Newsletter March/April 2020 Volume 19 Issue 4 CAPRISA - contributing to the

South African Covid-19 response In this Issue APRISA has stepped Group of the International up to make a signifi- Steering Committee for the Our feature story this month fo- cant contribution to the COVID-19 SOLIDARITY Tri- cuses on CAPRISA’s role in the C fight against the COVID-19 al. Professor Lynn Morris, South African Covid-19 response and the appointment of Professor pandemic in South Africa. Interim Executive Director of the National Institute for as the Chair of the Ministerial Advisory Com- Professor Salim Abdool Communicable Diseases mittee on Covid-19. Karim, CAPRISA’s Director (NICD) and Honorary Senior has been appointed the over Scientist at CAPRISA, is On page 2, Professors Salim -arching Chairperson of the playing a leading role in and Quarraisha Abdool Karim Ministerial Advisory Commit- COVID-19 testing in the are named the recipients of the tee on COVID-19 (MAC) that country and is a member of prestigious John Dirks Canada was established by Minister the MAC laboratory sub- Gairdner Global Health award. Zweli Mkhize. This commit- committee. tee includes 50 professionals A special tribute to a friend, colleague and fellow scientist, from a diverse range of sci- President Ramaphosa, Professor Gita Ramjee who entific and medical back- declared a national lockdown passed away from Covid-19 re- ground to provide high level in South Africa effective at lated complications is provided advice to the Minister of midnight on 26th March to on page 3. Health and the National De- mitigate the transmission of partment of Health. the SARS-CoV-2 virus and On page 4, we highlight the on 9th April the lockdown case book, Radiological Features In addition, the committee was extended to 30th April. of TB in HIV Co-infected Pa- is required to use its exper- These were unprecedented tients, edited by Prof Kogie Nai- tise, linkages, resources and measures to control an un- doo from CAPRISA and Dr Kam- influence to help the depart- lesh Daji, a diagnostic radiolo- precedented epidemic. ment overcome obstacles, gist; and the publication: COVID th 19 : Science and Global Health bottlenecks as identified by On 13 April, President Governance under attack, by the National Departmental Ramaphosa and the Nation- CAPRISA’s Head of Ethics and Health in its response to the al Covid-19 Command Law, Prof Jerome Singh. coronavirus epidemic. Council mandated the Minis- ter of Health, Dr Zweli The Ministerial Advisory Mkhize to hold a live zoom Committee has 4 sub- public engagement to deal committees: Laboratory ser- CONTACT DETAILS with technical aspects relat- vices, chaired by Professor ing to the country's COVID- CAPRISA Koleka Mlisana; Clinical ser- Doris Duke Medical 19 response. Research Institute (DDMRI) vices chaired by Professor Photo (top): Professor 2nd Floor Marc Mendelson; Public This meeting was joined Salim Abdool Karim, University of KwaZulu-Natal Health, chaired by Professor by experts on Covid-19 and Chair of the Ministerial Private Bag X7, Congella 4013 Advisory Committee South Africa Shabir Madhi; and Research Professor Salim Abdool Ka- chaired by Professor Glenda (MAC), (middle) Professor T: +27-31-260 4555 rim, delivered a presentation Quarraisha Abdool Karim, F: +27-31-260 4566 Gray. Professor Quarraisha titled: ‘South Africa’s Covid- member of the Public E-mail: [email protected] Abdool Karim, CAPRISA’s 19 epidemic: Trends and Health MAC committee Associate Scientific Director next steps’ which was broad- and (bottom) Professor www.caprisa.org.za is a member of the Public cast live on three national Lynn Morris, member of

Caprisaofficial Health sub-committee and is television channels. the Laboratory MAC com- a member of the Executive Continued on page 2 mittee. @CAPRISAofficial March/April2020; 19(4): page 2 Salim and Quarraisha Abdool Karim named recipients of the 2020 John Dirks Canada Gairdner Global Health Award

APRISA’s Professors Sal- their tireless efforts to conduct im and Quarraisha Abdool research that impacts human C Karim are the laureates of health.” the prestigious 2020 John Dirks Canada Gairdner Global Health The world-renowned infec- Award awarded for outstanding tious disease epidemiologists re- achievements in global health ceived the award "for their dis- research." covery that antiretrovirals prevent sexual transmission of HIV, The Gairdner Foundation an- which laid the foundations for pre nounced the 2020 Canada -exposure prophylaxis (PrEP), Gairdner Award laureates on the HIV prevention strategy that 31st March, recognizing some of is contributing to the reduction of the world's most significant bio- HIV infection in Africa and medical research and discover- around the world. ies. The research undertaken in Africa by The Foundation said that “During these this South African couple has played a key challenging times, we believe it is important role in shaping the local and global re- to celebrate scientists and innovators from sponse to the HIV epidemic, said the Foun- around the world and commend them for dation.

Continued from page 1. MAC COVID-19 Members

In addition to the contribution to the MAC, CAPRISA is conducting several COVID-19-related studies including Angelique Coetzee, Anne van Gottberg, Cheryl a prospective epidemiological and phylogenetic study to Cohen, Dean Gopalan, Eftyhia Vardas, Elijah establish how the SARS-COV-2 coronavirus is spreading Nkosi, Francesca Conradie, Francois Venter, in urban and rural KwaZulu-Natal in order to guide locally

-appropriate prevention and clinical care. Gesine Meyer-Rath, Glaudina Loots, , Harry Moultrie, Helen Rees, Ian Sanne, Professor Quarraisha Abdool Karim is providing support Imraan Patel, Jacqui Miot, James McIntyre, to the National Heath Laboratory Service (NHLS) for their testing outreach activities and Professors Nesri Pa- Jeremy Nel, John Black, Juliet Pulliam, Kamy dayatchi and Kogieleum Naidoo are supporting the Kwa- Chetty, Kerrigan McCarthy, Koleka Mlisana, Zulu-Natal’s Provincial Department of Health’s response Lance Lasersohn, Lindiwe Ringane ka Seme, to COVID-19. LR Mathivha, Lucille Blumberg,

The CAPRISA mobile clinic in the Umgungundhlovu Lynn Morris, Marc Mendelson, Matildah district was assigned to pilot the outreach in Ward 9. Mokgatle, Moherndran Archary, Morgan Chet- The study received funding from the Department of Sci- ty, Motlaji Maloba, Natalie Mayet, Ndiviwe ence and Innovation (DSI) through the South African Mphothulo, Nombulelo Magula, Prakash Medical Research Council (SAMRC) for research on Jeena, COVID-19 transmission. Quarraisha Abdool Karim, Salim Abdool Ka- Watch Professor Abdool Karim’s presentation here: rim, Shabir Banoo, Shabir Madhi, Shaheen Mehtar, Sibulele Bandezi, Silingene Ngcobo, https://www.youtube.com/watch?v=HLTQeMCtcfo Simon Nemutandani, Sithembiso Velaphi, Theo Lightem, Wendy Stevens, Wolfgang Preiser, Yunus Moosa, Zinhle Makatini March/April 19(4): page 3 A tribute to a friend, colleague and fellow scientist:

Gita Ramjee

learnt with deep sadness of the untimely death of Professor Gita Ramjee who passed away in hos- I pital on Tuesday 31st March from a COVID-19 related illness. Gita Ramjee was not only a colleague, but she was a dear friend, a scientist and scholar in HIV prevention, a mother of two sons, a grandmother and a wife to her husband Pravin.

On behalf of CAPRISA, Quarraisha and I wish to extend our heartfelt condolences to her family and friends. Her passing is an immense loss and has left an indelible void in HIV research and treatment, par- ticularly on the African continent.

Gita Ramjee was the Chief Scientific Officer of HIV Prevention at the Aurum Institute. For several years she held the position of Chief Specialist Scientist and Director of the South African Medical Research Coun- cil’s HIV Prevention Unit as well as Clinical Professor of Global Health, in the Department of Global Health, in the School of , at the University of Wash- ington, Seattle. She held an Honorary Professorship in the Department of and Population Health at the London School of Hygiene & Tropical Medicine, in the UK and was an honorary scientist at summed up the chutzpah of Gita Ramjee, “I did not CAPRISA. dream that the love of my job, my passion and drive would get me this far! If I was much younger and not She was a Fellow of the Royal College of Physi- committed to my family life, I think I would like to have cians in Edinburgh and received several awards and done a medical degree after my PhD.” accolades for her scientific work. Most recently, in 2018, she was awarded the EDCTP/ European Union Professor Ramjee trained as a basic scientist at Outstanding African Female Scientist award and in the University of Sunderland in the United Kingdom. 2017 she received the SAMRC Gold Medal Scientific She completed a Masters degree in the role of afla- Achievement Award. She was a member of several toxins in childhood malnutrition at the former Universi- local and international committees and published ty of Natal. She received a MRC scholarship to pur- more than 200 research articles. sue her PhD which focused on the role of proteinuria in childhood kidney diseases. Thereafter, she worked She epitomised dedication and commitment to her with me leading the COL-1492 vaginal microbicide scientific calling – to control the HIV epidemic through trial for the prevention of HIV among a group of sex clinical scientific rigour. I recall my first discussion with workers working along the trucking route between her while she was a post-doc with Prof Coovadia do- and Johannesburg. She later commented ing research on kidney disease – her passion, com- that the trial was her introduction to HIV prevention mitment and dedication to science shone through so among high risk populations. Her commitment to clini- clearly that I recruited her to join me at the MRC a few cal research in HIV prevention was exponential and months later. She climbed through the ranks at the she was an investigator on almost all microbicide tri- MRC to eventually succeed me as the Head of the als since then. I have fond memories of Professor MRC’s HIV Prevention Research Unit. She was an Gita Ramjee – her passion, drive and tenacity which excellent role model of what can be achieved through she believed are ‘critical traits to have for scientific sheer determination and hard work. excellence’.

It was a privilege to mentor and work with Gita She will be remembered for her commitment to over the past 26 years. Known for her unwavering finding ways to empower women to protect them- tenacity she embarked on new challenges with bold- selves from HIV and for making a difference in the ness and enthusiasm. This was the key to her suc- lives of so many researchers and research partici- cess – her innate ability to persevere. pants over the years. May her soul rest in peace.

In an interview in 2018, her poignant words Salim S Abdool Karim March/April 19(4): page 4 Radiological Features of TB in HIV Co-infected

Patients

his case book, Radiological Features death from an infectious disease globally, of TB in HIV Co-infected Patients, ed- and the leading cause of death from any T ited by Professor Kogie Naidoo, Head cause in South Africa. Poor identification, of CAPRISA’s HIV&TB treatment research and delayed diagnosis of TB remain the and Dr Kamlesh Daji, a diagnostic radiolo- main contributors of ongoing high levels of gist, describes and discusses varied radio- TB transmission and TB-associated morbidi- logical manifestations of TB among HIV- ty and mortality. infected patients using available routine chest radiographs. The handbook, initiated by the KwaZulu- Natal Department of Health clinician, Dr Improvement in clinicians’ knowledge of Yeney Graza Fernandez, will serve as a typical and atypical features of TB, will im- quick reference guide to frontline clinicians prove TB case identification, timeous TB grappling with interpreting varied radiologic treatment initiation and better health out- features of TB in HIV. comes in settings endemic to TB and HIV, explained Naidoo. Naidoo said that the first 1,500 copies of the book will be made freely available to front- She said that ‘the last decade has wit- line clinicians, and will be distributed through nessed enormous advances in the preven- existing training networks of district training tion, diagnosis and treatment of TB’. “ De- co-ordinators, regional training centres, and spite this, TB remains the leading cause of support partners throughout the country.

COVID-19: Science and global health governance under attack

ecent developments in the US and SA high- NGO bought an urgent applica- light that misguided ideology, partisan infor- tion to the Constitutional Court, R mation flows, politics, and pseudoscience arguing against the lockdown pose a critical threat to science and undermines glob- on the grounds that COVID-19 al health governance. was not being harmful to Afri- cans. While the Constitutional In the US, President Donald Trump, has touted an Court dismissed the applica- antimalarial drug as an effective treatment against tion, the case revealed that COVID-19 without sufficient corroborative scientific charlatans were peddling sci- evidence, and against the advice of senior scientists. entific falsehoods, and that With the US now leading the world on COVID-19 inci- such information was being dence and mortality, Trump has sought to blame the misused for misguided political WHO for this parlous state of affairs. and ideological ends.

On 14 April 2020, Trump announced that he was The US and South African experiences underscore halting funding to the WHO while a review was con- how easily a populist, hyper-partisan, fragmented ducted of the WHO’s ‘role in severely mismanaging global information ecosystem can undermine science and covering up the spread of coronavirus’. Trump’s and threaten health governance. decision to scapegoat the WHO in an attempt to dis- tract attention away from his administration's domes- - Jerome Singh. tic failings, is amoral and constitutes an assault on global health governance, endangers public health, For further reading see: and is akin to committing ‘a crime against humanity’. Singh JA. COVID-19: Science and global health govern- ance under attack. South African Medical Journal 2020;110 Meanwhile, in South Africa, soon after the coun- (5):. DOI:10.7196/SAMJ.2020v110i5.14820. Accessible: try’s lockdown was announced, an obscure local http://www.samj.org.za/index.php/samj/article/view/12908 March/April 2020 19(3): page 5 Scientiic papers published in 2020

Misra N, Padayatchi N, Naidoo P. Dose-related adverse events in South African patients pre- 8* scribed clofazimine for drug-resistant tuberculosis. South African Medical Journal 2020; 110(1):32- 37. Furin J, Loveday M, Hlangu S, Dickson-Hall L, le Roux S, Nicol M, Cox H. “A very humiliating ill- 9 ness”: a qualitative study of patient-centered Care for Rifampicin-Resistant Tuberculosis in South Africa. BMC Public Health 2020; 20(1):76 doi: 10.1186/s12889-019-8035-z. Joseph Davey DL, Pintye J, Baeten JM, Aldrovandi G, Baggaley R, Bekker LG, Celum C, Chi BH, Coates TJ, Haberer JE, Heffron R, Kinuthia J, Matthews LT, McIntyre J, Moodley D, Mofenson LM, Mugo N, Myer L, Mujugira A, Shoptaw S, Stranix-Chibanda L, John-Stewart G; PrEP in Pregnancy 10 Working Group. Emerging evidence from a systematic review of safety of pre-exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading? Journal of the International AIDS Society 2020 23(1):e25426. doi: 10.1002/jia2.25426. Vandormael A, Tanser F, Cuadros D, Dobra A. Estimating trends in the incidence rate with interval 11 censored data and time-dependent covariates. Statistical methods in medical research. Statistical Methods in Medical Research 2020;29(1): 272-281.

Ayton SG, Pavlicova M, Tamir H, Abdool Karim Q. Development of a prognostic tool exploring 12 female adolescent risk for HIV prevention and PrEP in rural South Africa, a generalised epidemic setting. Sexually Transmitted Infections 2020;96(1): 47-54. Zhao LP, Fiore-Gartland A, Carpp LN, Cohen KW, Rouphael N, Fleurs L, Dintwe O, Zhao M, Mood- ie Z, Fong Y, Garrett N, Huang Y, Innes C, Janes HE, Lazarus E, Michael NL, Nitayaphan S, Pitisuttithum P, Rerks-Ngarm S, Robb ML, De Rosa SC, Corey L, Gray GE, Seaton KE, Yates NL, 13 McElrath MJ, Frahm N, Tomaras GD, Gilbert PB. Landscapes of binding antibody and T-cell re- sponses to pox-protein HIV vaccines in Thais and South Africans. PLoS One 2020; 15 (1):e0226803. doi: 10.1371/journal.pone.0226803. Ditse Z, Mkhize NN, Yin M, Keefer M, Montefiori DC, Tomaras GD, Churchyard G, Mayer KH, Karu- na S, Morgan C, Bekker LG, Mlisana K, Gray G, Moodie Z, Gilbert P, Moore PL, Williamson C, 14 Morris L. Effect of HIV Envelope Vaccination on the Subsequent Antibody Response to HIV Infec- tion. mSphere 2020; 5(1): e00738-19.

Hill J, Dickson-Hall L, Grant AD, Grundy C, Black J, Kielmann K, Mlisana K, Mitrani L, Loveday M, Moshabela M, Le Roux S, Jassat W, Nicol M, Cox H. Drug-resistant tuberculosis patient care jour- 15 neys in South Africa: a pilot study using routine laboratory data. The International Journal of Tuber- culosis and Lung Disease 2020; 24(1):83-91.

Perumal R, Naidoo K, Naidoo A, Ramachandran G, Requena-Mendez A, Sekaggya-Wiltshire C, Mpagama SG, Matteelli A, Fehr J, Heysell SK, Padayatchi N. A systematic review and meta- 16 analysis of first-line tuberculosis drug concentrations and treatment outcomes. The International Journal Tuberculosis and Lung Disease; 2020; 24(1):48-64.

Thakoordeen-Reddy S, Winkler C, Moodley J, David V, Binns-Roemer E, Ramsuran V, Naicker T. Maternal variants within the apolipoprotein L1 gene are associated with preeclampsia in a South 17 African cohort of African ancestry. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2020; 246:129-133.

*continuation from previous newsletter

Board of Control: B Ntuli (Chair) • M Rajab (Deputy Chair) • Q Abdool Karim • SS Abdool Karim • AC Bawa • D Clark • JM Frantz • LP Fried (US) • S Harrison ) • S Madhi • K Naidoo • N Padayatchi  D Ramjugernath • LV Theron Scientific Advisory Board: F Barré-Sinoussi (Chair) • T Quinn (Vice Chair) • P Godfrey-Faussett • R Hayes • J Mascola • Y Pillay • S Swaminathan

Registration number: 2002/024027/08 • PBO number: 930 018 155