Eliminating Malaria: the Challenges Ahead

THE NEWSLETTER OF BURNET INSTITUTE | SPRING 2015

ELIMINATING MALARIA: THE CHALLENGES AHEAD

MYANMAR: IMPROVING PUBLIC HEALTH IN A SUSTAINABLE WAY

burnet.edu.au DIRECTOR’S REPORT

Welcome to the spring issue of IMPACT.

As many of you know the Institute has been mourning the tragic death of our long-serving Chair, Alastair Lucas AO in July. Ironically, this champion of medical research died far too young of a brain cancer for which science has not yet discovered an answer. In this issue we reflect on the significant contributions Alastair made to Burnet Institute during his 12-year tenure. To recognise and celebrate his achievements the Institute has established the Alastair Lucas Endowment Fund that will support the Alastair Lucas Prize for Medical Research in perpetuity. This internationally competitive prize will fund a talented mid-career researcher to work at Burnet with a focus on research relating to our mission; improving the health of the poorest and most vulnerable people in Australia and the world. I would welcome your support of the endowment fund. More information is available at burnet.edu.au/alastairlucas. INSIDE FEATURES I take this opportunity to welcome long-serving board member Mr Robert Milne as Burnet’s incoming Chair. Rob has served the Institute as a non-executive 3 NEW BURNET INSTITUTE CHAIR director since 1998 and stepped in as interim-Chair when Alastair became NANJING BIOPOINT LABORATORY ill last year. He brings a wealth of corporate experience with him, especially LAUNCHED through his career as CEO, then Chairman, of Cockram Constructions. We look 4 TRIBUTE TO ALASTAIR LUCAS AO forward to Rob’s leadership and working together as we commence a new phase of the Institute’s growth. 6 ELIMINATING MALARIA 8 LATEST DISCOVERIES FROM OUR LABS In this issue of IMPACT we also focus on disease elimination, highlighting 9 BURNET INSTITUTE CHAIR VISITS PNG the challenges of eliminating malaria, a disease that claims more than 600,000 lives each year. There is a renewed commitment globally to the 10 MYANMAR: IMPROVING PUBLIC HEALTH possibility of eradication and elimination of infectious diseases. However, IN A SUSTAINABLE WAY only smallpox has been successfully eradicated to date, where the global 12 TAP STUDY: A KEY TO HEPATITIS C incidence of infection has been totally reduced to zero. Polio and measles are ELIMINATION prime examples of what can be achieved through effective vaccination and 14 PHILANTHROPIC SUPPORT IN ACTION treatment programs. But can diseases such as malaria, HIV and hepatitis C 15 GIFTING IN YOUR WILL be effectively eliminated? While Burnet is already engaged in research focusing on the elimination Burnet Institute is an Australian, unaligned, of infectious diseases, our plans are to ramp that up significantly into the independent, not-for-profit, medical research future. Our malaria researchers recently discovered how antibodies work and public health organisation whose in partnership with other proteins in the blood in blocking malaria infection, mission is to achieve better health for poor opening the door towards an effective vaccine and this, together with other and vulnerable communities in Australia and interventions offers real hope for elimination. internationally through research, education and public health. The development of a newly available class of drugs and new candidate vaccines offers potential for the elimination of hepatitis C. While the new drugs offer significant hope for a cure to those already infected with the virus, the combination of vaccination and drug treatment means that the potential for elimination of hepatitis C is very real. Similarly, the HIV cure initiative, new drugs and the potential that pre-exposure prophylaxis (PrEP) offers, Cover image: means that elimination of HIV is also a very real possibility. Woman being We have initiatives that relate to hepatitis C, HIV and malaria elimination tested for malaria – and we plan to do much more. Much of this work can only be made possible in Myanmar. with your support, so thank you for all you do in helping make this possible. As always I am happy to talk about any aspect of the Institute’s activities and All donations over $2 are fully tax deductible. Where possible people how you can help us to achieve a healthier world. who appear in images included in this publication were photographed with their permission. There is no implication that these people have any infectious diseases. If you would like to discuss any issue from this edition please call Paul Rathbone on (03) 9282 2111. Managing Editor: Tracy Parish. Contributing Editor: Angus Morgan. Burnet staff writers: James Beeson, Lia Burns, Jason Smith. Photo credits: Angus Morgan, Corey Wright Photography, Htin Kyaw Thu, Paul Gilson, Paul Rathbone, Soe Lin Htut, Tope Adepoyibi, Wai Yan Min Htay. Design: Francis Maurice Design. Professor Brendan Crabb AC Director and CEO

2 IMPACT SPRING 2015 Robert Milne the new Burnet Institute Chair

Long-serving board member, Robert Milne is the incoming Chair of the Board, following the sad passing of Burnet champion, Alastair Lucas AO.

Mr Milne, who has spent He has pledged to do all “He leaves behind an Mr Milne has a background more than 15 years on in his power to honour the amazing contribution and in engineering and more than “amazing contribution” shoes that are very hard to four decades of experience the Board, was Acting of the man he succeeds. fill, but fill them we shall, in the construction industry. Chair from September as we seek to enhance the He has been Chairman of “Alastair’s contribution to 2014 when Mr Lucas scope, nature and output Cockram Construction since Burnet Institute has been of Burnet to fulfil Alastair’s 2000. He joined Cockram in was diagnosed with a enormous, helping to steer dream of improving the 1984 as Managing Director terminal brain tumour. the Institute through many health outcomes of poor and and helped to establish it as challenges over the 12 years marginalised communities in a specialist high-tech design of his tenure as Chair and Australia and internationally. and construction contractor three years as a non-executive throughout Australia and Asia. director,” Mr Milne said.

NANJING BIOPOINT LABORATORY LAUNCHED

Burnet Institute‘s vision of commercial development a long-term engagement in in conjunction with our China has taken a major step investment partners at forward with the launch of GuoMinXinHe Group,” the R&D laboratory facility for Associate Professor the Burnet spin-off company, Anderson said. Nanjing BioPoint Diagnostics Technology Co. Ltd. “This venture also provides a tangible funding stream to Burnet Institute Deputy support the wider work of Director, and President and the Institute with vulnerable CEO of Nanjing BioPoint, communities in the western Associate Professor David provinces of China and other Anderson said the facility, resource-poor settings.” officially opened by the Australian Ambassador A point-of-care (POC) test to to China, HE Ms Frances identify undiagnosed liver Adamson, would translate disease is the first target of Burnet’s diagnostic research R&D and commercialisation at and technologies into Nanjing BioPoint in conjunction commercially viable products. with Burnet’s Melbourne-based laboratory team. “Nanjing BioPoint is a strong signal of our long-term “This POC liver test will commitment to collaborative help fill an unmet medical research and development need for patients, especially in China, and will facilitate those living in low-income timely delivery of new health countries where laboratory Above: Australian Ambassador to China, HE Ms Frances Adamson technologies to our target testing is difficult to access with President Bai Muchun from GuoMinXinHe Group (middle) and populations worldwide and expensive,” Associate Burnet board member, Mr Ben Foskett. through cost-effective Professor Anderson said.

IMPACT SPRING 2015 3 A TRIBUTE TO BURNET CHAMPION ALASTAIR LUCAS AO

BURNET CHAIR 2002-2014

Undoubtedly, Alastair Lucas loved “His strategic advice and financial “He was a great the Burnet Institute. When he acumen enabled Burnet to establish a global reputation for excellence in joined the Board in 1998 he was believer in science research and public health activities, and committed to making a difference, put itself in a strong and stable financial and its application to enhancing Burnet’s business position,” Professor Crabb said. and strategic opportunities, to to create a healthier, In a fitting farewell, more than 350 ensuring its mission was achieved friends, family and colleagues gathered more equitable and through a culture of excellence, in Melbourne in August to pay tribute innovation and impact. to Alastair. better world. He was a

He became part of the Burnet family, Australia’s Ambassador for Women and passionate supporter serving on the Board from 1998-2014, and Girls, Ms Natasha Stott Despoja AM spoke as Chair for 12 of those years. Sadly, aged warmly about how Alastair had convinced of our work and our 63, Alastair passed away on 6 July 2015 her to join the Burnet Board and his after being diagnosed with an inoperable passion for international health that was mission to achieve brain tumour the previous year. evident during their trips to visit Burnet’s projects in Myanmar, Lao PDR and Papua better health for the Close friend, and Institute Director New Guinea. and CEO, Professor Brendan Crabb AC poorest and most said Alastair’s passionate commitment “As Chair of Burnet for more than a marginalised people to medical research and international decade, he wanted to change lives for health had touched many lives. the better, especially in disadvantaged in our own community communities around the world. He “Alastair leaves an outstanding legacy understood better than most, the notion and throughout for all those whose lives were touched that the accident of birthplace should not by him, and the many lives saved through determine our fates or our futures and the world.” his generosity and passionate support he took seriously his responsibility as of medical and public health research,” a global citizen to make a difference,” – PROFESSOR BRENDAN CRABB AC Professor Crabb said. Ms Stott Despoja said. Alastair’s contribution, not only to Burnet, but Australian public life, had been exemplary.

4 IMPACT SPRING 2015 Australia’s Federal Health Minister, the He will be remembered for his Hon Sussan Ley MP shared Prime Minister extraordinary intellect, his involvement in Alastair Lucas Tony Abbott’s reflections on the impact significant conservation causes, and most Endowment Fund that Alastair had achieved through this importantly, his quest for a sustainable advocacy for better health for poor and resource dedicated to medical research,” vulnerable people. Professor Samuel said. The fund will support in “Alastair made an impressive contribution New Burnet Institute Chair, Mr Rob Milne perpetuity the Alastair Lucas to our nation as a businessman, has pledged to honour the “amazing Prize for Medical Research into philanthropist and humanitarian, and contribution” of his predecessor and said he inspired those around him with his Alastair’s vision and passion for Burnet’s diseases affecting poor and wisdom, dedication and sense of duty. work would live on through the Alastair disadvantaged communities. Alastair’s legacy is enshrined in part by Lucas Endowment Fund. It was launched with generous the Medical Research Future Fund. He was financial contributions from a tireless advocate for increased support Founding Partners, Goldman for medical research, and the fund, as well as the Fellowship established in his name, Sachs Australia, the Macquarie will be a lasting memorial to him,” “Our lives are all Group and GuoMinXinHe Group. Minister Ley said. enriched by having To make a donation go to Professor Graeme Samuel AC first met burnet.edu.au/alastairlucas Alastair in the 1980s and said he was known and loved grateful for so many years of friendship, support, wisdom and above all his this greatly unqualified integrity. honourable man.” “He was the significant driving force behind the establishment of Burnet – MR ROBERT MILNE as a sustainable international leader in research into infectious diseases.

businessman philanthropist advocate humanitarian

IMPACT SPRING 2015 5 ELIMINATING MALARIA: THE CHALLENGES AHEAD By Professor James Beeson

Malaria is a disease n an era of emerging While the recent reduction cases of malaria each year. of poverty. Of the resistance to frontline in malaria burden is a Resistance initially emerged Itreatment drugs and vector tremendous achievement, in Cambodia and appears to 600,000 deaths control interventions, there there are major challenges be spreading or developing attributed to malaria is a renewed commitment by ahead to progress towards in other Asian countries, and each year, most are the malaria community, global malaria elimination. Ongoing there is increasing concern caused by Plasmodium leaders and major funding innovative research to resistance will also eventually organisations towards malaria develop and evaluate novel develop in Africa. falciparum in African elimination. Short term, the antimalarial drugs, vaccines, children younger goal is to eliminate the deadly and diagnostics is needed, Currently, there are no new disease from as many regions along with developing drugs in the immediate than ﬁve years as possible, and ultimately to new strategies for malaria pipeline to replace the of age. This is despite achieve global eradication in elimination and surveillance artemisinin. Meeting this the future. in affected populations. challenge, the Fowkes increased global efforts Laboratory at Burnet is that have halved Major gains in reducing the Burnet’s malaria program involved in studies tracking malaria-related deaths global malaria burden have is strongly aligned with the and containing artemisinin been achieved in the past global vision for malaria resistance in the Mekong in recent years. decade through increased elimination. Our research is region of South East Asia, control measures such as addressing several key areas investigating how malaria insecticide-treated bed nets, and activities that aim to immunity inﬂuences drug access to early diagnosis strengthen malaria control resistance, and developing and effective treatment, and and build capacity in PNG, tools to predict resistance increasing the use of the most Myanmar and Timor-Leste. and contain it. The Gilson/ effective group of antimalarial Crabb Laboratory has been drugs, artemisinins (typically Resistance to conducting research into the artesunate, artemether, or malaria parasite’s biology to dihyroartemisinin). However, antimalarial drugs identify ‘chinks in its armour’ malaria remains a major and insecticides that can be exploited as health issue, affecting an An emerging global crisis targets for new antimalarial estimated 219 million people in malaria treatment and drugs. Already compounds each year, mostly in the control is the emergence and have been discovered that regions closest to Australia spread of resistance to the prevent parasites from and where Burnet Institute artemisinin drugs. These are infecting red bloods cells works, such as Papua New the frontline treatment for where they cause disease and Above: Naw Thin July Win is an Guinea (PNG), Myanmar, Lao malaria and currently used to for starving the parasites to outstanding volunteer working PDR, Timor-Leste, Indonesia treat several hundred million prevent them from growing. on Burnet’s malaria project in and sub-Saharan Africa. Kayin State, Myanmar.

6 IMPACT SPRING 2015 MALARIA is caused by the parasite Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body the parasites multiply in the liver and then infect red blood cells. If not treated, it can quickly become very serious and life-threatening by disrupting the blood supply to vital organs.

The ﬁrst symptoms – fever, headache, chills and vomiting – may be mild but if not treated within the ﬁrst 24 hours a child Above: Wolly Gerson (right) and daughter Racheal Orim are volunteers in Burnet’s malaria at home project in Matalua Village, East New Britain, PNG. can become severely ill.

Vaccines Associate Professor David to quantify the coverage Anderson, the malaria of malaria prevention There is an urgent need for the team is also using a novel and control measures, development of highly effective vaccine platform to generate and identify gaps that vaccines to protect people highly effective vaccines, can be ﬁlled as part of against malaria and to advance in partnership with Artes Burnet’s Healthy Mothers, malaria elimination. Vaccines Biotechnology and the PATH Healthy Babies program. have proved to be extremely Malaria Vaccine Initiative. This important work is valuable in the control and in collaboration with key elimination of other infectious Every 45 seconds partners and stakeholders diseases. Developing highly Improving access in PNG including the East a child dies protective malaria vaccines to treatment and New Britain Provincial from malaria has proved hugely challenging prevention Government, the PNG partly due to our limited Maximising access to early Institute of Medical understanding of immunity to diagnosis and effective Research, National malaria. Recent work by the treatment of malaria, Department of Health, Beeson, Richards, Fowkes, insecticide-treated bed nets, and University of PNG. Jaworoswki and Ramsland and preventive treatment In Myanmar, Burnet 600,000 laboratories have made major in high-risk groups (young collaborates with Karuna insights into human immunity deaths each year children and pregnant women) Myanmar Social Services to malaria, revealing key are all part of a global strategy and the National Malaria immune mechanisms that in the ﬁght against the Control Program. prevent and clear malaria disease. However, in many infection. Studies have shown areas access to essential Recent gains in malaria that antibodies produced by the treatment and prevention control have ignited a great immune system recruit a group 219 million is still low. Since 2012, Burnet sense of optimism about of blood proteins known as has been implementing the future elimination cases globally complement, or immune cells community-based of malaria. However, called monocytes, to effectively management of malaria this will require a kill or neutralise malaria. programs in East New long-term commitment Burnet researchers believe that Britain Province in PNG, with many major generating this type of double- and more recently on the challenges to overcome. punch immune response could Burnet’s malaria research 2.3 billion Myanmar-Thailand border be crucial to developing highly that aim to maximise access and implementation teams people at risk effective malaria vaccines to malaria testing and are strongly committed for elimination. With the effective malaria treatment to this long-term goal, Head of Burnet’s Diagnostic using community volunteers. working closely with Development Laboratory, Research is also underway our partners nationally and internationally.

IMPACT SPRING 2015 7 LATEST DISCOVERIES FROM OUR LABS

Burnet Institute’s Discovery of malaria-blocking happens to the parasite, the researchers immune response opens door could establish what the proteins are internationally renowned doing and in what order they were for vaccine malaria researchers working. It is an important step towards This breakthrough research by Professor vaccine development. in the Centre for James Beeson and his team was published in the prestigious international journal, “It has enabled us to ascribe more Biomedical Research have Immunity. The discovery of how antibodies precisely the roles of the different proteins. published groundbreaking work in partnership with other proteins What’s new is that no one’s ever taken this in the blood, known as complement, in approach before,” Dr Gilson said. discoveries in prestigious blocking malaria infection, opens the door towards an effective vaccine. This The research was published in Nature international journals. new research provides evidence that Reviews Microbiology. complement plays a key role in antibody- mediated immunity to blood-stage New insights into how monocytes replication of Plasmodium falciparum attack the malaria parasite Figure 1 malaria in humans. (Fig 1). Researchers from the Jaworowski Laboratory have identified the type of “Exploiting this malaria-blocking activity is monocyte – white blood cells critical to a new approach in developing a vaccine. We immune function – best equipped to attack have shown that it is possible to effectively the malaria parasite, along with new generate this protective immune response insights into how the monocyte does this. by immunising humans with a candidate Published in the journal BMC Medicine, the vaccine,” Professor Beeson said. research identifies intermediate monocytes “Creating a vaccine that can rapidly as responsible for ingesting red blood cells induce this type of immune response infected with the malaria parasite, which is in children to prime the immune system important for the control of malaria in the to fight malaria when infected, may blood and for orchestrating subsequent prove a valuable strategy to prevent immune responses. They noticed the the devastating effects of malaria.” special role of intermediate monocytes by experimenting using whole blood rather A first: Live cell imaging of malaria than the conventional approach using purified white blood cells. The research is a For the first time, Burnet researchers have step towards the development of a test that captured how certain proteins are used will predict the effectiveness of vaccines. by the malaria parasite to invade a red blood cell. Using highly specialised video equipment Dr Paul Gilson and his team documented the invasion of red blood Image: Parasites cells by the malaria parasite in real time. deforming a red By blocking different proteins the parasite blood cell captured by uses for invasion and observing what Dr Gilson’s innovative research video.

8 IMPACT SPRING 2015 Burnet Institute Chair visits PNG By Mr Robert Milne

Just getting to and from initiative, is funded totally and analysed in a specially flagship program, especially Kokopo in East New Britain from philanthropic donations fitted-out Burnet laboratory the tremendous support Province in Papua New Guinea and led by Professor James at St Mary’s Hospital. Some provided by our donors. was an experience in itself. Beeson. Dr Michelle Scoullar is samples are sent to other labs After flying to Brisbane for leading the project in Kokopo, for further testing and reference Mr Milne travelled with Burnet an overnight stop, then on to assisted by a wonderful samples are sent to Burnet’s Director and CEO, Professor Port Moresby, our connecting team of employees who Melbourne laboratories for Brendan Crabb AC, Head of flight to Kokopo was cancelled have been recruited from the safekeeping at -80C conditions. Public Affairs and Development requiring an overnight stay, local communities. We are Mr Paul Rathbone, and cutting short our stay in working in close collaboration My congratulations are long-time Burnet supporter, Kokopo by a day. with the PNG Department extended to everyone Dr Elizabeth Xipell. of Health, Kirby Institute, involved in this Burnet After being met by some of the St Mary’s Hospital, and local team from our Kokopo office, hospitals and health centres. we visited a village where the Community involvement is Ward representative (village critical to our success. elder) Gregory and Mary, I have just returned from my first a volunteer, explained how The driver for the HMHB visit as Chair to PNG to see first hand the malaria program, funded program is the extremely “the malaria and Healthy Mothers, by The Global Fund, operates. poor health outcomes for mothers and their babies in Healthy Babies programs. What an Our team led in Kokopo the antenatal and postnatal – Mr Robert Milne by Hadlee Supsup has recruited stages. Using strong scientific eye-opener it was! 100 local volunteers, equipped principles the program them with point-of-care is identifying the prime malaria test kits, trained causes of these adverse and supervised them in outcomes and will lead to their use, and dispensed the development of new the antimalarial, Malar1. interventions to improve the The outcomes are proving health of these communities. very beneficial, including early diagnosis and treatment for The scale and complexity malaria, referral to health of the program are massive. centres for people with Dr Scoullar and her team are continued fever (pneumonia, recruiting a cohort of 700 bronchitis etc), and a great women, testing them at five sense of commitment and pride stages of their pregnancy from from the local volunteers and first identification through their supporters. to delivery, then one month, three months, six months and Our Healthy Mothers, Healthy twelve months after birth. Babies (HMHB) program, Samples, including blood and which is a major Burnet urine are processed, recorded

IMPACT SPRING 2015 9 MYANMAR

Improving public health 130+ in a sustainable way staff 15 projects

86 townships

“Burnet Institute has been actively involved in health programs ALL States in Myanmar for more than a decade and it is testament to the and Divisions outstanding abilities and efforts of our international operations staff that we continue to make a positive impact.” 13 NGO – PROFESSOR BRENDAN CRABB AC, DIRECTOR AND CEO, BURNET INSTITUTE project-based

Since the late 1990s Burnet core team of national staff in remain despite recent partners Institute has been active in Yangon, and supported by our political changes that have Myanmar, building initially Melbourne headquarters. The resulted in progress toward on small consultancies core approach is to strengthen development and resourcing of and capacity support, to national and community comprehensive development 16 establishing an office in health systems and services strategies for the social the capital Yangon and with civil society partners, sectors,” Ms Burns said. networking working in each of the 14 international organisations, partners States and Divisions. This UN agencies and Government “At least a quarter of the has been possible through stakeholders across censused population in 2014 a historic Memorandum of 86 townships. of 52 million people live below Understanding (MoU) with the poverty line, with five per the Ministry of Health signed Burnet’s Country Program cent living in absolute poverty.” 480,000+ in 2003, which formalised Manager for Myanmar, Ms Lia The three priority areas people have Burnet’s presence as an Burns outlines the challenges that respond to nationally international non-government faced in responding to ongoing benefitted identified health issues are organisation (NGO) in and emerging needs in a also aligned to Burnet’s areas from our HIV, the country. country experiencing significant and rapid socio-political and of specialisation and globally TB, malaria, More than a decade on, economic growth. recognised expertise – major with a recently updated MoU, infectious diseases; maternal, and maternal Burnet’s Myanmar Program is “Significant disparities in neonatal and child health; and and child delivered and managed by a wealth and opportunity adolescent health. health work

10 IMPACT SPRING 2015 Major infectious death and disability due to Improving public health generation for translation diseases – HIV, a lack of skilled health care in a sustainable way into improved practice in for mothers, newborns and evidence-based programing. tuberculosis children aged under ﬁve.” In a country undergoing and malaria rapid change, Burnet’s Research and program aims to contribute These preventable diseases are Adolescent health to improving public health in development projects the leading causes of death and This is a new and exciting a sustainable way. Myanmar “Delivering services through illness in Myanmar resulting area of the program Country Representative, Dr ﬁve drop-in centres according in diminished economic, using the expertise of Phone Myint Win said this will to international best practice educational, and socio-political targeted partnerships and be achieved through timely in harm reduction services opportunity and participation. collaborations with national, and relevant contribution to for people who inject and use regional and international “Our program seeks to prevent, health systems strengthening drugs is already underway,” agencies to respond to the and service delivery. Dr Phone said. diagnose and ensure treatment changing demographics in and care for vulnerable Myanmar. As a country in pre- “We are supporting the “The aim is to minimise populations susceptible to transition economic growth, in-service training of midwives harms to individuals and these infectious diseases, the adolescent population and auxiliary midwives for the community of drug use, and to minimise the burden has an important place in the improved quality of care across and improve the quality of life of ill health,” Ms Burns said. future social and economic a range of areas for pregnant and opportunity for economic women and newborns. This “For example, we are currently development. and social participation for involves maternal nutrition, working with key affected those people.” “It’s a young country, with emergency obstetric care, populations of people who 28 per cent of the population newborn care and skilled birth Burnet’s expanded operational inject and use drugs and men between 10 - 24 years of attendants,” he said. and primary research projects who have sex with men where age, but almost two-thirds will contribute to, and inform, the HIV prevalence is highest of adolescents are living in The Myanmar program ongoing policy development (23 per cent, 6.6 per cent).” rural areas where access to draws on Burnet’s global and programing, ensuring economic opportunity and reputation in public health the best use of resources for Maternal, neonatal social services is limited,” research and evaluation positive health outcomes. and child health Ms Burns said. to promote knowledge Outcomes remain poor, “The Myanmar Government and coupled with a weak Burnet’s projects in Myanmar recognises the interdependence health system, there are of positive health and barriers hindering women’s Harm reduction education outcomes, participation in socio-economic Malaria and prioritises support to life, greater empowerment and Maternal, neonatal and child health adolescents in the areas gender equity. Men who have sex with men of sexual and reproductive KACHIN Tuberculosis “We recognise that the health, and primary and involvement of the entire secondary education. family in health seeking “Burnet is planning a decisions and behaviours is program of work within the SAGAING critical to increasing demand monastic schooling system and access to quality health that addresses barriers to CHIN services,” Ms Burns said. retention in school. These SHAN MANDALAY “Our program supports the barriers affect sexual empowerment of women and reproductive health, RAKHINE encultured gender inequities and men of reproductive MAGWAY age to understand maternal and gender-based violence. KAYAH and child health needs. They We will also be focusing on also learn how to access water supply and sanitation, BAGO services in a timely manner including menstrual hygiene KAYIN to prevent unnecessary management,” she said. YANGON

AYEYARWADY MON

TANINTHARYI

Left: Role play with midwives during in-service training for emergency obstetric care.

IMPACT SPRING 2015 11 TAP STUDY:

A KEY TO HEPATITIS C ELIMINATION

Hepatology medicine has reached a watershed that could result in the elimination of hepatitis C virus (HCV) in Australia within 15 years through the combination of vaccination, new direct-acting, all oral drugs and changes in treatment.

n a world-first, Burnet “A treatment and prevention not yet subsidised under addresses this by providing Institute’s innovative approach gives us the the Pharmaceutical Benefits nurses to treat and monitor ITreatment and Prevention opportunity to eliminate Scheme. Trials indicate participants in outreach vans (TAP) Study directly targets the virus by treating people sofosbuvir and ledipasvir and clinics located in their those at greatest risk of HCV infected with hepatitis C for are highly effective with local communities. infection, people who inject their own direct health benefit cure rates better than drugs (PWID). who are missing out now, 95 per cent, can be taken for “To eliminate hepatitis C in and at the same time stopping a shorter duration, and are Australia, we have to work Head of Burnet’s Centre for ongoing transmission of well tolerated with minimal out how to use these new Population Health, Professor the virus.” side effects. Because these medications sensibly in Margaret Hellard believes new HCV medications require community settings to reduce hepatitis C treatment and Conducted in collaboration less specialist expertise than the disease transmission.” prevention presents an with St Vincent’s Hospital existing treatments, this The TAP Study explores the unprecedented opportunity and The Alfred hospital presents an opportunity for concept of ‘treatment and to eliminate HCV in Australia, in Melbourne, TAP will new models of care and the prevention’ (also known as and reduce harms and costs. assess the feasibility of prospect of treating PWID ‘treatment as prevention’) The TAP Study is examining the community-based treatment, without them having to where treatment not only feasibility of this approach. and whether treatment attend a hospital service. and prevention can reduce results in cure for the “There is stigma and hepatitis C transmission “Attending a large hospital or individual, but also prevents discrimination against people and prevalence. TAP Study health service has commonly the spread of HCV to others. infected with hepatitis C, and participants infected with been a barrier to care for Recent modelling suggests the populations who are at hepatitis C will be treated people who inject drugs,” that treating PWID and risk of hepatitis C,” Professor with new medications, TAP Clinical Director, their immediate contacts Hellard said. sofosbuvir and ledipasvir, Dr Joseph Doyle said. simultaneously (a ‘bring your made available through a friends’ strategy), versus “But if treatment can be multimillion-dollar grant “But they are comfortable treatment of an individual delivered effectively to by Gilead Sciences. Both being treated in a community alone, will substantially high-risk transmitters such drugs have been approved setting by clinicians, and reduce long-term HCV as people who inject drugs, in the USA and are now other support services, prevalence and treatment significant reductions in future licensed in Australia, but they know and trust. TAP costs. The ‘bring your hepatitis C cases are possible.

12 IMPACT SPRING 2015 We now have the privilege and opportunity to stop deaths from hepatitis C, to stop transmission and to eliminate the virus as a public health problem.

– PROFESSOR MARGARET HELLARD

Above: TAP Clinical Director, Dr Joseph Doyle and Head of Burnet’s Centre for Population Health, Professor Margaret friends’ strategy reduces Melbourne linked to The Alfred Hellard in one of the TAP outreach vans. the risk of HCV reinfection and St Vincent’s hospitals. post-treatment and impacts on HCV transmission through Throughout the course of HEPATITIS C “the network. the study approximately 270 people will receive treatment For the TAP Study there for their hepatitis C. Study > A blood-borne disease, hepatitis C is caused will be three groups of 140 visits will include blood by a virus that infects the liver. In time, it can participants each, including tests, clinical assessments lead to cirrhosis, liver cancer or liver failure. 40 primary participants in by a research nurse including each group who must have a mobile liver scan, and > Hepatitis C affects an estimated 130–170 HCV, and 100 secondary questionnaires about drug million people globally and causes the deaths participants, partners and use, health and quality of of 350–500,000 people each year. friends of primary participants life. No one who participates who do not have to have HCV. and is HCV-positive will miss > In high-income countries, people who out on treatment with new Recruitment for TAP started in medications. The study will inject drugs (PWID) are at greatest risk April 2015 with participants run for approximately two of HCV infection. drawn initially from the years, with the ﬁrst results SuperMIX Study, a cohort of expected by the end of 2016. > More than 230,000 Australians, most with a more than 700 PWID, many history of injecting drug use, live with chronic with chronic HCV infection, “TAP has a pivotal role to play hepatitis C. who have been participating in in this. We expect the results research with Burnet for many of this study will be used > Only one-to-two percent of these people are years. There will be further to support equitable access recruitment from Burnet’s to these new medications treated annually. PATH Study of prisoners with in the future, and inform a history of injecting drug use, the roll-out of hepatitis C and PWID linked to a number of treatment globally,” HCV outreach services across Professor Hellard said. TAP STUDY DESIGN

GROUP Participants given deferred Below: TAP Study participants will be treated with new medications, treatment at the end of the study sofosbuvir and ledipasvir. A

GROUP Only the primary participants B are treated immediately

GROUP Both primary participants and HCV-positive secondary C participants will be treated immediately. This is the ‘bring your friends group’ and represents a novel approach to treatment.

IMPACT SPRING 2015 13 Thanks to you ... In recent months your gifts have enabled us to progress our work into new cancer treatments, better health for mothers and babies, and reducing harm from injecting drug use.

Burnet’s new laboratory at St Mary’s Hospital in Kokopo, Papua New Guinea ...

Then And Now! NEW LABORATORY HELPS SAVE LIVES OF MUMS AND BABIES A vacant room at St Mary’s Hospital in Kokopo, Papua New Guinea has been transformed into a functional laboratory that will save lives. It is the ﬁrst laboratory in the region that has the capability of undertaking a range of tests for infections that can claim the lives of vulnerable mothers and babies. Thank you for making that possible!

Smart technology offers prospect of better TB diagnosis, thanks to you!

The TB test that we are working on will look and operate in a very similar way to this VISITECT® CD4 test, which was also developed thanks to the generosity of people like you. Above: Dr Suman Majumdar, Ms Mary Garcia, Associate Professor David Anderson and Dr James Trauer (L-R).

“This simply wouldn’t have been possible without your help. Thank you!”

Professor Brendan Crabb AC, Director and CEO, Burnet Institute

14 IMPACT SPRING 2015

A GIFT IN YOUR WILL CAN CREATE A HEALTHIER WORLD

When I started training as a young infectious diseases physician in the early 1980s HIV was a new and frightening epidemic. My colleague Anne Mijch and I started the ﬁrst HIV clinic at Fairﬁeld Hospital in Melbourne. It was pretty hard in those days as we knew so little about how to treat people with HIV. I received a fellowship in San Francisco in the mid-1980s to learn as much as I could about HIV, before returning to Burnet Institute.

Since then, research efforts around the world have been translated into knowledge and treatment for HIV infection, and as a result many HIV-positive people can now expect to live an almost full life-span.

I have some patients that I have been looking after since the early days. Together we have witnessed a transformation.

A bequest to Burnet Institute in the mid-1990s enabled us to start our educational work in India, helping train doctors to treat HIV infection. Those programs have now expanded into Lao PDR, Myanmar, Indonesia and Fiji.

Another bequest contributed to the very earliest stages of development of the HIV VISITECT® CD4 point-of-care test that determines whether an HIV-positive patient needs to start life-saving antiretroviral treatment.

Every bequest can make a difference.

“I have seen the critical importance of bequests and gifts to Burnet Institute.” Professor Suzanne Crowe AM Associate Director & HIV research scientist, Burnet Institute

IMPACT SPRING 2015 15 APPEAL “I have lived with HIV for 30 years. Managing the side effects of medication requires determination and a positive outlook on life.” – Paul

Side effects from HIV medication can be life-threatening. New drugs are urgently needed to ensure that people living with HIV continue to lead healthy lives. We urgently need your help to develop the next generation drugs against HIV. Please give today at burnet.edu.au

AUSTRALIA Overseas Offices Head Office The Institute has offices in Myanmar, Papua New Guinea and Lao PDR. For more information 85 Commercial Road, Melbourne, Victoria 3004 about our work or to contact our international offices, please email [email protected] or Tel: +61 3 9282 2111 call +61 3 9282 2111. Fax: +61 3 9282 2100 Email: [email protected] MYANMAR PAPUA NEW GUINEA No 226, 4th Floor, 226 Wizaya Plaza U, Port Moresby /burnetinstitute @BurnetInstitute Wisara Road, Bahan Township, 3 Mile, School of Medicine, Yangon Medical Sciences Building, University of PNG A.B.N. 49 007 349 984 LAO PDR Kokopo Lane 01B Dong Palane Thong, PO Box 1458, Kokopo Post Office, Ban Dong Palane Thong, East New Britain Sisattanack District, PO Box 2644, Vientiane burnet.edu.au You can make the difference of a lifetime, month by month.

Become a Burnet Health Champion TODAY! perf

Yes, I would like to become a Burnet Health Champion and change lives. Step 1: My gift Your monthly gift I would like to make a monthly gift of: $20 $50 $100 Other $

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Email: Please send me information about including a gift to Burnet Institute in my Will. Thank you for your support! Please send this form in the enclosed Reply Paid envelope or mail to: Burnet Institute, GPO Box 2284, Melbourne, Victoria, 3001. An acknowledgment will be sent to you promptly. You may also call Jason Hearn on (03) 8506 2370 to donate over the phone. Gifts over $2 are tax deductible in Australia. ABN 49 007 349 984 perf

Yes, I would like to become a Burnet Health Champion and change lives. Step 1: My gift Your monthly gift I would like to make a monthly gift of: $20 $50 $100 Other $

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