On the ground
Interview with Dr. Gita Ramjee
Dr. Gita Ramjee is a world-renowned scientist specializing in HIV prevention, treatment, and care. Dr. Ramjee is the director of the South African Medical Research Council’s HIV prevention program and has been involved in clinical trials of microbicides for more than a decade. Dr. Ramjee’s research in HIV prevention was awarded one of the largest grants ever made by the National Institutes of Health for research conducted outside of the United States. She is overseeing another microbicide trial, called the VOICE trial, which aims to confirm the recent success of CAPRISA 004 trial. The CAPRISA trial was the first proof-of-concept that a microbicide can protect women against HIV. The CAPRISA trial was supported by the US Agency for International Development.
Q: For many years, microbicide trials failed. How difficult was it to keep exploring new prospects for microbicides?
A: I think with every failure there was much disappointment, but there were so many new questions that arose out of each disappointment. Only recently, after 2007, we realized that a product nonspecific to HIV was not going to work. So every unsuccessful outcome, there was a new lesson learned. Even if the products were not successful, we learned a lot in terms of how to do the research better.
Q: What do you mean by “nonspecific” to HIV?
A: With the earlier, nonspecific products, there were some that destroyed the cell membrane of viruses and bacteria, and also destroyed the membrane of the vagina, for example. Now we are moving toward the ARV (anti-retroviral) products that are highly specific to HIV.
Q: Following the CAPRISA trial, what are your expectations for finding a better result in other trials?
A: We are extremely hopeful. CAPRISA was a smaller study. This research needs to be confirmed. We are currently testing both an oral form of ARVs as well as a topical form. We are moving in the same direction now and should receive results in 2013. In addition, there is another South African study planned to confirm CAPRISA results.
Q: How important was US funding in keeping the microbicide research alive?
A: To date, we have received most of the funding from the US and some from the UK. We wouldn’t have been able to do the work without US-funded scientific research. It also helped us build scientific capacity to do the work. The funding assisted us in providing scientific capacity for young researchers to conduct clinical research. Through the US-funded research, we were able to provide a high standard of care to women participants. This had a huge public health impact.
A lot of times people think research is just research. But they don’t understand there is an enormous amount of public health benefit to it. In our case, many, many women were getting access to a high level of care, which they wouldn’t have otherwise.
Q: It cannot be a simple decision for women to participate in these trials. What are the different motivations to do so?
A: It depends on the country. In South Africa, every other woman is at risk of getting infected with HIV. It’s a generalized epidemic. In India, it’s a highly targeted group with HIV, mostly sex workers. So I think for us to conduct large-scale clinical trials in Africa, I hope the motivation for women to participate is primarily because women want to contribute toward finding a solution for HIV prevention, especially for women. I think the motivation is that the next generation of women would be HIV free. The second thing is that participating in clinical trials is quite lucrative in a way. We give women 150 Rand (about US$20) for every visit. I don’t think we can completely ignore the monetary incentive for participants. But based on what we know, there is a lot of altruism in wanting to find a product that works for HIV prevention.
Q: How much is South Africa contributing to microbicide research?
A: Most of research is being funded by the United States. Post-CAPRISA results, there is now a lot of enthusiasm from the local Department of Health and the Departments of Science and Technology and there is a move toward a public-private partnership, together with our US partners. In addition there is some funding from the South African government for the FACTS trial, in which a consortium of South African scientists is trying to come together to confirm the CAPRISA trial, which was initiated and conducted in South Africa.
There is a lot of enthusiasm and not the negativity there had been in the past. Remember, we have a new government now, a new Department of Health, a new Minister, a new Ministry of Health, and that has made a huge difference in support for HIV prevention research. At last the scientists, advocates and health ministries are working together.