From a vaccine for malaria to ending the HIV epidemic, UNC infectious diseases researchers in Malawi gear up to take on more challenges in a changing country.
By Jamie Williams
UNC Project-Malawi is a global health success story. From Malawi, a landlocked country in southeastern Africa, emerged the knowledge that helped shape global understanding of HIV and other infectious diseases, while saving millions of lives.
But in research, answers beget more questions.
So, what’s next?
Current work in the field of HIV research continues to build upon past accomplishments like the world-changing HIV Prevention Trials Network’s 052 study, which showed that early treatment of HIV with antiretroviral therapy (ART) could reduce sexual transmission by 96 percent. Clearly, treatment works. And now, a focus of UNC’s work in Malawi is increasing testing and outreach to reach at-risk groups, while also developing the most effective methods of treatment. The goal of this current work is to maximize adherence of people with HIV.
“Some of our biggest problems in HIV treatment are nonadherence,” said Mina Hosseinipour, MD, MPH, UNC Project-Malawi’s Scientific Director. “Now we are working to study solutions, methods and products that may make it easier for people.”
Patients that do adhere to their ART regimen can now live with HIV under control. Better HIV prognoses have been a major contributor to a 20 year increase in life expectancy in Malawi between 1990 and 2015. But as in the West, aging brings with it other health problems including diabetes, high blood pressure and cancer. Hosseinipour said a key to the long-term success of the health care system in Malawi will be integrating HIV care with the rest of the needs of an aging population.
And so, while the team at UNC Project-Malawi is constantly working to reach at-risk populations and get patients into treatment as soon as possible after infection, the research focus centers on prevention of new infection.
The most extensive of these studies, the Antibody Mediated Prevention (AMP) study, is now enrolling HIV negative participants. Led by the HIV Prevention Trials Network and HIV Vaccine Trials Network – UNC is a key participant in both groups – the AMP study is testing a first-of-its-kind infusion of antibodies delivered via IV once every two months. In the development of traditional vaccines, researchers test a vaccine to see if participants develop antibodies. The AMP study will test whether or not these direct antibody infusions can prevent infection.
“We are in the very early stages, but Malawi is an absolutely critical site for this study,” said Myron Cohen, MD, Associate Vice Chancellor for Global Health, Director of the Institute for Global Health and Infectious Diseases, and the AMP study’s protocol chair. “As we’ve said for years, the work in Malawi puts us on the absolute cutting edge of research.”
Other studies are testing the viability of a long-acting injectable as HIV prevention, work that will kick off in the fall of this year.
“All of this, either treatment or prevention, is meant to end the epidemic, to make HIV something we don’t have in our next generation. The goal is that it goes the way of small pox,” Hosseinipour said.
With all of these studies just beginning, Hosseinipour says years of work lie ahead, with results expected to be reported in the next four to five years.
Progressing towards Malaria Vaccine
UNC Project-Malawi researchers have been working to lessen the impact of malaria in the country for decades. In 2009, the first injection of a malaria vaccine in the third phase of clinical trials was administered in Lilongwe. Over the course of that trial, more than 1,500 Malawian infants were enrolled and followed. That trial found that the vaccine was around 50 percent effective, lower than researchers had hoped, but UNC’s Irving Hoffman, PA, MPH, said that modeling showed the vaccine would save a lot of lives.
Now, Hoffman, UNC Project-Malawi’s International Director, is overseeing another study to more closely test the vaccine. The original vaccine trial was conducted across 11 countries. This time it will focus on Kenya, Ghana and Malawi.
Hoffman said UNC’s success implementing previous clinical trials – including phase III of the malaria trial – combined with its research infrastructure, was a key reason Malawi was selected for this extension of the malaria vaccine work.
Patients are now enrolling in the trial which will ultimately vaccinate 240,000 children between the ages of six months and four years, and monitor them over the course of three years.
“There is more work to be done, and more careful study, but we hope this can ultimately help save lives here in Malawi, across Africa, and beyond,” Hoffman said.
The trial is being run by the WHO and will be implemented in Malawi by UNC, along with the Malawian Ministry of Health, the Wellcome Trust, and the London School of Hygiene and Tropical Medicine.