Important note: Information in this article was accurate in December 2000. The state of the art may have changed since the publication date. IAVI Report - December 2000 / January 2001
As a growing number of HIV vaccine candidates enter the development pipeline, more attention is going to the mammoth task of planning and preparing for the large clinical trials down the road — the Phase III efficacy studies that test whether an experimental vaccine actually protects people against AIDS.
Many of the trials will take place in developing countries being devastated by the AIDS epidemic, adding to the complicated mixture of political, scientific, human and logistical issues surrounding these studies.
The IAVI Report has covered vaccine trial preparations in the past from a variety of different angles. Here we take a new one, profiling three African sites that face these complex issues each and every day. Based on visits to the sites as well as off-site discussions and research, we describe on-the-ground experiences of researchers who are managing to do good science in settings of extreme poverty and a lack of basic resources and services. Key ingredients of their success: establishing trust and rapport with local organizations, scientists, communities and governments.
First, a caveat. The three sites we present here were chosen exclusively as representing different "evolutionary" stages in this type of research. Many other communities and projects, both within and outside of Africa, are deeply committed to similar types of work and will play key roles in large-scale vaccine trials. We will present some of them as we continue this series of profiles throughout the year, focusing in the next issue on Hlabisa, South Africa — the site of vaccine preparedness work since the mid-1990's, and a pioneer of early, intensive community involvement.
This time, we begin at the Perinatal HIV Research Unit (PHRU) in the township of Soweto, South Africa. With over a dozen clinical trials of HIV therapeutics and prevention strategies already under its belt, the PHRU has a well-developed infrastructure, patient care clinic and strong community support — essential building blocks in their effort to expand into HIV vaccine work, in collaboration with several South African partners.
We then move to the Rakai region of Uganda, where a Ugandan–US collaboration begun in the late 1980's has established a prospective cohort of over 15,000 people, completed several major research projects on HIV epidemiology and interventions and is now conducting vaccine preparedness work — yet continues to struggle for financial and scientific security.
Last, we go to the mining community of Carletonville, South Africa, home to the highest reported rates of HIV in the country — if not the world. Although there are no concrete plans for HIV vaccine trials at this point, the intervention research described here illustrates how scientists were able to establish community-based projects and garner local support at a flaming hotspot of the epidemic.
Although these projects all involve different populations and circumstances, they share a similar grass-roots philosophy in which communities are viewed as early and key allies. "The challenge is how to make science really work in the developing world," says Brian Williams, a South African epidemiologist who heads the Carletonville project. "The point is to work very closely with the local community and look at good science in the context of real peoples' lives. Any projects that aren't rooted in an established community or just give lip service to community involvement are simply asking for trouble."
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©2000. The IAVI Report.
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