yellow fever free.

The ministry of Health says between the 1st to the 30th of June 2016 there were no cases of active transmission in the country. A vaccination coverage of 94 percent, which is above the World Health Organisation (WHO) recommended coverage of 90 percent was achieved in the three affected districts of Masaka, Rukungiri and Kalangala.

Following the successful yellow fever vaccination campaign in the affected districts, no new cases have been confirmed, said Professor Anthony Mbonye, the acting director of general health services, Ministry of Health.

A total of 627,706 residents (aged six months and above) were vaccinated including 273,447 in Masaka district and 304,605, 49,654 in Rukungiri and Kalangala districts respectively.

Thereafter, the Public Health Emergencies Operations Centre Network (PHEOC) coordinated a one month enhanced Yellow Fever surveillance in 17 districts surrounding the three districts with no confirmed cases.

However, disease surveillance to detect any other possible outbreak and heightened efforts to prevent the risk of transmission through international travel is still ongoing, said Prof. Mbonye.

It is mandatory that individuals travelling from yellow fever high risk countries into Uganda are fully vaccinated against it before entry into Uganda. Unvaccinated travellers from Uganda are also advised to access the yellow fever vaccine from accredited centres.

On 7th April 2016, yellow fever was confirmed by Uganda Virus Research Institute (UVRI) on 3 samples from Masaka by serology. This diagnosis was re-confirmed on 21st April 2016 by CDC Fort Collins (WHO Collaborative Centre for Yellow Fever)

Intensification of yellow fever Surveillance activities also confirmed yellow fever in Rukungiri and Kalangala districts on 13th April 2016 and 4th May 2016 respectively.

From 24th March to 4th May 2016, a total of 65 suspected yellow fever cases were reported from districts in the greater Masaka region and 7 cases were confirmed from Masaka (5), Rukungiri (1) and Kalangala (1). Three of confirmed cases died.

With support from World Health Organization (WHO), the CDC, ICG, GAVI, UNICEF and other partners, the Ministry of Health conducted a reactive yellow fever vaccination in the three districts that had confirmed outbreaks.

The vaccination campaign was implemented from 19th May 2016 to 22nd May 2016 in Masaka and Rukungiri districts and from 4th June 2016 to 7th June 2016 in Kalangala district.

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