MRC CLINICAL AND COMMUNITY HIV-TB RESEARCH COLLABORATING CENTRE SYMPOSIUM
The MRC Clinical And Community HIV-TB Research Collaborating Centre was established in 2015 between UCT and Walter Sisulu University (WSU). The Centre aims to develop research capacity and skills in the fields of HIV and TB, and to build partnerships between UCT and institutions in the Eastern Cape. With the support of the Collaborative Centre, UCT has established a Research Unit at Jose Pearson Hospital which is managed by a research nurse, Sr Liziwe Rwentela, who is employed by UCT.
The Centre is led by Professor Graeme Meintjes from CIDRI-Africa in the IDM and Department of Medicine at UCT. The leadership team comprises: Dr Limpho Ramagoaela from Jose Pearson Hospital and Drs John Black and Garrick Barber from Livingstone Hospital, all in Port Elizabeth; and Drs Andy Parrish and Dave Stead from Cecilia Makiwane Hospital and Walter Sisulu University in East London.
Two activities were held in Port Elizabeth over 19th and 20th October 2017 to support the research and educational aims of the Collaborative Centre:
A business meeting on Thursday 19th October to discuss current and future collaborative studies.
This was held at Jose Pearson Hospital in Port Elizabeth on 19th October 2017, and was attended by members of the leadership team. The agenda included an update on the Collaborative Centre funding for 2018, and discussions on the progress of existing studies at Jose Pearson Hospital and plans for future studies, mainly to be conducted in East London. The current projects at Jose Pearson include a prospective cohort study to evaluate drug exposures and clinical outcomes of patients with drug-resistant TB, with a focus on bedaquiline and linezolid, as well as a study to describe linezolid resistance amongst patients with treatment failure. Proposed projects for East London included a study of urine-based diagnostics for hospitalised patients with HIV, and an evaluation of the programmatic outcomes of patients on the new short course regimen for MDR-TB.
Left: Dr Sean Wasserman and Sr Liziwe Rwentela Right: Collaborating Centre Committee Jose Pearson Research Unit
A Symposium on Friday 20th October 2017 at Livingstone Hospital in Port Elizabeth.
L to R: Organising Committee and presenters: Gary Maartens, Graeme Meintjes, Fareed Abdullah, Sean Wasserman, Kathryn Wood, John Black, Lindelwa Cindi, Candice Roux, Garrick Barber, Mpiko Ntsekhe, Limpho Ramangoaela, Andy Parrish and Dave Stead
The Symposium was held over one day in the auditorium of the Resource Centre based at Livingstone Hospital. The event brought together experts from around the country, as well as local speakers, to cover topics in TB and HIV and to provide networking opportunities for clinicians working in the Eastern Cape. The symposium included the following sessions:
Challenges in HIV-TB management
Dr John Black from Livingstone Hospital discussed TB epidemiology in the Eastern Cape and the clinical challenges relating to the high burden of TB in the region. Dr Fareed Abdullah, the director of the SA-MRC Office of AIDS/TB Research presented an overview of the status of these diseases in South Africa, as well as the research priorities of the SAMRC in HIV-TB. He was accompanied by Ms Candice Roux, Project Manager for the SAMRC HIV-TB Collaborating Centres. Key issues in the clinical management of HIV-TB were covered by Profs Gary Maartens and Graeme Meintjes with talks on drug interactions between ART and TB treatment and TB-IRIS, respectively.
Drug resistant TB
The local experience with treating XDR-TB was presented by Dr Limpho Ramagoaela from Jose Pearson Hospital. Dr Lindelwa Cindi described the challenges in interpretation of discordant results of drug susceptibility testing at Nkqubela Hospital in East London. The latest results from NIX-TB, STREAM-1, and the delamanid phase 3 trial were presented by Dr Francesca Conradie from the Wits Health Consortium. Dr Garrick Barber from Livingstone Hospital discussed the role of rifabutin in DR-TB and his planned research on this issue, and Prof Maartens gave a presentation on the mechanisms and management of drug-related QT prolongation.
In line with the Collaborating Centre’s aim to develop research capacity in the Eastern Cape, a full session was dedicated to practical advice on various aspects of clinical research. Talks included how to define a research question by Professor Graeme Meintjes, writing a research proposal by Professor Gary Maartens, applying for research funding by Dr Sean Wasserman and the ethical issues of conducting research in a busy clinical setting Professor Andy Parrish.
Key issues in TB diagnosis and management
This final session included a presentation on the role of urine LAM and other urine-based diagnostics to improve outcomes in HIV-TB, presented by Dr Dave Stead from Cecilia Makiwane Hospital. Dr Sean Wasserman from CIDRI-Africa discussed the use of linezolid in DR-TB. Prof Mpiko Ntsehke gave a talk on the research journey of the IMPI trial and showed how the findings influenced the management of TB pericarditis.
The Symposium was very well received and supported with 140 delegates filling the auditorium beyond capacity!
Following comments from the delegates on the day and a feedback questionnaire, a need for continued sessions in this field of research would be greatly appreciated.
- 95% of respondents felt that the topics were relevant and useful for their clinical or research work.
- 94% felt that the information would positively affect their clinical practice.
Some comments received:
- Well planned and organized, Topics were well presented
- The session was extremely informative, but a bit too crammed with too many speakers
- Thank you for a well presented topic and all the issues that we would never have thought about.
- Share the slides of all presentations to reflect on the information later
- A bit doctor orientated, Sessions must be more nurse orientated as well
Defining a research question
Graeme Meintjes University of Cape Town
TB-IRIS (Tuberculosis Immune Reconstitution Inflammatory Syndrome)
Graeme Meintjes University of Cape Town
Drug Interactions with ART and TB Treatment
Gary Maartens University of Cape Town
Writing a research proposal
Gary Maartens University of Cape Town
The QT Interval – Safety endpoint for DR-TB trials
Gary Maartens University of Cape Town
Clinical Experience of treating XDR-TB at Jose Pearson
Limpho Ramangoaela Jose Pearson TB Hospital
Discordant results of drug-susceptibility testing
Lindelwa Cindi Nkqubela Hospital
TB epidemiology and clinical challenges in the Eastern Cape
John Black Livingstone Hospital
Ethical issues regarding undertaking clinical research in a busy clinical setting
Andy Parrish Cecilia Makiwane Hospital (WSU)
Urinary TB Diagnostics in HIV
Dave Stead Cecilia Makiwane Hospital (WSU)
Linezolid in Drug Resistant TB
Sean Wasserman University of Cape Town
Management of TB pericarditis: lessons from IMPI
Mpiko Ntsekhe University of Cape Town
UCT AND NIH RESEARCH METHODS WORKSHOPS
Held at Sefako Makgatho Health Sciences University and Walter Sisulu University
As a result of a U01 research grant awarded through a collaboration between the National Institutes of Health (NIH) and the South African Medical Research Council (SAMRC), University of Cape Town (UCT) and Stellenbosch University (SUN) researchers collaborate with researchers from the US National Institute of Allergy and Infectious Diseases (NIAID), on a study of the ‘Inflammatory and cellular determinants of disease severity and treatment outcome in South African TB patients’. With supplementary funding support to provide research opportunities via our research to scientists at two historically disadvantaged universities in South Africa, we partnered with Sefako Makgatho Health Sciences University (SMU) in Pretoria and Walter Sisulu University (WSU) in Mthatha to firstly conduct research workshops at both institutions, and in the future, to award research fellowships for candidates from SMU and WSU to work with scientists at the collaborating institutions – UCT, SUN or at the NIAID.
Workshop at SMU
This first workshop was held from 10th to 11th August 2017 at a conference venue, Bentley’s Country Lodge, close to the SMU campus. Seventeen applicants were accepted to attend the workshop following review of their submission of research proposal abstracts. After an inspiring welcome from SMU Deputy Vice-Chancellor Professor Olekan Ayo Yusuf, Faculty members from SMU, Professor Mapaseka Seheri, Professor Gloria Selabe, Professor Joshua Olowuyo, Professor Chantelle Baker and Professor Siyazi Mda also joined the UCT and NIAID collaborators in presenting lectures and participating in 2 intensive small-group breakaway sessions for the development of the applicants’ research proposals. We were fortunate that Professor Alan Sher from the NIAID and Professor Bruno Andrade from FIOCRUZ in Brazil were able to travel to South Africa to join the UCT team lead by Professor Robert J Wilkinson from the Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) at UCT. The other UCT team members were Professor Graeme Meintjes, Dr Yolande Harley, Dr Elsa Du Bruyn, Dr Delva Shamley (SMU workshop), Dr Maia Lesosky (WSU workshop) and Ms Kathryn Wood who supported the team with logistics and administration.
We are grateful to Professor Mapaseka Seheri for her guidance, local organisation and intensive advertising of the workshop.
The topics covered were:
- Objectives and aims of the workshop
- Priorities for health research at SMU
- Clinical study design and the elements of a research proposal
- Statistical considerations and graphical presentation of data
- Why Immunology matters in Africa
- Research integrity and ethics
- Grant writing
- Funding opportunities within South Africa
The workshop was very well received with ratings of the lectures and the proposal development small group sessions by the delegates between 75% and 95%.
The workshop ended with short presentations from each SMU delegate on their research proposal, demonstrating the progress achieved in just 2 days!
Workshop at WSU
This workshop followed a week later from 19th to 20th August 2017 and was held at the Conference Centre in the Hotel Savoy in Mthatha, very close to the Faculty of Health Sciences campus of WSU.
Applications to attend this workshop were numerous and resulted in 35 delegates from Mthatha, Port Elizabeth and East London participating as well as 4 members of the WSU Faculty - Dr Pam Mda, Professor Zukiswa Zingela, Professor Khulile Moeketsi and Dr Busi Mrara - who also led the research proposal development groups with the UCT and NIAID leaders. Dr Pam Mda was instrumental in the local organisation and advertising of the workshop, and Professor Zingela kindly led the visiting Faculty on a tour of new parts of the WSU Health Sciences campus. We are also grateful for the kind welcome from Dr Nomabandla Cishe and Dr Vincent Nakin.
Topics covered during the lectures were similar to those at SMU as well as an interactive discussion on the experiences of researchers at WSU that highlighted a number of issues to be discussed further by the WSU Faculty team who participated in the workshop.
This workshop also ended with presentations from selected representatives of each research proposal development group, again demonstrating that the combination of intensive small-group input from the Faculty and the enthusiasm of the delegates achieved excellent progress on each delegate’s research proposal.
This workshop was also very well received with many favourable comments resulting in ratings of 85% to 95%.
Selection of the comments received:
“Thank you for this opportunity for exposure to, and education in, research!”
“Informative and relevant”
“Helped me with understanding the concept”
“Thank you kindly for involving such knowledgeable and experienced people for group leaders”
“Group sessions: Great input/ Very good – benefitted the most from this/ Extremely helpful”