15th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 3-6, 2008

Conf Retrovir Opportunistic Infect 2008 Feb 3-6;15: (abstract no. 7)

David Serwadda¹, M Wawer², N Sewankambo³, R Gray², and for the Rakai Hlth Sci Prgm
¹Makerere Univ Sch of Publ Hlth, Kampala, Uganda; ²Johns Hopkins Univ Bloomberg Sch of Publ Hlth, Baltimore, MD, US; and ³Makerere Univ Sch of Med, Kampala, Uganda

BACKGROUND: We reviewed key research findings and programmatic experiences from the Rakai Health Sciences Program (RHSP) between 1988 and 2007, in the context of the global war on HIV/AIDS.

METHODS: The core of the RHSP is the 50-village prospective, open Rakai Community Cohort Study (RCCS), situated in a rural district of southwestern Uganda. A wide range of studies (epidemiological, behavioral, demographic, basic science, preventive, programmatic, clinical, and modeling), nested within the cohort population, have yielded information on HIV dynamics, risk factors, demographic effects, evolution, interactions with other pathogens, prevention, care, and treatment, as well as on multiple challenges facing HIV/AIDS research and programs.

RESULTS: Key results from RHSP studies will be presented. These include observational data on HIV risk factors, which led to population-based Rakai trials of sexually transmitted disease control for HIV prevention in adults and for prevention of mother-to-child transmission, and of male circumcision for HIV prevention in both HIV– men and in female partners of HIV+ men. Trial results will be reviewed. Analyses of cohort data and of studies nested within the cohort have also demonstrated the important roles of HIV viral load and HSV-2 in HIV transmission; assessed the effects of key behavioral interventions (including voluntary counseling and testing, and “ABC” promotion) on subsequent behaviors and HIV risk; and explored successes and challenges related to ART rollout and associated services. The critical contribution of the population-level cohort in facilitating HIV research (including the efficient implementation of randomized clinical trials), in enhancing the interpretation of study results, and in evaluating services, will be discussed. Finally, the evolution of human capital and infrastructure development, of international research partnerships, and of training (for both Ugandan and international students, professionals, and scientists) within the RCCS “population-based laboratory,” will be described.

CONCLUSIONS: The Rakai community cohort enables the RHSP to pursue a population-based approach to HIV research and services, facilitating a wide-ranging research program from the molecular to the community level. This has enhanced the understanding of the HIV/AIDS epidemic, of potential interventions, and of the substantial challenges which remain.

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2008-02-03
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