Fellowship Site: South Africa

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) is a not for profit research organization that was established in 2002 through a consortium of five key institutions. University of KwaZulu-Natal, Columbia University, University of Cape Town, University of the Western Cape, and the National Institute of Communicable Diseases. The CAPRISA headquarters are located in the Doris Duke Medical Research Institute at the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal. The main goal of CAPRISA is to undertake globally relevant and locally responsive research that contributes to:

• Understanding HIV pathogenesis, prevention and epidemiology
• Interaction between Tuberculosis and AIDS
• Reducing mother to child transmission of HIV

In keeping with this goal, CAPRISA contributes to research in six main areas: HIV Pathogenesis, HIV Vaccines, HIV and TB treatment, Microbicides, Prevention and Epidemiology, and PMTCT.

Research:

CAPRISA 004: Phase II trial to assess the safety and effectiveness of the vaginal microbicide, 1% Tenofovir gel, for the prevention of HIV infection in young women in South Africa
This 1250-woman trial is being conducted at the CAPRISA eThekwini and Vulindlela Clinical Research Sites to test the safety and efficacy of 1% Tenofovir gel in sexually active women at high risk of acquiring HIV infection in South Africa. Tenofovir is an antiretroviral agent, used widely in the treatment of AIDS. It has great potential as a microbicide gel because of its known safety profile in long term users and its long half life. Participants are followed up monthly. The trial includes multiple novel components including a theory based Adherence Support Program, and multiple mechanisms for measuring product use including laboratory markers. Accrual will be completed by the end of 2008 and follow-up will continue into the third quarter of 2009. In addition to a number of ancillary studies underway and planned linked to the trial has a number of innovative facets including amongst others - a theory based customized adherence programme linked to biological and self-report measures of adherence and an enhanced informed consent process.

UKZN-CAPRISA HIV/AIDS Clinical Trials Unit (CTU)
The UKZN-CAPRISA HIV/AIDS CTU comprises a core team based at the CAPRISA DDMRI offices in Durban and 5 Clinical Research Sites (CRSs) (Aurum, eThekwini, Vulindlela, Umbilo and Umlazi). The UKZN-CAPRISA CTU is affiliated to five of the NIH funded HIV/AIDS Clinical Trials Networks viz HVTN, ACTG, IMPAACT, HPTN and MTN. Current projects include:

• ACTG 5221 study: The primary objective of this study is to compare the proportion of participants in the immediate ART arm versus the deferred ART arm surviving without AIDS progression (defined as a new AIDS-defining illness) at week 48. All the treatment programs have the capacity to treat commonly occurring OIs on- site, including pulmonary and extra-pulmonary TB, candidiasis (through participation in the government's diflucan program, pneumonia, gastro-enteritis, and other respiratory infections. Referral networks exist for the triaging of sick patients into district and tertiary facilities.
• HPTN 046 study: This Phase III, multi-site, randomized, double-blind, placebo controlled trial aims to evaluate the efficacy and safety of an extended regimen of nevirapine (NVP) from 6 weeks to 6 months or through cessation of breastfeeding, whichever is earliest, for prevention of mother-to-child transmission of HIV through breast milk compared with placebo among infants who are provided nevirapine for the first 6 weeks (through Day 42) of life and are HIV-uninfected at age 6 weeks.

The CAPRISA AIDS Treatment (CAT) Program
The CAT program was started in 2004 as a supplemental program to deal with the large volume of HIV positive clients that were screened out of other studies at CAPRISA. By the end of March 2008 this program had successfully enrolled 2114 patients on antiretroviral therapy (ART) and a further 6052 were receiving palliative care. The strength of the current CAT program lies in its ability to provide an integrated package of prevention and treatment services and employs an innovative method of providing antiretroviral treatment by integrating the TB and HIV care as well as counseling and testing, family planning, sexually transmitted infections (STI) treatment, prophylaxis and treatment for opportunistic infections (OIs) and other HIV associated conditions. In addition the CAT programme in Vulindlela is a nurse driven model of ARV provision in a rural primary care setting.

Housing Availability:
U.S. trainees are provided with a car service on arrival for their transfer to their accommodation. Temporary housing at a bed and breakfast is secured for their first month by CAPRISA; administrative support is provided to students to assist them in securing permanent housing for the rest of their traineeship period. Housing is preferably sought within a 1-10km distance from the CAPRISA offices to facilitate travel. Transportation is arranged for the first day of work, after which Scholars are advised on safe and convenient public bus and taxi transport routes, shuttle services, and information for those interested in purchasing motor vehicles. The monthly stipend is generous in meeting housing, transport and living costs for the duration of the fellowship at above-average living standards.

Generally the housing available for trainees consists either of an apartment or accommodation attached to a private residence or a cottage on a private residential property. The average cost of housing ranges from R 1,500 - R 4,500 per month depending on whether the housing is a room, apartment or cottage. The distance to the research facility would be dependent on where the accommodation is and trainees can either purchase a used car (and often take over the car from a trainee who has completed his/her fellowship) or alternatively, use a public bus service. Private taxis are also a reliable option but are more costly. Trainees often share the use of a car and running costs.

Prior to arrival all Scholars will be provided with more detailed information on accommodation and transportation.

Health Issues and Immunizations Needed for this Site:
See the Centers for Disease Control and Prevention Web site and The Yellow Book: Health Information for International Travel.

The FICRS program mandates that all Scholars see a physician prior to their assignment abroad. The site will require a formal letter from your physician stating that you have received the necessary immunizations prior to the start of your fellowship.

Safety and Danger Issues:
Like most cosmopolitan cities, safety is an important consideration. During orientation on arrival at CAPRISA, students are provided with specific and up-to-date information on crime "hot-spots" and additional precautions when traveling in the city and between clinical research sites. International students who are not familiar with the city or country are advised to avoid walking alone in unfamiliar places, especially in the evenings, and to be in the company of a person who is familiar with the place, especially at night. On campus, Security Services offers Guard Escort Service after dark.

See the U.S. State Department Web site for additional information.

Language Requirements other than English:
The University of KwaZulu-Natal is an English-speaking institution therefore, English proficiency would ensure the ability of U.S. Scholars to function effectively. The majority of the research participants in CAPRISA trials and patients in CAPRISA projects speak isiZulu. For more direct interaction with participants and patients, it is desirable (but not essential) to have a working knowledge of isiZulu. In addition to private tutors, the university has special isiZulu language classes for medical students.

What is it like to live in South Africa?
South Africa is an exhilarating and complex country. With its post-apartheid identity still in the process of definition, there is undoubtedly an abundance of energy and a sense of progress about the place. The climate is kind and there are few better places to see Africa's wildlife.

Diversity is a key feature of South Africa, where 11 languages are recognized as official; where community leaders include rabbis and chieftains, rugby players and returned exiles; where traditional healers ply their trade around the corner from stockbrokers; and where housing ranges from mud huts to palatial homes with swimming pools.

Durban has a sub-tropical climate, getting very hot and humid in the summer months (November to February). The rest of the year has an extremely pleasant temperature and it never really gets cold. Durban lies in a summer rainfall area and is a popular summer holiday destination for South Africans because of its beautiful beaches. Durban also provides easy access to several game parks and the Drakensberg mountain range. In addition, it is about a two-hour drive from the St. Lucia wetlands, a world heritage site. The city has many good restaurants, theatres, shopping centres, movie houses and many other facilities to keep visitors entertained.