As the pre-eminent academic institution at the epicentre of the HIV epidemic in South Africa, UKZN has taken up the challenge of providing leadership in response to HIV and AIDS, and is undertaking ongoing research to enhance and strengthen the biomedical and broader societal response to the epidemic. UKZN continues to attract international recognition for its groundbreaking research in both HIV prevention and treatment.

In the field of HIV/AIDS research, well-established partnerships exist which facilitate networking and collaboration with researchers within UKZN, at other South African academic institutions, and around the world.
At a global level, UKZN strives to nurture international institutional partnerships such as its long-standing relationship with the universities of Columbia and Harvard, both in the United States. In recognition of its standing as a world-class research centre in HIV/AIDS and TB, the University has successfully attracted funding from influential international organisations such as the Howard Hughes Medical Institute (HHMI), the Wellcome Trust, the US National Institutes for Health (NIH), the US Agency for International Development (USAID), and the European Union (EU).

Through the Columbia University-Southern African Fogarty AIDS Training and Research Programme, the institution is committed to building scientific capacity in HIV/AIDS and tuberculosis research in several countries in Southern Africa to enhance continuing efforts to counter the HIV/AIDS and TB epidemics. Now in its 16th year, the programme has trained many of South Africa’s young AIDS and TB researchers.

UKZN’s focus on HIV/AIDS, TB and Health Promotion is a multi-faceted and multi-disciplinary initiative, involving a number of established research groups and projects which recognise the importance of rigorous scientific inquiry aimed at, for example, an understanding, of the pathogenesis, virology, immunology and epidemiology as it relates to HIV/AIDS, or the role of breastfeeding in mother-to-child HIV transmission and the facilitation of clinical trials for treatment of HIV and TB in both children and adults.

At the same time, however, this research cluster does not neglect the socio-economic implications and impact of diseases such as HIV/AIDS and TB. Thus, there is significant emphasis on research into the ethics, law and human rights issues as they relate to the administering of AIDS vaccines through the ELH (Ethics, Law, Human Rights) programme, and the HIV/AIDS Vaccine Ethics Group (HAVEG). The broad socio-economic impacts of AIDS are examined through the Health, Economics and HIV/AIDS Research Division (HEARD), and the research around the role of indigenous health care systems in addressing the epidemic is conducted under the leadership of a Chair in Indigenous Health Care Systems.

Working in partnership is critical, given the complexity of the virus, and the extent of its impact on our population.

The Africa Centre for Health and Population Studies
The Africa Centre for Health and Population Studies, one of UKZN’s Research Centres which conducts community-based research on HIV epidemiology, prevention and treatment, partners with the local Department of Health in the rural area of Hlabisa in northern KwaZulu-Natal to provide AIDS treatment to thousands of patients at each of the 17 primary health care clinics in the district.

With core funding from the Wellcome Trust, the Centre hosts a large demographic and health surveillance system with annual household and individual surveillance of 90 000 people in 11 000 households. Another major area of research is the role of breastfeeding in mother-to-child transmission of HIV.

Using the data from its demographic surveillance system, the Africa Centre has demonstrated the relative importance of the lifetime number of partners (as opposed to concurrent partners) as the main risk factor for HIV infection. It has also investigated trends in adult mortality before and after the introduction of the HIV treatment programme, showing a significant decline in overall population mortality and HIV-related adult mortality following ART roll-out, in a high HIV prevalence community.

Subsequently, research at the Centre has also shown a decline in early (0-2 years) childhood mortality and it was estimated that the decline was partly due to the roll-out of the Prevention of Mother-to-Child Transmission (PMTCT) programme and reduction in the number of HIV-infected children.

Another multi-institutional team works under the banner of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and undertakes cutting-edge research on HIV epidemiology, pathogenesis, prevention and treatment and examines the links between tuberculosis and AIDS care.

Established in 2002 under the NIH-funded Comprehensive International Programme of Research on AIDS (CIPRA) by five partner institutions – the Universities of KwaZulu-Natal, Cape Town, and the Western Cape; the National Institute for Communicable Diseases, and Columbia University in New York – CAPRISA is a designated UNAIDS Collaborating Centre for HIV Prevention Research.

Since its inception, the CAPRISA research programme has delivered a number of significant findings which are making a tangible impact on the way in which the epidemic is currently being managed and treated at home and beyond.

Studies at the rural Vulindlela Research Centre near Howick, for example, have provided a detailed understanding of the epidemiology, risk factors and vulnerability to high rates of HIV infection in young women in South Africa; the CAPRISA 004 trial of the Tenofovir gel microbiocide provided the proof-of-concept evidence that antiretrovirals can prevent HIV infection in women; the 002 Acute HIV infection study has generated new data on how viral and host factors impact on the risk of HIV and its natural progression as a key contribution to vaccine development and testing; and the 003 SAPiT trial provided critical evidence for World Health Organisation guidelines on how to treat patients with HIV and TB co-infection.

In addition, the Enhancing Care Initiative, part of the NIH-funded network, which conducts clinical trials of therapeutics for HIV infection and subsequent complications in children and adults, played an important role in uncovering the epidemic of extensively drug-resistant tuberculosis (XDR-TB) at the Church of Scotland hospital in the rural area of Tugela Ferry.

The HIV Pathogenesis Programme which conducts research into HIV immunology, virology and pathogenesis also contributed towards the discovery of the various HLA (human leukocyte antigen) genotypes that are associated with lower viral load.

The HIV/AIDS, TB and Health Promotion initiative is a highly dynamic focus area which is constantly evolving and expanding to meet needs and respond to exigencies on the ground. To this end, four areas of intensive research into tuberculosis and HIV/AIDS – which are likely to yield significant breakthroughs within a few years in the diagnosis, prevention and treatment of the diseases – are underway, thanks to a multi-million rand grant from the Howard Hughes Medical Institute (HHMI) in the United States.

The grant, the biggest ever for medical research in South Africa, will establish the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), to construct a new building for the Institute at the University’s Nelson R Mandela School of Medicine and fund TB and HIV research at UKZN for the next 10 years.

The Institute, which will be one of the most sophisticated of its kind in the world, will offer state-of-the-art facilities for researchers and students from across Southern Africa.