World AIDs Day 2023: Early Career Grant research into HIV and AIDS

01 Dec 2023

For World AIDs Day 2023, we spoke to a number of our Early Career Grant awardees about why they chose to focus on AIDS and HIV in their Early Career Grant research, and what this year’s theme of ‘Let Communities Lead’ means to them.

Lughano Ghambi

Research Topic: Respiratory pathogens and clinical characteristics of HIV-infected infants hospitalized with non-TB and non-CMV pneumonia, Malawi Liverpool-Wellcome Trust Clinical Research Programme, Malawi

RSTMH/NIHR Small Grant Awardee 2020​​​​​​​

"HIV infection in infancy greatly affects the infant's survival. In my research, we noted that most infant HIV cases were due to PMTCT failure which we attributed mostly to social issue i.e. pregnant women are more likely to be tested for HIV than their partners during antenatal visits, as such fear of informing their partners of the new HIV diagnosis meant no compliance to ART and no PMTCT to protect the infant as such leading to HIV infection in the infant.

"I believe if communities lead HIV programs through health education and awareness, pregnant women will be empowered to inform their partners of their new HIV diagnosis hence freely take ART's and reduce transmission to their unborn infants.

"I chose to study "Respiratory pathogens and clinical characteristics of HIV-infected infants hospitalised with non-TB and non-CMV pneumonia in Malawi" so that we can use the microbiological data to improve antimicrobial treatment options therefore hope to improve their survival. 

"HIV-infected infants generally present late to hospital when their symptoms are very advanced, as such survival chances are very thin.

"Communities can also lead in initiatives that promote good health seeking behaviour for mothers with infected or exposed infants, so that they can improve hospital outcomes."

Lucy Grace Banda

Research Topic: Assessing the determinants of and strategies for postpartum HIV-retesting among women who tested HIV negative antenatally in Thyolo district, Malawi

RSTMH/NIHR Small Grant Awardee 2021

"I decided to embark on this study since in Malawi, PMTCT services focus on an opt-out approach where a woman can opt out of a test rather than a mandatory approach. All pregnant women are offered HIV test at their first ANC visit then a repeat HIV testing at 3 months and during delivery if status is unknown. However, detection of HIV infection in women in late pregnancy or the postpartum period is uncommon as testing practices often focus on testing at the first antenatal visit and postpartum mothers can “opt-out”. Currently, upon confirming the HIV positive status of a postnatal mother, she is counseled and initiated on ART immediately whilst the baby is given Nevirapine syrup as prophylaxis. The National PMTCT program updates for 2020 reported that 36% of the new HIV infections among children during postpartum and breastfeeding were from mothers who became HIV positive after testing HIV negative during antenatal period.

"To achieve the goal of zero mother-to-child transmission of HIV, strategies should focus on the promotion of sustainable HIV re-testing within the PMTCT programme. In Malawi however, there is a paucity of evidence on the factors influencing low levels of HIV retesting and the strategies to improve that. My study, therefore, aimed to assess the factors that influence and strategies that would promote postpartum HIV retesting in women who were HIV negative during the antenatal period. This information would be incorporated in the Prevention of the Mother-to-Child Transmission (PMTCT) program strategies to prevent HIV infection in new-born."

World AIDS Day 2023 theme “Let communities lead” in relation to my study topic:

"The community is made of people and they need to be engaged when instituting some interventions to ensure their buy-in. Lack of their involvement in policy development enhances chances of low adoption of a particular intervention or strategy.   My study aimed at attaining insights from the postpartum mothers themselves to understand the determinants for HIV retesting and hear from them some of the strategies that they feel can increase the uptake of HIV retest following delivery. We enquired among others some of the community based factors for HIV retesting to have an insight on how the community plays its role in promoting or discouraging HIV retesting after delivery bearing in mind how powerful the community is in influencing decision making. Most of the respondents (postpartum mothers) from my study verbalized the need to involve the beneficiaries so that interventions are tailored to a particular population which will enhance adoption."

Victoria Etuk

Research Topic: Rates and determinants of COVID-19 vaccination uptake among people living with HIV in federal capital territory, Nigeria

RSTMH/NIHR Small Grant Awardee 2022

"My research looks at the intersection of 2 pandemics- HIV and COVID-19, primarily uptake of COVID-19 vaccinations among people living with HIV. Community leadership is key and a primary recommendation to improve COVID-19 vaccine uptake and vaccine confidence among people living with HIV. 

"Investigating uptake of COVID-19 vaccinations among people living with HIV in Nigeria is important, to provide evidence for prioritization of communities with HIV during vaccination campaigns for COVID vaccines. People with HIV are immunocompromised, with a higher risk of severe COVID, thus should be prioritised for COVID vaccinations. My research also seeks to understand barriers and facilitators to COVID vaccine uptake among PLHIV, thus guiding vaccination policy makers on areas of interventions."

Edwin Ochomo

Research Topic: Impact of COVID-19 pandemic on the implementation of HIV partner notification services in Kisumu County, Kenya

RSTMH/NIHR Small Grant Awardee 2022

"Identifying those who do not already know their HIV status in the community will ensure the chain of infection is broken. Knowing your partners HIV status protects you from risk of infection. 

"COVID-19 pandemic ushered in a time where HIV care was not prioritized which could potentially lead to poor adherence. Poor adherence leads to high viral load thus higher risk of HIV transmission. Closure of schools and other systems meant more free time for leisure, which could include irresponsible sexual behaviour especially among the youth."

Okechukwu P Onyenuru

Research Topic: Comparison of Urinary TB-Lipoarabinomannan with stool Xpert in the detection of TB in Children with Advanced HIV Disease in Lagos

RSTMH/CIFF Small Grant Awardee 2021

"The hierarchical health administration model has resulted in a disconnect between policies and actual needs. When research, health policies, and resources lack a people-centered focus, they lose their effectiveness. To effectively address contemporary health challenges, it is imperative to shift from a top-to-bottom pyramid structure and ensure the inclusion of everyone in the decision-making process. The struggle against global threats like HIV/AIDS and TB has not achieved desired success due to policies neglecting the diverse socioeconomic and political dynamics across regions.

"The adoption of a uniform, one-size-fits-all approach, driven by the perspectives of top policymakers, has limited the success of policies as they often inadequately represent the community. This year's theme, 'Let communities lead', is not a call to replace health leaders but an invitation to incorporate the voices of the people affected by the situation. It emphasizes the need not just to listen to them but to actively involve their perspectives in decision-making processes. Caregivers, survivors, dependents, and all those impacted by an individual's HIV/AIDS or TB status should be encouraged to share their experiences, contribute ideas, and have confidence that their input will significantly influence the final solutions.

"In 2003, I lost a friend to relapsed TB. Late 2002, he was diagnosed of pulmonary TB and administered drugs. After two months of therapy and feeling better, he discontinued his TB medication, leading to a relapse that became resistant to drugs and eventually resulted in his death. From 2018 to 2022, my professional experience at a TB and HIV/AIDS screening center exposed me to the high mortality rates associated with HIV/AIDS coinfection. Additionally, I witnessed the critical impact of late detection on the TB prognosis of children. Challenges such as the difficulty of children producing representative sputum, a limited number of centers equipped with GenXpert machines, and poverty hindering access to healthcare in low-income regions motivated my research on diagnosing TB in HIV/AIDS-affected children.

"Despite the World Health Organization's (WHO) recommendation in 2015 of the lateral flow assays for early TB detection in urine, the TB-LAM was not readily available, and many health centers were unaware of its existence. Faced with conflicting studies on the effectiveness of TB-LAM, my study aimed to validate its accuracy in the literature and identify any community-specific factors that could influence the assay’s performance. This underscores the importance of community-based leadership, research, and evaluation in medical interventions and policies. Achieving success in this fight requires collaborative efforts from all stakeholders."

Joab Khasewa

Research Topic: Effect of comprehensive HIV prevention information package on risky sexual behaviour among youth in Kakamega and Kericho counties, Kenya

RSTMH/NIHR Small Grant Awardee 2021

"Let the Youth lead the HIV prevention response. Empowering youth with correct information on HIV reduces their vulnerability to HIV infection.

"The youth account for over 41% of new HIV infections in Kenya. Reducing risky sexual behaviour among youth will reduce their exposure to HIV infection. Preventing new HIV infections among youth will reduce future treatment costs."

Fredrick Mwawule

Research Topic: Assessing access to anti-hypertensive and anti-diabetic medications amongst people living with HIV in Soroti district, Eastern Uganda.

RSTMH/NIHR Small Grant Awardee 2022

"Several efforts have been put in place to end the HIV pandemic. However, a few countries have tried their level best to handle the entire human health holistically through a one-health approach. That means managing a patient having non-communicable diseases as well as HIV in one go. That said, a number of countries are still struggling with the management of non-communicable diseases in persons living with HIV due to resource constraints.  Several low- and middle-income countries receive support in the area of HIV care under donations without any support in the management of non-communicable diseases among the same patients. With this trend, the efforts to achieve the 95-95-95 goal will remain a dream since the majority of the people on treatment will succumb to death due to the surge of non-communicable diseases in this category of persons."

Richmond Osmond

Research Topic: Health-related Quality of life of Patients living with HIV, Hypertension, and Diabetes in Ghana

RSTMH/NIHR Small Grant Awardee 2022

“Community means togetherness…it is imperative we make this be at the forefront of control and management of HIV globally.”

“Community involvement is the fulcrum around which primary health care revolve. Let’s make it reflect in HIV discussions”

“In many LMICs, all we’ve known is the community, where we share common goals, beliefs, and culture. It is a spirited environment where miracles happen…together we can! Let communities L E A D!!!

“…the fate of humans is not predictable, whatever we suffer we may not have control over, ultimately, what matters is how we manage what happens to us…people living with HIV must still enjoy optimal level of quality of life possible!

“Living with HIV and chronic NCD comorbidities could be complicate life for the patients. The health-related quality of life of these population should matter. Communities leading can help!!!”

“I believe the solution to every problem begins with identifying the problem…establishing a baseline of the health-related quality of life of people living with HIV and hypertension and diabetes is fundamental to design appropriate interventions to improve their lives…”

Majahonkhe Shabangu

Research Topic: Distinctive morpho-mechanical cell signatures of malignancy and drug resistance in South African patients with HIV/AIDS-associated Kaposi's sarcoma

RSTMH/NIHR Small Grant Awardee 2021

"The Kingdom of Eswatini, my home country, currently holds the unfortunate distinction of having the highest prevalence of HIV/AIDS globally. In my current residence, South Africa, we grapple with the highest number of people living with HIV (PLWH) in the world. The situation in Southern Africa and sub-Saharan Africa remains undeniably challenging. Despite these challenges, there have been positive developments. Eswatini, having declared HIV/AIDS a national emergency over two decades ago, has made significant progress, recently achieving the 95-95-95 targets under the longstanding slogan "i-HIV/AIDS yindzaba ye2u sonkhe," which emphasises that HIV/AIDS is our collective concern. While celebrating these milestones, it is important not to become complacent but to persist in the ongoing fight.

"Global health research can benefit from progress in various fields such as physical oncology, particularly as people living with HIV now have lifespans comparable to uninfected individuals on a global scale. Alongside this commendable progress, new challenges are emerging, including a rise in HIV-associated malignancies. This emerging issue requires immediate attention and focus. Achieving a sustained response to eradicate HIV/AIDS will rely significantly on engaging all stakeholders, and affected communities play a pivotal role in this regard. To realise a sustainable response leading to the end of HIV/AIDS, the comprehensive empowerment of these communities is paramount.

"In the early stages of the HIV/AIDS era, Kaposi’s sarcoma (KS) initially served as one of the diagnostic morbidities associated with HIV/AIDS and continues to be the most prevalent opportunistic tumour in people living with HIV (PLWH) today. Despite the effectiveness of combination antiretroviral therapy (cART) in its treatment, recent studies have revealed that KS can still manifest, even in instances of viral suppression and strict adherence to cART. Similar to other HIV-associated malignancies, KS is frequently diagnosed at advanced stages, leading to poor outcomes. My research specifically focuses on understanding distinctive morpho-mechanical cell signatures linked to KS malignancy and drug resistance in South African patients with HIV/AIDS-associated KS. By focusing on these potentially unique features, my objective is to propose context-specific strategies for the early diagnosis of KS and the efficient detection of chemoresistance. This is of particular significance in resource-limited settings burdened by a high prevalence of HIV/AIDS, where addressing these challenges can significantly improve patient outcomes."

Maria Eugenia Castellano

Research Topic: Clinical characteristics and outcomes of HIV patients co-infected with tuberculosis and histoplasmosis in an urban Latin American setting

RSTMH/NIHR Small Grant Awardee 2021

"People living with HIV who have concurrent tuberculosis and histoplasmosis infections are characterized by advanced HIV disease. The leadership of communities and their connection with the public health sector are essential for designing innovative and effective strategies for early HIV and opportunistic infection screening and for access to recommended treatments against these infections.  These interventions are needed to prevent the progression to advanced HIV disease and to reduce mortality. 

"In Latin America, tuberculosis and histoplasmosis are two of the most common opportunistic infections in people living with HIV (PLHIV). However, there is limited data on the clinical characteristics and outcomes of PLHIV with concurrent tuberculosis and histoplasmosis infections. Therefore, my Guatemalan partners and I wanted to understand the impact of concurrent tuberculosis and histoplasmosis infections on PLHIV, their clinical and laboratory characteristics, and the optimal therapeutic strategies."

Afeez Babatunde Oyetola

Research Topic: Evaluating the Impacts of HIV Self-Testing Services in Adolescents and Young People in Calabar, Southern Nigeria

RSTMH/NIHR Small Grant Awardee 2021

"As a public health expert in HIV management, it is important to note that for us to achieve the UNAIDS' 95 - 95 - 95 targets toward achieving epidemic control, empowering our clients is essential. Sometimes, it is difficult to achieve this as HIV implementation can be paternalistic on account of it being target-driven. Despite this, to achieve sustainability and ownership of the huge investments and gains garnered over the years, these clients, and the community from which they come, must have louder voices. It is only then that we can be confident of a glorious future for them and for us.

"When I was in secondary school, I would always maintain that the only motivation for me to study pharmacy was to develop a cure for HIV. While I'm not currently into Drug Design and Development, my research work is at the intersection of policy, access and sustainability. These approaches are also needed for us to achieve control of HIV. I'm passionate about ensuring access to appropriate health interventions for the most vulnerable populations - whether they are key populations or children living with HIV and AIDS, Adolescents and Young People etc."  

Sylvester Adeyemi

Research Topic: Facility-based study of comorbid and multi-morbid non-communicable diseases among patients living with HIV infection in Nigeria

RSTMH/NIHR Small Grant Awardee 2022

"Establishing a community-driven model of care is crucial for enhancing ARV adherence and addressing challenges in ART delivery. Communities now play a more pivotal role in spearheading initiatives that enhance care for individuals living with HIV(PLWHIV). My experience in supporting differentiated service delivery in Northern Nigeria inspired me to study  the significant issue of poorly managed non-communicable diseases (NCDs) among PLWHIV. My research focuses on facility-based approaches used in managing NCDs within HIV care, aiming to comprehend the current models of integrated care. With increased community involvement, initiatives targeting NCDs can contribute to better outcomes for PLWHIV."

Louise Afran

Research Topic: Immune dysregulation in HIV-exposed uninfected infants

RSTMH/CIFF Small Grant Awardee 2021

"HIV-1-exposed uninfected (HEU) children have a substantially increased morbidity and mortality compared with children born to uninfected mothers (unexposed uninfected, UU), predominantly from infectious causes. My work focused on isolating CD34 stem cells from babies blood to look for indications HIV induced altered gene expression patterns."

Ezechiel Semengue

Research Topic: Evaluation of HIV Drug Resistance in Pro-viral DNA among patients following exposure to Integrase Inhibitors in Cameroon

RSTMH/NIHR Small Grant Awardee 2021

"When applying for the RSTMH small grant our goal was to improve the care and treatment strategy of HIV-patients receiving integrase inhibitors-based regimens in Cameroon. The outcomes of this project contributed to confirming the effectiveness of tenofovir+lamivudine+dolutegravir (TLD) in our ART program nationwide. Our findings therefore support the achievement of HIV elimination by 2030 (>96% viral suppression). Additionally, we have contributed in raising awareness of the clinical relevance of archived resistance mutations in patients previously exposed to first generation integrase inhibitors within our context. 

"Our results were disseminated at national level for rapid endorsement by local stakeholders and a quick implementation in the communities. In effect, we think that HIV drug resistance will not be a major backlog in the achievement of UNAIDS third 95’ goal if all patients under ART are fully complying and adherents; and this could not be effective if the communities are not actively involved and at the frontline. Celebrating this world AIDS day 2023, more than celebrating scientific progress, we are also encouraging communities to take the lead so as to pave the way to more ART adherence, more therapeutic success, and elimination of AIDS by 2030."