These research grants, which amount to more than US$9 million, make it possible for UCT’s researchers to tackle some of Africa’s most intractable health problems, such as HIV, TB and malnutrition. Most of the projects are large in scale and many involve collaboration with partner universities elsewhere in Africa. The funding may come from the USA, but one of its most significant impacts is building capacity in Africa to address its own health problems.

Unravelling the mysteries of sickle cell anaemia

Associate Professor Ambroise Wonkam, senior specialist in the Division of Human Genetics in the Faculty of Health Sciences, runs one such project focusing on sickle cell anaemia. “Seventy percent of those with the disease were born in Africa, yet 70% of what we know about it was discovered outside Africa,“ says Associate Professor Wonkam. “We in Africa have to solve these problems ourselves: it is our duty.”

The immediate goal of Associate Professor Wonkam’s project is to find out why some patients get sicker than others, despite having the same gene malformation. He and his colleagues are looking for variations in other parts of the genome: this will help determine which patients have the disease from birth, enabling early interventions, and may lead to developing a drug to treat it. 

Schizophrenia in the Xhosa population

Professor Dan Stein, head of the Department of Psychiatry and Mental Health, is leading a project on the genetics of schizophrenia in the Xhosa population of South Africa. Professor Stein says, “This project will be the first to use modern genomic sequencing approaches to study schizophrenia in a population of Sub-Saharan African lineage. If successful, our approach will identify genes important for the disorder in populations worldwide … and help develop more effective treatment and prevention strategies.”

HIV: eliminating mother-to-child transmission

Dr Mary-Ann Davies, senior researcher at the Centre for Infectious Disease Epidemiology and Research (CIDER), is looking at closing the gaps in prevention of mother-to-child transmission of HIV coverage, early infant diagnosis and treatment. “Virtual elimination of transmission of HIV from mothers to their babies is within reach in South Africa. Despite high levels of HIV among pregnant mothers, transmission to their babies has been reduced to less than 2%,” says Dr Davies. If there were no interventions, the figure would be closer to 30%, so the programme has been hugely successful. “Yet, elimination remains elusive, with up to 1 000 infants still acquiring HIV in the Western Cape each year.”

High-calibre research

It is the calibre of the scientists leading these projects at UCT that is part of the secret to South Africa’s outstanding success in attracting grants from the NIH. The NIH have said that scientific quality is one of the main reasons why so many of its funded projects are located in South Africa.

“They fund based on excellence,” says Associate Professor Nicola Mulder, head of the Computational Biology Group that receives NIH funding for bioinformatics. “It is an equal, peer-reviewed process, in which reviewers score the proposals based on scientific excellence.”

In October 2013, the Research Centre for Adolescent and Child Health (REACH) was opened at the Red Cross War Memorial Children’s Hospital. This state-of-the-art expanded clinical research centre is devoted to child health and is headed by Professor Heather Zar, head of the Department of Paediatrics and Child Health in the Faculty of Health Sciences.

REACH is the first of its kind in Africa and also serves as a hub supporting other clinical research sites in the community and at other healthcare facilities, and contributing to the development of capacity in child health and in clinical research.

The centre has about 40 full-time members of staff funded through grant support, and has several local, national and international collaborations. It is undertaking research with an important impact on child health globally.

Studies currently under way address key health priorities such as childhood TB, pneumonia, whooping cough, HIV and adolescence, and diarrhoea. A unique birth cohort study, the Drakenstein Child Lung Health study, is currently under way in Paarl and is supported by this core centre.

This study, a first for Africa, investigates the determinants of child health from the antenatal period through birth and early childhood and includes a focus on maternal and paternal health.

The research team was headed up by Dr Molebogeng Rangaka and included clinic staff working for Médecins Sans Frontières (MSF) and the Western Cape Provincial Government, with supervision from Professor Gary Maartens and Professor Robert Wilkinson from the Department of Medicine. They conducted a trial of IPT in people on ART to prevent TB at Khayelitsha Site B Clinic in Cape Town. The addition of IPT was found to be safe and to reduce TB incidence by 37%.

Discussing the purpose of the study, Professor Maartens explains that it is well established that the risk of TB can also be reduced by IPT in HIV-infected people not on ART. However, ART also reduces the risk of TB. It was previously unknown whether isoniazid would give additional benefit and whether it was safe in patients on ART.

“These findings will change clinical practice and contribute immensely to the reduction of the scourge of TB. It is one of the highlights of research in the faculty in recent times,” says Professor Bongani Mayosi, head of medicine.

The study was funded by the Department of Health, MSF, the Wellcome Trust and the European and Developing Countries Clinical Trials Partnership, while MSF were key partners in conducting the study.

Meintjes attracted attention with his work in the field of HIV and TB research and he is the lead investigator on the randomised placebo-controlled trial of prednisone for the treatment of Tuberculosis-Immune Reconstitution Inflammatory Syndrome (TB-IRIS), which demonstrated that prednisone provides benefits in terms of reduced hospitalisation and improvement in symptoms.

This was the first clinical trial of IRIS treatment and the evidence has been incorporated into national and international guidelines. His work has defined the diagnostic approach to TB-IRIS, highlighting the importance of excluding drug-resistant TB. Professor Meintjes says there is definitely a need for TB-preventive therapy that, when added to ART, reduces the risk of TB by 37%, as reported in The Lancet recently by a team led by Dr Molebogeng Rangaka of the Clinical Infectious Diseases Research Initiative.

His work has defined the diagnostic approach to TB-IRIS, highlighting the importance of excluding
drug-resistant TB.

Since 2005, Associate Professor Meintjes has also collaborated with researchers from St George’s Hospital, London, on trials aimed at improving initial treatment of cryptococcal meningitis.

As a result of this research, he was asked to be a member of the WHO’s Guidelines Development Group for guidelines on the diagnosis, prevention and management of cryptococcal infection in adults and children, thereby impacting policy and clinical practice in Africa.

Jointly based in the Bertha Centre for Social Innovation and Entrepreneurship at the GSB and in the Department of Medicine and Groote Schuur Hospital, the Inclusive Health Innovation Initiative (IHII) is a response to the complexity of the challenges facing health care.

“Now, more than ever, innovation is required to develop solutions that can improve the delivery of health care in Africa in an inclusive, effective and affordable manner,” says Dr François Bonnici, director of the Bertha Centre. “These solutions must transcend current challenges in the system to improve health outcomes for patients, but also to change the routines, responsibility and values of our health workers responsible for delivering the care.”

Kicking off its activities, the IHII hosted a summit in Cape Town in January 2014, the first of its kind in Africa, that gave international and local innovators, experts and influencers the opportunity to discuss and debate what healthcare innovation means in and for an African context. The summit was one of the first official events on the World Design Capital 2014 calendar, and was organised around the theme of “designing solutions, addressing needs”.

The IHII also hosted the country’s first health hackathon a week before the summit. Based on a proven international innovation model, this event exposed participants to the role technology can play in transforming healthcare delivery in an African context, and challenged participants to create and build innovative mobile health applications that addressed real and pressing health challenges.