ADAPT Update

AfriCan ForumEntebbe, 17-19 January 2013

A African

D Development of

A AIDS

P Prevention

T Trials

Capacity

Goal of ADAPT:Build local capacity so that Africans can plan, conduct and analyse large scale, multi-centred AIDS prevention trials

Lack of prevention evidence from RCTs

More than 6000 HIV prevention studies published between 2000 and end of 2012

Less than 300 were RCTs

Lack of African involvement

213 67

0 50 100 150 200 250 300

HIV prevention RCTs published between 2000 & 2012

Outside Africa In Africa

Lack of African involvement

213 51 16

0 50 100 150 200 250 300

HIV prevention RCTs published between 2000 & 2012

Outside Africa In Africa Led by African researchers

2007-2009 2010-2014

ADAPT trainingSADC researchers 2007, 2009

HIV prevention epidemiologyRCT techniques

SADC researchers 2013

HIV prevention epidemiologyResearch proposals

UNAM faculty2012, 2013

Systematic reviews

SADC laboratory staff2013

HIV serology for DBSHIV incidence testing

Botswana parliamentarians2011, 2012

Using evidence for decision making

First course participants

• 23 researchers from 11 African countries• Botswana, Lesotho, Malawi, Mozambique,

Namibia, Nigeria, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe

• From government (via NAAs), universities, and NGOs

Where are they now?

Left HIV prevention work and joined a bank

Moved from NGO to National AIDS Authority

Prominent in National AIDS Authorities

Elected – became Minister – NAA in remit

With CIET in Nigeria – on faculty for next course

Head of department in University

Promoted within research organisation

Coordinating CIET work in Botswana

Post-doctoral fellowship

Completing MSc Epidemiology and Statistics

Who has multiple concurrent sexual partnerships in Botswana? Results of a national cross sectional survey.

Laetsang D, Ho-Foster A, Masisi M, Anderson M, Tlhoiwe D, Cockcroft A, Andersson N

Community views of inter-generational sex: findings from focus groups in Botswana, Namibia and Swaziland.

Kunda JL, Kgakole L, Cockcroft A, Masisi M, Laetsang D, Ho-Foster A, Marokoane N, Andersson N

Characteristics and attitudes of the choice-disabled in Namibia.Van Rooy G, Mitchell S, Masisi M, Cockcroft A, Andersson N

Socio-economic status and HIV and AIDS stigma in Tanzania.Mbaraka A, Mitchell S, Cockcroft A, Andersson N

Choice disability and HIV prevention knowledge, attitudes and practices in Botswana.

Ho-Foster A, Andersson N, Cockcroft A, Masisi M, Laetsang D, Kgakole L

What has happened to multiple sexual partnerships in Swaziland between 2002 and 2008?

Cockcroft A, Andersson N, Ho-Foster A, Marokoane N, Mziyako B

ADAPT presentations at AIDS impact conference

Ho-Foster A, Laetsang D, Masisi M, Anderson M, Tlhoiwe D, Cockcroft A, Andersson N. .

Gender-specific patterns of multiple concurrent sexual partnerships: a national cross sectional survey in Botswana.

AIDS Care 2010: 1-6 (doi: 10.1080/09540121003758598)

Cockcroft A, Lengwe Kunda J, Kgakole L, Masisi M, Laetsang D, Ho-Foster A, Marokoane N, Andersson N.

Community views of inter-generational sex: findings from focus groups in Botswana, Namibia and Swaziland.

Psychology, Health and Medicine 2010 (in press)

Amuri B, Mitchell S, Cockcroft A, Andersson N. Socio-economic status and HIV and AIDS stigma in Tanzania.

AIDS Care 2010 (in press)

Cockcroft A, Andersson N, Ho-Foster A, Marokoane N, Mziyako B What happened to multiple sexual partnerships in Swaziland?

Analysis of five linked national surveys between 2002 and 2008.AIDS Care 2010: 1-6 (doi: 10.1080/09540121.2010.482123)

ADAPT publications in peer reviewed journals

Second course

• Nominations from SADC NAAs• 1st three week block 28 Jan–15 Feb 2013• 20 participants:

– 4 Botswana, 1 Mauritius, 3 Namibia, 4 Swaziland, 2 Tanzania, 2 Zambia, 4 Zimbabwe

• Epidemiology and statistics relevant to RCTs• Support to develop fundable HIV prevention

research proposals

Research topics• Multiple concurrent partnerships in young women• HIV risks in female sex workers• Sexual behaviour after male circumcision• Sexual behaviour among college students• Condition cash transfers and HIV trial• HIV infection through breastfeeding• Role of older people in youth HIV prevention

Systematic review module• 16-20 July 2012• School of Nursing and Public Health, UNAM• 10 participants – mostly SNPH faculty

Systematic review module• Methods of analysis of RCTs• RCTs and non-experimental

study designs• Elements of SR and meta-

analysis– data extraction – dealing with heterogeneity

between studies– interpretation of forest plots – assessment of quality of

studies and SRs

Systematic review module• Practical experience

– navigating Cochrane website – searching literature – using Revman software to conduct meta analysis

Systematic review module

The Dean of the SNPH presented certificates on the final day

Capacity building for Botswana parliamentarians

Participants in the first session – November 2011

Botswana parliamentariansEvidence-based decision makingTwo training sessions

– 31 October/1 November 2011– 12 and 14 November 2012

Logistic organisation by NACAAttended by

– 36 of 61 MPs– Including 7 ministers

Laboratory skills training

National Institute for Communicable Diseases, Johannesburg, S Africa

Two SADC one-week courses:HIV serology on dried blood spotsNew techniques for estimating HIV incidence

Participants:

>With basic laboratory skills

ADAPT trainingSADC researchers HIV prevention epidemiology

RCT techniques

SADC researchers HIV prevention epidemiologyResearch proposals

UNAM faculty Systematic reviews

SADC laboratory staff HIV serology for DBSHIV incidence testing

Botswana parliamentarians Using evidence for decision making

Challenges

• Retaining trained individuals in system• Organisations not allowing time out for

higher qualifications• SADC bureaucracy (laboratory courses)• Obtaining funding for African led research

By end of ADAPT• Network of trained HIV researchers in SADC

countries• Improved institutional capacities for research• Several fundable proposals for RCTs led by

African researchers • Better informed and equipped decision makers