2016 Our passion for what we do makes us pioneers in our - Wits Health Consortium
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Contact Information Wits Health Consortium Te l e p h o n e : + 2 7 1 1 2 7 4 9 2 0 0 Fax: + 2 7 1 1 2 74 9 3 0 4 Email: info@witshealth.co.za We b s i t e : w w w.w i t s h e a l t h . c o . z a WHC 2016 ANNUAL REVIEW
CONTENTS Wits Health Consortium 2016 Annual Review EXECUTIVE SUMMARY WHC STRUCTURE 04 16 INTRODUCTION B OA R D O F D I R E C TO R S 05 17 W H C C O M PA N Y P R O F I L E MAJOR RESEARCH UNITS 05 24 FINANCIAL OVERVIEW OT H E R R E S E A R C H U N I TS 06 49 HUMAN RESOURCE OVERVIEW MESSAGE FROM CEO 12 52 VISION, MISSION & MESSAGE FROM VA L U E S F A C U LT Y 14/15 52
4 EXECUTIVE SUMMARY We a r e t h e r e s u l t o f o u r h a r d wo r k . Our passion for what we do makes us p i o n e e r s i n o u r s e c t o r. The Wits Health Consortium (Pty) Ltd (WHC) is a private, wholly owned company of the University of the Witwatersrand, Johannesburg (Wits). WHC was established as a result of an initiative from the Faculty of Health Sciences which proposed the company in order to unlock commercial opportunities that would provide additional sources of revenue for the Faculty and its Departments. Council approved the Faculty’s proposal in October 1997 and the Company was registered in 1998. All academic endeavors are directed, managed and controlled through the University structures with WHC research active staff joint appointed with the University conducting research, managing donor- funded activities, clinical trials and pursuing entrepreneurial innovation in health. WHC operates a Shared Services Centre (SSC) and several key subsidiary businesses.
INTRODUCTION 5 The Wits Health Consortium (WHC) was formed in 1998 as an entity through which the Faculty of Health Sciences is able to undertake third stream income activities. This is done while supporting academic research and the management of donor funding for research as well as related activities in the medical and health sciences industry. We have numerous research entities that we service and they operate in South Africa, across the African continent, in the US as well as Europe. We are the enabling environment for an entrepreneurial approach to academia. We perform this role through our Shared Services Centre (SSC), which employs over 170 skilled staff. By doing what we do well, we free up our internationally renowned academics and researchers to do what they do best we enable them to pursue specialist research in their respective fields of expertise. This report provides an overview of our operations and highlights the success of our research units and their achievements during 2016. WHC Shared Support Centre (SSC): These are entities are in support of WHC academic activities and the Faculty of Health Sciences strategy We operate a SSC to support research activities and provide the following support: • Financial Administration • Contract and Legal Services • IT Solutions • Human Resource Management • Training and Development • Payroll Services • Research Ethics • Clinical Trials • Grant Management • Internal Audits • Continuing Professional Development • Speer IT Services and Solutions: Software, IT systems, network connectivity and cloud storage and management solutions • Integrated Health Delivery Network: Self-funding clinical health centres and medical teaching platforms that offer affordable and quality healthcare • Academic Advance: Good Clinical Practice courses and training, conducted in line with CPD requirements for the Health Professions Council of South Africa • Ukwenza Print and Graphics Studio: Graphic and web design, print and multi-media production and research data collection and design
6 FINANCIAL OVERVIEW 2016 FINANCIAL OVERVIEW Our financial overview gives us the opportunity to provide a view of the financial position of Wits Health Consortium.
7 WITS HEALTH CONSORTIUM PROPRIETARY LIMITED STATEMENT OF PROFIT OR LOSS AND OTHER COMPREHENSIVE INCOME For years 2016 and 2015 2016 2015 R R Surplus before operating expenses 1,573,710,183 1,119,368,517 Expenses 1,569,938,702 1,114,999,307 Personnel costs 917,041,451 669,782,248 Consultants 99,205,904 25,401,748 Depreciation 29,884,500 23,439,580 Operational costs 444,939,393 342,897,899 Travel costs 64,705,781 42,231,367 Training costs 14,161,673 11,246,465 Surplus before net finance income 3,771,481 4,369,210 Net finance income 39,849,607 26,559,464 Surplus before income tax 43,621,088 30,928,674 Income tax expense 92,374 115,282 Surplus for the year 43,528,714 30,813,392 Attributable to CORE 15,370,117 9,759,875 Syndicates - Restricted - - Syndicates - Unrestricted 28,158,597 21,053,517 Dividend declared to the University of 6,800,000 5,600,000 Witwatersrand, Johannesburg
8 WITS HEALTH CONSORTIUM PROPRIETARY LIMITED STATEMENTS OF FINANCIAL POSITION For years 2016 and 2015 2016 2015 R R ASSETS Non-current assets Property, plant and equipment 138,016,083 101,981,483 Goodwill 485,608 485,608 Deferred tax 53,107 - 138,554,798 102,467,091 Current assets Inventory 1,352,733 738,014 Trade and other receivables 238,123,374 187,521,513 Tax receivable 111,088 89,903 Cash and cash equivalents 770,413,738 666,316,694 1,010,000,933 854,666,124 Total Assets 1,148,555,731 957,133,215 EQUITY AND LIABILITIES Equity Share capital 100 100 Accumulated reserves 351,755,113 315,026,399 351,755,213 315,026,499 Liabilities Non-current liabilities Borrowings 1,654,334 2,148,958 Deferred income 1,267,503 5,069,892 Deferred tax - 222 2,921,837 7,219,072
9 2016 2015 R R Current liabilities Borrowings 502,544 464,526 Deferred income 3,802,390 3,802,390 Trade and other payables 185,686,678 165,065,141 Income received in advance 597,962,591 460,525,793 Unallocated receipts 5,924,478 5,029,794 793,878,681 634,887,644 Total Liabilities 796,800,518 642,106,716 Total equity and liabilities 1,148,555,731 957,133,215 CASH BALANCES 900 800 700 600 Millions 500 400 300 200 100 2012 2013 2014 2015 2016
10 PROPERTY, PLANT AND EQUIPMENT 160 140 120 Millions 100 80 60 40 20 2012 2013 2014 2015 2016 INCOME GROWTH PROJECTIONS 1,800 1,600 1,400 1,200 Millions 1,000 800 600 400 200 2014 2015 2016 2017 2018
11 DIVIDEND DECLARATIONS 8 7 6 Millions 5 4 3 2 1 2012 2013 2014 2015 2016 INCOME PER DONOR 800 700 600 Millions 500 400 300 200 100 ID IH F L S C ER LS IA G D D N A C TH N BM C C US FU ER O M L BA M LO O C G
12 2016 HUMAN RESOURCE OVERVIEW JOINT APPOINTMENTS EE STS (All) EE STS Active Division Headcount Joint Appointment Title Headcount Clinical HIV Research Unit 8 Associate Researcher 30 Health Economics Research Office 20 Lecturer 4 Johannesburg Oncology 1 Researcher 74 MatCH Research Unit 7 Senior Researcher 13 MatCH Health Systems 3 Associate Professor 5 Non Communicable Disease Visiting Professor 1 1 Research Perinatal HIV Research Unit 28 Professor (Chair / Personal) 1 Respiratory & Meningeal Pathogens Grand Total 132 13 Research Unit Rural Health Advocacy Project 1 Sbimb-H3ABionet 1 Wits Reproductive Health & HIV 45 Institute Grand Total 128 Other Syndicates Respiratory & Meningeal 8% Perinatal HIV Research Unit Pathogens Research Unit 13% 8% WHC - SSC 6% Agincourt 5% Clinical HIV Research Unit 4% MatCH Research Unit MatCH Health Systems 4% 20% Clinical Laboratory Services 3% Health Economics Research Office 2% Non Communicable Disease Research 2% Empilweni Services & Research Unit National Institute for 1% Communicable Disease Wits Reproductive Health & 1% HIV Institute 23% National Institute for Communicable Disease Empilweni Services & Research Unit Non Communicable Disease Research Health Economics Research Office Clinical Laboratory Services Clinical HIV Research Unit MatCH Research Unit Agincourt WHC - SSC Respiratory & Meningeal Pathogens Research Unit Other Syndicates Perinatal HIV Research Unit MatCH Health Systems Wits Reproductive Health & HIV Institute
13 2016 HUMAN RESOURCE OVERVIEW CONT. SYNDICATES DECEMBER 2016 HEADCOUNTS National Institute for Communicable Disease 36 Empilweni Services & Research Unit 38 Non Communicable Disease Research 53 Health Economics Research Office 72 Clinical Laboratory Services 87 Clinical HIV Research Unit 115 MatCH Research Unit 126 Agincourt 170 WHC - SSC 185 Respiratory & Meningeal Pathogens Research Unit 254 Other Syndicates 269 Perinatal HIV Research Unit 439 MatCH Health Systems 653 Wits Reproductive Health & HIV Institute 760 Total 3257
14 Our Mission is to support the teaching, research and public health service mission of Faculty
15 V i s i o n , M i s s i o n a n d Va l u e s Our Vision is to be a valued strategic partner of Faculty, recognised for the additional resources, commercial / business expertise and supplementary income we are able to make available to it. Our Mission is to support the teaching, research and public health service mission of Faculty; either through the provision of commercial and administrative support for income-generating activities ancillary to the main objectives of Faculty (namely teaching, research, and the provision of medical services), or by directly engaging in teaching, research, medical service or other related activities which are complementary to the main objectives of Faculty. Our Values: Stewardship - We recognize our role as stewards of the Faculty’s assets by managing our resources responsibly, effectively, and efficiently. Employees - We are committed to the success of our employees, as they are our most valuable resource, and so provide them opportunities for development, growth and personal success. Respect - We are courteous, conscientious and respectful in our dealings with our customers, employees, Faculty and the communities where we work. Variety - We embrace different viewpoints and support mutually beneficial partnerships among a diverse mix of individuals, departments, institutions, and community groups. We also embrace the wide and varied range of activities that we undertake in achieving our Vision and Mission. Integrity - We conduct ourselves in a fair, ethical and honest manner. We strive to make all decisions in the best interests of our customers, employees, Faculty and the communities where we work. We are accountable and answerable for our actions. Customer Service - We value innovative, timely, efficient, solution-oriented, and cost-effective services and systems. We are committed to achieving the highest levels of customer satisfaction achievable, given the resources at our disposal. Entrepreneurship - We foster a culture where entrepreneurship and prudent risk taking are encouraged, where the entrepreneur is able to benefit as a partner in their venture.
16 W I T S H E A LT H C O N S O R T I U M S T R U C T U R E Our Board of Directors include leading academics, business experts and specialist advisors • Professor Martin Veller is the Non-Executive Director and Chairman of WHC • Mr Alfred Farrell is the Executive Director and Chief Executive Officer A skilled Executive Team oversees day-to-day operations of WHC and comprises the following: Mr Alf Farrell Chief Executive Officer Dr Ntsikelelo Itumeleng Funani Chief Academic Officer Mr Ralph Bagirathi Chief Operations Officer Mrs Christine Grobler Deputy Chief Operations Officer Mr Jean Du Randt Chief Financial Officer Mr Daniel Mosia Chief Strategic Officer Mr Mamatsabu Maphike Chief Risk & Compliance Officer Mr Karl Basson Head of Speer Management Services (IT) Mrs Robyn Hayes-Badenhorst Head of the Office of the CEO B E H I N D O U R B R A N D I S A G R E AT T E A M
B OA R D O F D I R E C TO R S 17 WHC has a highly-respected Board of Directors, selected for their internationally recognized academic excellence and management experience. Responsible for overseeing all governance, internal controls, risk management, financial management and human resource services that WHC provides to its research units and to the University of the Witwatersrand. Non-Executive Director and Chairman Professor Martin Veller MB BCh, FCS (SA), M Med (Surg) Professor Veller is Dean of the Faculty of Health Sciences at the University of the Witwatersrand and a Professor in the University’s Department of Surgery. He is an expert in Vascular Surgery with extensive academic, research and teaching experience. Professor Veller also serves on the Board of Directors of the Wits Donald Gordon Medical Centre. He has trained at the University of Witwatersrand and at St. Mary’s hospital at London’s Imperial College Executive Director and Chief Executive Officer Mr Alfred Farrell B Comm, B Compt (Honours), CA (SA) Mr Farrell is a skilled financial and accounting manager with many years of experience in senior financial management positions at companies such as the Automobile Association of South Africa, Interleisure and the Premier Group. Prior to joining WHC in 2002, Alf held the position of Chief Financial Officer for BDFM Publishers (Pty) Ltd. Mr Farrell has steered Wits Health Consortium with invaluable insights gained through his successful career. Since joining Wits Health Consortium Mr Farrell has directed its portfolio of development and research programmes, managed through the Shared Service Centre, and has ensured the growth of Wits Health Consortium has been combined with high standards of delivery. Under Mr. Farrell’s tenure the total income of Wits Health Consortium has grown from R150 million in 2002 to over R1.8billion in 2016
18 Board of Directors Mr Desmond Arnold CA (SA), FCMA, AMP (Wharton) Mr Arnold is a highly-skilled accountant and has held numerous financial positions in some of South Africa’s leading corporates. He is a past President of the South African Institute of Chartered Accountants (SAICA) and was awarded honorary life membership in recognition of his services to the accounting profession. Mr Arnold is Chairman of the WHC Audit Committee and is also a member of the WHC Risk Committee. He is also a Trustee of the Absa Pension Fund. Dr Rachel Chikwamba MBA, PhD (Genetics) Dr Chikwamba is responsible for strategic alliances and communication and is an expert in scientific and industrial research. Her research has focused on metabolic engineering for nutrition and pharmaceutical applications. She has studied in the US and Australia and was an Honorary Research Fellow at St George’s Hospital at the University of London. She has also taught post-graduate classes at the University of Pretoria. Mr Prakash Desai B Comm, B Compt (Honours), CA (SA) With many years of experience and skill in senior management roles, Mr Desai supports WHC in areas such as risk, audit, strategy and investment. He is currently Chief Executive Officer at Afrifocus Securities and worked as a former Group Chief Executive and Group Finance Director at Avusa. Prior to this, he was a Non-Executive Director at M-net Supersport Ltd and at Caxton Publishers and Printers Ltd.
Board of Directors 19 Professor Mkhululi Lukhele MB BCh, M Med (Orthopaedics), FCS (SA) Professor Lukhele heads up the School of Clinical Medicine at the University of the Witwatersrand’s Faculty of Health Sciences. He has published widely and has specialised in orthopaedic research, including areas such as spinal cord injuries and spinal tuberculosis in HIV patients. Professor Lukhele has participated in various multi-national clinical trial studies and is Academic Head of the Wits University Division of Orthopaedics. Professor Johnny Mahlangu MB BCh, M Med (Haem), FCPath (SA) (Haem) (Clin Haem) Professor Mahlangu is Head of the University of the Witwatersrand’s School of Pathology and Head of the Haematology Diagnostic Section in the Department of Molecular Medicine and Haematology. He has peer reviewed many journal publications and international congress presentations. He also sits on the editorial boards of various haemophilia treatment guideline committees and participates in multi-national clinical trials. Dr Tshepo Motsepe MB BCh; MA (Public Health) Dr Motsepe is a KwaZulu-Natal and Harvard University graduate. She has worked in private medical practice locally and abroad and has developed specialist knowledge in several fields, including family health, refugee health and HIV. She was Deputy Director of the Chris Hani Baragwanath Hospital in Johannesburg and Ch airperson of the Health Accreditation Committee for the Gauteng Provincial Government.
20 Board of Directors Associate Professor Maria Papathanasopoulos Professor Papathanasopoulos is an established scientist who has built an exceptional reputation in the infectious diseases, bioinformatics, and virology fields. She has established world class laboratories that conduct innovative research on HIV-1 drug discovery, and vaccine designs that are recognised at a national, regional and international level. In the last eight years she has completed research for the South African Strategic Health Innovation Platform, the South African HIV/AIDS Research and Innovation Platform, the National Research Foundation, the International AIDS Vaccine Initiative Innovation Fund, the Carnegie Foundation, the Poliomyelitis Research Foundation and several others. Professor Helen Rees GCOB, OBE, MBBChir, MA (CANTAB), MRCGP, DCH, DRCOG, RCOG FP Instructor Professor Rees is Executive Director of the Wits Reproductive Health and HIV Institute. Her specialist area focuses on HIV and Reproductive Health and she has published extensively in these fields. She has been internationally recognised for her expertise and for her contribution both nationally and internationally to research and medical advances in these areas. Professor Zeblon Vilakazi PhD (Physics) Professor Vilakazi is Deputy Vice-Chancellor of Research and Post-Graduate Affairs at the University of the Witwatersrand. His research interests include computational physics and heavy-ion collisions at high energies and his work saw him nominated as a Young Global Leader by the World Economic Forum in 2010. He is globally recognised for his expert knowledge in physics and nuclear research.
Board of Directors 21 Mr Mahomed Salim Ismail (Mac) Gani Mac Gani is an independent consultant with a distinguished career in accounting and financial management. He spent two years working in London for an auditing firm and has gained valuable experience locally working his way up to being a partner in a leading accounting firm as well as a financial executive leader. He has also developed a special interest in higher education and health services. Sub-Committees The following Sub-committees have been established to assist the Board to perform its duties. • Audit and Risk Committee • Remuneration Committee • Strategy and Investment Committee • Academic Oversight Committee • Social and Ethics Committee (incorporating Sustainability Committee) • Directors’ Affairs Committee
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23 MAJOR RESEARCH UNITS 2016
24 MAJOR RESEARCH UNITS Wits Reproductive Health Institute The Wits Reproductive Health and HIV Institute (Wits RHI) aims to tackle Africa’s health challenges through science and innovation. It is acclaimed for its pioneering research, innovating services and providing evidence-based policy development and advocacy. Its areas of expertise cover HIV, Sexual and Reproductive Health and Vaccine Preventable Diseases. Who we are: Wits RHI is part of the Wits RHI began implementing the Faculty of Health Sciences of the OPTIMIZE project, a rigorous clinical University of the Witwatersrand and trial that will potentially yield a new the largest research institute within the first-line regimen with the potential to university. It is committed to developing transform healthcare for HIV-positive and conducting relevant research, people. This will operate in tandem and providing technical assistance with an engagement programme that Professor Helen Rees and capacity building that is geared incorporates communities, clinicians Executive Director of the Wits to informing policy development and regulators. If successful, OPTIMIZE Reproductive Health and HIV and evidence-based programmes. will be better tolerated, allowing for Institute We push boundaries with innovation improved durability through better Head Office Contact Details: in health services by using a multi- adherence. University of the Witwatersrand pronged approach to improve health Hillbrow Health Precinct outcomes and influence policy. This Wits RHI was awarded USAID-UNITAID Hugh Solomon Building ranges from generating evidence funding for ADVANCE, a study that Hillbrow, 2001 related to health issues, to testing falls under OPTIMIZE and will compare Tel: +27 11 358 5300 and evaluating interventions, to newer drugs in the first line ARV regimen Email: rhicomms@wrhi.ac.za translating evidence into policy. to standard of care. Web: www.wrhi.ac.za We continued with three robust United Strategy in 2016: We continued to grow States President’s Emergency Plan for our research footprint in our three key AIDS Relief (PEPFAR) programmes with focus areas, namely HIV, Sexual and a strong implementation science focus, Reproductive Health and Vaccine aimed at strengthening care for sex Preventable Diseases. We consolidated workers and truck drivers, adolescents our leadership in the fields of HIV and the youth. These programmes are prevention and treatment, completing aimed at supporting districts to achieve several globally significant trials. We their goals for HIV testing, initiation of also launched several new research treatment and viral suppression at 12 initiatives on HIV treatment optimisation months after treatment initiation as laid for adults and children. out by UNAIDS. Wits RHI has developed a significant Regarding new developments in HIV portfolio of HIV treatment optimisation prevention, technologies continued to work with the aim of developing be developed including Pre-Exposure safer, more robust and less expensive Prophylaxis (PrEP). We presented and antiretroviral therapy (ART) regimens. published the results of our Microbicide This reduction in costs will help improve Trials Network ASPIRE dapivirine ring health outcomes as more and more trial. Open-label extension studies now people access ART follow while registration of this product is pending. Key developments in 2016: We also initiated enrolment into the
Major Research Units 25 exciting HPTN 081 trial of the safety Wits RHI staff engaged with national research grants were investigator and efficacy of VRC01 monoclonal policy makers on the finalisation driven. antibodies for the prevention of HIV. of a cervical cancer prevention strategy, and contributed at a global Wits RHI staff published 83 papers in ISI Furthermore, 2016 was an important level to policy initiatives around the accredited journals. This was achieved year for launching several programmes development of vaccines for sexually with a staff of 45 joint appointments, operating at the policy, facility and transmitted infections. while 15% are classified as research end-user level to demonstrate how active. The organisation has a robust best to deliver PrEP in South Africa to Wits RHI staff extended their work on postgraduate support programme with sex workers, adolescent girls and young Sexual and Reproductive Health and 17 PhD candidates affiliated to it. women. Wits RHI actively contributed the interface with Vaccine Preventable to PrEP guidelines and training and Diseases by initiating several studies on In 2016 Wits RHI had a staff complement engaged in technical working groups vaccination of pregnant women and of 748. A significant proportion of to advise the Department of Health. or/infants. staff are female, and attention is We were central to the success of the The Institute will participate in a phase III given to ensuring the development launch of the National Sex Worker study to determine the immunogenicity and representation of historically programme by the South African and safety of a Respiratory Syncytial disadvantaged groups in leadership National AIDS Council, which included Virus (RSV) F Nanoparticle vaccine and management positions. PrEP delivery. Wits RHI staff also with aluminum in healthy third trimester Our contribution to policy continued supported the national She Conquers pregnant women (RSV-M-301). to gain local and global recognition campaign, aimed at reducing HIV We will also participate in a phase 1/11 in 2016. Our staff were invited to incidence in adolescent girls and young double bind, randomised, placebo- present at conferences, to contribute women. An important addition to our controlled descending-age, dose to conference committees, and to work has been the inclusion of research escalation study to examine the safety, provide expert guidance on policy around prevention of gender-based tolerability and immunogenicity of and programme development. Sixty violence within these HIV programmes. the trivalent P2-VP8 subunit rotavirus presentations were made across a Results from this work will be known in vaccine in healthy South African adults, range of platforms, including 56 oral the next two years. toddlers and infants. presentations. A study to explore strategies to eliminate Wits RHI is working with the Respiratory Also, 58 abstract-driven presentations mother to child transmission of HIV and Meningeal Pathogens Research including 16 oral presentations, 20 (EMTCT) was launched in 2016. Known Unit (RMPRU) to lead the development poster presentations and 22 poster as the Mother-Infant Pairs Study, this of the African Local Initiative for exhibitions were made at international prospective cohort study will provide Vaccinology Expertise (ALIVE) conferences. important data on HIV incidence consortium, which will strengthen Apart from its research output, Wits and risk factors for new HIV infections vaccinology research capacity in the RHI continued to provide expert in mothers and infants, explore ART region, and address a region-specific guidance on policy and programme use in pregnancy and post-partum Vaccine Preventable Disease agenda development. The Institute played and explore the potential for male across the spectrum, ranging from a key role in the development of involvement in these programmes. vaccine discovery to vaccine. the Prevention of Mother To Child ALIVE secured a grant from the Bill & Transmission of HIV National Guidelines. On a global level, the ECHO study was Melinda Gates Foundation for start-up launched in several countries. Aimed at activities and was recently awarded quantifying whether there is an excess a grant by the National Research risk of HIV infection in women who use Foundation as a Wits University Flagship injectable contraception compared Project. with other forms of contraception, this study will provide important and Other achievements: In 2016, Wits RHI possibly definitive data to address this had 67 grants totalling over R400m question. under management. Of this, 33% of
26 Major Research Units Wits Perinatal HIV Research Institute The Perinatal HIV Research Unit (PHRU), celebrating 21 years of research excellence, aims to improve life through research. PHRU’s research scope spans HIV and TB prevention and its treatment. Who we are: The PHRU is a large clinical We continue to conduct adult, pediatric research unit with diverse capacity to and adolescent HIV and TB research conduct a range of observational and and in 2016, we were awarded The NIH clinical trial research. We are a Unit Division of AIDS clinical research site of the University of the Witwatersrand. (CRS) status in Matlosan, building on our Although our primary research site exisiting CRS’s in Soweto. remains Soweto, after 20 years, we Dr Neil Martinson have three research sites in Limpopo, We continued to recruit into four Executive Director of the Wits one in Botshabelo, in the Free State, US Government-funded cluster Perinatal HIV Research Unit and a large site in Matlosana (around randomized trails assessing earlier Klerksdorp) in North West Province. We diagnosis of TB in household contacts Head Office Contact Details: are expanding capacity at these sites of TB cases and HIV-infected pregnant New Nurses Home to conduct clinical research into the women. Chris Hani Baragwanath HIV and TB epidemics Academic Hospital In addition to numerous investigator- Soweto, Johannesburg Our External Mission is to conduct driven and publicly-funded clinical Tel: +27 11 989 9700 community-partnered, ethical, trials, PHRU also conducts clinical trials Email: 011 989 9700 innovative and multi-disciplinary for pharma. PHRU has established Web: www.phru.co.za research that influences knowledge important behavioural and social and policy. science research. We continue to advocate for research access and the Our Internal Mission is to provision of care to key communities. develop passionate, caring and empowered researchers to work Strategy in 2016: Our focus was on in the health development sector. increasing the number of publications that our investigators authored and Research in 2016: PHRU continued also to increase and diversify grant having an impact on clinical income. Indeed in 2016, PHRU staffers research. In 2016, we published over co-authored 54 publications. 52 manuscripts in international peer- reviewed publications. We were In 2016, PHRU continued to participate awarded several new grants and in Community Advisory Boards (CABs) continued and expanded others. HIV alongside traditional healers, religious vaccine research has been a particular leaders, social workers, police officers, focus and in 2016 PHRU both prepared LGBTIs and NGOs participating in CABS for and recruited to several important in Soweto and Matlosana. clinical HIV vaccine trials. Research was conducted for the Moreover, we planned to expand PHRU IMPAACT network (International capacity to recruit at two separate Maternal Pediatric Adolescent AIDS vaccine research sites in Soweto. Clinical Trials) and the ACTG (AIDS Clinical Trials Group).
Major Research Units 27 PHRU teams also worked on the HPTN Facilities in 2016: PHRU continued to programme (HIV Prevention Trials enjoy a well-established, world class Network) and the HVTN (HIV Vaccine research facility. Trials Network). This includes a series of research clinics and counselling centres, a pharmacy, Ground-breaking study in 2016: We a laboratory, a data management launched the first-ever HIV vaccine centre, a training centre and efficacy study. This will establish whether administrative offices — each located an experimental vaccine regimen at the Chris Hani Baragwanath Hospital. safely prevents HIV infection among South African adults. The study, called Staffing in 2016: In 2016 PHRU remained HVTN 702, involves a new version of the a growing research unit with more than only HIV vaccine candidate ever shown 400 employees on staff. The PRHU team to provide some protection against the is led by Dr Neil Martinson. virus. HVTN 702 aims to enroll 5,400 men and women, making it the largest and Funding in 2016: most advanced HIV vaccine clinical We continued to collaborate with trial to take place in South Africa. funders worldwide including NIH, US The Soweto CTU sites will be enrolling Government’s CDC, the Global Fund participants into this historic study. to fight AIDS, TB and Malaria, the Aurum Health Institute, WHRI, SAMRC, UKMRC, Clinical research in 2016: PHRU Right to Care and SFH/PSI. recruited or followed up participants in approximately 45 active studies, including clinical research sites in Limpopo, North West and Free State Provinces. These studies included a diverse range of participants such as pregnant woman, HIV-infected children, HIV exposed uninfected adolescents and adults – both HIV infected and HIV seronegative. Mentorships in 2016: In the year under review, PHRU continued with important mentorship and academic research training. We had the following mentorships: • 5 PhD candidates • 9 Masters students • 4 NRF National Research Foundation Interns • 1 SHAPe Scholars • 2 HPTN International Scholars • We hosted five graduate students from the John Hopkins University Center for Global Health
28 Major Research Units Wits Clinical HIV Research Unit & the Health Economics and Epidemiology Research Office The Wits Clinical HIV Research Unit (CHRU) and the Health Economics and Epidemiology Research Office (HE2RO) aim to deliver excellence and quality clinical research, services and support. CHRU is based in Johannesburg at the Helen Joseph Hospital and HE2RO’s headquarters are in Parktown, Johannesburg. Satellite sites operate at the Sizwe Hospital in Sandringham in Johannesburg and in Durban at the King Dinuzulu Hospital Complex. Who we are: The Clinical HIV Research We are now well-positioned to conduct Unit (CHRU) is part of the University of more TB trials. Shorter TB treatment the Witwatersrand’s Faculty of Health is a key aim and, during 2016, CHRU Professor Ian Sanne Sciences. embarked on two treatment-shortening Division Head of CHRU and studies, namely the A5349/TBTC study HE2RO As an internationally recognised 31 for drug-sensitive TB and the STREAM CHRU: research and technical assistance 2 study, which is looking at optimising Themba Lethu Wing unit, the CHRU delivers clinical, and shortening MDR treatment. Helen Joseph Hospital epidemiologic and health economic 1 Perth Road research services. The unit also ensures Noteworthy is the NIX trial that was Westdene that research information is invested at conducted at the Sizwe hospital. This Johannesburg operational level for the prevention, study is exploring the use of a shortened treatment and management of HIV oral treatment regimen for XDR TB. HE2RO: and associated diseases. Preliminary results look promising for the Unit 2 treatment of a disease with a very high Empire Road Where we operate: CHRU is located at mortality rate. Parktown the Themba Lethu Clinic in the Helen Johannesburg Joseph Hospital. We are one of the Other trials included the REPRIEVE, A5288 Tel: +27 11 276 8800 largest HIV and TB clinics in South Africa. and MHAVE studies. The START study, Email: info@chru.co.za originally planned to end in December Web: www.chru.co.za Staffing in 2016: In the year under 2016 was extended for another year. Web: www.heroza.org review, the CHRU expanded its team The last patient visit for the A5282 study and employed more than 90 staff. was conducted in 2016. Research in 2016: Staff continued to Strategy in 2016: The unit aligned itself work on important studies initiated with the current international trend of previously, including the A5338 study focusing on drug sensitive and drug and several other Pharma trials. resistant TB trials. During 2016, CHRU completed the Key developments in 2016: During the A5290 study. Another achievement was year, we completed important building the A5300 feasibility study, conducted renovations at our site, including a state at CHRU. This vital study will pave the of the art air filter system for our new TB way forward for the Phoenix Study, clinic. which aims to look at prophylaxis for MDR-TB in household contacts.
Major Research Units 29 Future plans: The chemotherapy HE2RO 2016 synopsis: Significant records captured infusion unit is currently being used for achievements were made during using TherapyEdge-HIV and 24 in- the A5263 (Kaposi Sarcoma) study. the year under review, including the depth interviews with patients who Going forward, this facility could be following: initiated ART between April 2004 used for monoclonal antibody infusion and March 2005. Final analysis studies as more of these types of studies • In collaboration with the National and results will be disseminated in are being planned internationally. Department of Health, the World 2017. We successfully applied for two grants - Bank and Boston University, HE2RO • HE2RO published a chapter in with the TB sequel consortium and with implemented a large evaluation of the 2015/16 South African Health the PANACEA consortium respectively the National Adherence Guidelines Review discussing the barriers and and are preparing for these studies to for Chronic Diseases in South Africa. facilitators South Africa faces on begin in 2017. The TB study concerns • The study will assess the impact of its journey to achieving universal pathogenesis and risk factors of long- a subset of national adherence access to sexual and reproductive term sequelae of pulmonary TB defining guidelines for interventions on health services nationally. individual outcomes and public health HIV patients’ outcomes at public • HE2RO presented results on the impact. The PANACEA trial involves a sector clinics. The study will also impact of Xpert MTB/RIF testing on STEP trial looking a novel new TB agents estimate costs of interventions treatment delays among persons and treatment shortening regimens. and describe the cascade of care diagnosed with drug resistant TB We will also be collaborating with the for TB, hypertension and diabetes at the Union World Conference on Aurum institute in a TB Study looking in these state clinics. Lung Health in Liverpool. at host directed therapies added to a • To this end, four field teams have • HE2RO received recognition for an Rifabutin based TB treatment regimen. been established in Gauteng, abstract on poorer health-related The site is also planning on starting a North West, Limpopo and KwaZulu- quality of life among patients commercial study with long acting Anti- Natal to collect data from 24 sites. with drug-resistant TB. Tembeka Retroviral agents. • The study uses a randomised Sineke was awarded ‘Best Oral evaluation design to compare Presentation’ at the Public Health Publications in 2016: CHRU actively health facilities where the Association of South Africa (PHASA) published research in leading journals. interventions have been rolled out Conference in 2016. CHRU and HE2RO staff published 51 with facilities where they have not. • HE2RO also represented the Wits articles during 2016. • During 2016, 3324 patients were Health Consortium large research enrolled to the HIV cohorts (96% entities on the FHS FRC. Mentorships in 2016: The unit continued of study target) and a further 2997 to attract quality post graduate patients were enrolled to the TB, students. In the year under review, three Hypertension, Diabetes cohort. Masters students and five PhD students Information has been disseminated continued with their degrees, with and shared with the Department of ongoing supervision from senior staff. Health. • In 2016, HE2RO completed data Grants submitted and pending in 2016: collection and preliminary analysis Grants relate to a variety of important of a mixed-methods study research and service support. These conducted at an urban, public- include clinical trials to address the sector HIV clinic in a tertiary highest priorities in HIV/AIDS research, hospital in Johannes burg. This scientific and laboratory management, analysis aimed describe 10-year the delivery of technical assistance to treatment outcomes of patients the South African Department of Health initiated at the start of South for HIV/AIDS diagnosis and treatment Africa’s National ART programme and research into, MDR-TB and XDR-TB in 2004. and TB. • This included a 10-year outcomes analysis of electronic medical
30 Major Research Units Wits Maternal, Adolescent and Child Health Systems The Wits Maternal, Adolescent and Child Health (MAtCH) Systems is committed to supporting the implementation of sustainable public- sector health services, with a focus on maternal, adolescent and child health, HIV and TB prevention, treatment and care. Who we are: Maternal, Adolescent and offices in Overport, Mayville and at the Child Health (MatCH) Systems is a South KwaZulu-Natal Children’s Hospital. African donor-funded organization We also have offices in Mtubatuba in based in Durban in KwaZulu-Natal. Umkhanyakude and some of our teams are based in the eThekwini district We are a division of the Wits Health office, at eThekwini municipality offices Dr Arthi Ramkissoon Consortium, with oversight by the and at the Provincial Department of MSc (MedSc) PhD MBA School of Public Health. Health in Pietermaritzburg. Divisional Head MatCH has extensive experience in MatCH has project staff in Harry Gwala Head Office Contact Details: public health, primary healthcare and Nongoma. 145 Prince Street and service delivery. We have a multi- South Beach disciplinary group of senior academic In 2016 we continued with our Durban staff, reflecting expertise in medical international expansion under the KwaZulu-Natal science, epidemiology, public health, EQUIP project, and had offices in Port 4091 child health, behavioural science, au Prince in Haiti, Accra in Ghana and Tel: +27 31 350 4242 gender, HIV and TB. in Dar es Salaam, Tanzania. Email: info@match.org.za Web: www.match.org.za Maternal, new-born and child health EQUIP is a consortium of partners with research, including HIV and infant extensive experience and technical feeding, is a key focus area of our work, expertise providing comprehensive led by Professor Jerry Coovadia, who is high-quality HIV service delivery, the Director of Health Systems at MatCH. innovating new approaches to service He has been at the forefront of this delivery, scaling viral load technology field of work for many years. He is also and analysing cost and outcome data actively involved in the development to optimize HIV programmes. of WHO and National standards, and the implementation in South Africa of Our approach: MatCH’s approach is to breastfeeding policies, which have had support the South African Government a positive impact on child health. to roll out national programmes, including the National Core Quality Where we operate: MatCH has a long Standards, the Global Plan of Action history of working in KwaZulu-Natal on PMTCT, Primary Health Care Re- to support public sector sexual and engineering strategy and community reproductive health; maternal, child Caregiver programmes. and adolescent health; and HIV and TB services. MatCH implemented a WHO/South African National Department of Health Our geographic reach: In addition to Pregnancy Registry pilot project in May our head office operations in Durban, 2013 and this remained an ongoing South Africa, MatCH’s has satellite focus area in 2016.
Major Research Units 31 The objectives of the project include medical male circumcision programme. KwaZulu-Natal, North West and Eastern the following: MatCH started the programme with the Cape. KwaZulu-Natal Department of Health • To collect information about in the province in 2010. MatCH has a Research activities in 2016: Numerous maternal health and medicines contract to implement Medical Male research activities and positive exposure during pregnancy Circumcision Services in four districts in outcomes were achieved in 2016, KwaZulu-Natal. MatCH has circumcised including the following: • To establish a national sentinel over 140,000 males since the start of the surveillance system for major programme. • An evaluation of the MomConnect birth defects and still births Project at 51 facilities in two districts MatCH continued to conduct training • A pregnancy registry study to • To routinely provide information on a wide range of HIV and sexual and prospectively collect information and evidence to policy- reproductive health topics. Since 2009 about maternal health and makers, health care providers we have trained over 15,000 healthcare medicines exposure during and other stakeholders on the providers in KwaZulu-Natal. Key training pregnancy association between maternal programmes have included HCT/PICT; • A study to establish a national health indicators, antenatal care ARV treatment guidelines; NIMART, sentinel surveillance system for indicators and the use of specific medical male circumcision, family major birth defects and still births medicines during pregnancy. planning, male and female condom • Operations/Implementation promotion and provision. Science research on HIV/TB Staffing in 2016: By the end of the • Operations/Implementation year under review, MatCH had a staff All our training materials are in line with Science research on Adolescents, complement of 655 people, with 17 South African National and Provincial Girls & Young Women staff actively involved in research. guidelines and policies and are planned • A review of routine data and and scheduled with the Department of service delivery data for medical Programmes in 2016: MatCH’s portfolio Health (DOH). male circumcision in four districts in of HIV treatment and prevention KwaZulu-Natal programmes continued to expand and In 2016 MatCH was successful in 2016 saw the extension of our PEPFAR bidding for a five-year Centre for Community training and service grant, funded via USAID. This is being Disease Control grant for Programmatic in 2016: In the year under review, used to strengthen the District Response Implementation and Technical MatCH provided technical assistance for Better HIV/TB Patient Outcomes Assistance (TA) for HIV/AIDS and to National, Provincial and District in the eThekwini and Umkhanyakude Tuberculosis (TB) Prevention, Care, and Departments of Health. These focused districts in KwaZulu-Natal. Treatment Services throughout the mainly on improved HIV/TB and MCWH Health System in South Africa. clinical outcomes. MatCH’s adolescent, girls and young women portfolio included DREAMS This is under the President’s Emergency We continued to participate in funding in 2016 for facility level Plan for AIDS Relief (PEPFAR) of 2016. important forums such as the National interventions in two high prevalence DOH Task Force for STI, HIV and AIDS districts in KwaZulu-Natal. Under this five-year grant, MatCH Prevention, the National Health supports community-based HIV testing Research Committee, WHO Strategic The ELMA Philanthropies funded and evidence-based prevention and Technical Advisory Committee Unfinished Business project in eThekwini programmes in the Harry Gwala, and the KZN Children’s Hospital Steering and Umkhanyakude focused on eThekwini and Umgungundlovu districts Committee. addressing the treatment needs of in KwaZulu-Natal. adolescents and children is also on- going. The grant also includes evaluation of the implementation of community-based In 2016 MatCH continued to play HIV care and treatment interventions in an important role in KwaZulu-Natal’s three provinces in South Africa, namely
32 Major Research Units MRU (MatCH Research Unit) MRU (Maternal, Adolescent and Child Health Research Unit) aims to answer priority questions that will translate into improving sexual and reproductive health outcomes through expanding access to appropriate and acceptable contraceptive, HIV prevention and related health technologies and services. Who we are: MRU is affiliated to the than providing them separately. University of the Witwatersrand’s Faculty of Health Sciences, the School of Clinical Other publications focused on Medicine and to the Department of our core research areas including Obstetrics and Gynaecology. In 2016 contraception, HIV prevention, safer we were awarded Unit status. conception and other areas of sexual and reproductive health. Our mission: We aim to achieve the Professor Jennifer Smit following: Grant awards in 2016: In the year under Executive Director MRU • Conduct innovative research that review, MRU successfully applied for and Head Office Contact Details: informs policy and programmes was awarded several grants through MRU (MatCH Research Unit) • Conduct research that supports the collaborations and self-initiated grant 40 Dr. AB Xuma Street development of new technologies applications. One self-initiated grant 21st Floor, Suite 2117 on sexual and reproductive health, was awarded from over 800 applicants Commercial City Building HIV and related diseases globally. Durban • Engage the community in service KwaZulu-Natal delivery and research We have recently learned of two 4000 successful NIH applications that were MRU is based in Durban and our team submitted with collaborators in 2016. Tel: +27 31 001 1941 consists of highly skilled research, Email: jsmit@mru.ac.za clinical, laboratory, community, data New research scope in 2016: In 2016, Web: www.mru.ac.za and administrative staff from a wide we moved into a new area of research range of backgrounds including clinical, - Pre-exposure prophylaxis (PrEP) for HIV behavioural and social science. Prevention The first of these groundbreaking studies At MRU Is being Research publications in 2016: In 2016, carried out in collaboration with Harvard MRU published 13 articles in peer- University and the Massachusetts reviewed journals. Four of these were General Hospital in Boston. This five-year from a recently completed sex worker NIH grant was awarded for the “PrEP health service intervention project, Safer Conception for Women study” called the “Diagonal Interventions to which will be offering PrEP as part of a Fast Forward Enhanced Reproductive safer conception package. Health” (DIFFER) project, funded by the EU. A second study is being planned with the Eastern Virginia Medical School The project tested the hypothesis (EVMS)/ CONRAD, USA which will that combining vertical Sexual and be focusing on different branding Reproductive Health (SRH) interventions approaches to PrEP delivery. with horizontal strengthening of health systems for SRH, within existing health During 2016, our microbicide research facilities, is synergistic, feasible, and likely trials continued at the MRU Edendale to be more effective and cost-effective Research Site with the completion of
Major Research Units 33 the Phase III Dapivirine Ring Microbicide strengthen the national FC program’s infected mothers. In this research Trial -IPM 027. MRU started the IPM effectiveness and efficiency. we collaborated with HEARD at the 032, a Phase IIIb follow-on trial to IPM University of KwaZulu- Natal, as well as 027. This is designed as an open- label AIDS Conference 2016: MRU played with Harvard University clinical trial to collect additional safety a high-profile role at the International data and to establish adherence to AIDS conference held in Durban in July Our menstrual management ring use. This study uses the Dapivirine 2016. Professor Smit was an invited oral programme conducted an Vaginal Ring in healthy, HIV-negative speaker in a satellite session on hormonal acceptability study of menstrual cups women who were enrolled in the Phase contraception and HIV, and Deputy to high risk women. We entered the III ring trial IPM 027. Executive Director, Zonke Mabude planning phase of a new intervention participated in the International which will introduce menstrual cups in Complementary socio-behavioural Programme for Microbicides’ satellite up to 10 higher education institutions data collection is also underway to session. in KwaZulu-Natal. This project is being collect information around adherence funded by the DREAMS Innovation in microbicide trials. We presented 11 posters and Challenge initiative. contributed two papers to a special Government initiatives in 2016: MRU edition of the African Journal of Training and capacity building in 2016: continued to provide support to the Reproductive Health, which was MRU focused on capacity building and Provincial and National Departments launched at this conference. We training of researchers locally, regionally of Health (DoH) (SRH) in policy and disseminated a policy brief, on the and internationally during 2016. programme issues in the area of Sexual introduction of the SILCS diaphragm and Reproductive Health. In line with in South Africa, in collaboration with We are supervising four PhD candidates this, Professor Smit and Dr Beksinska PATH, and hosted a stall promoting (one in Uganda), and one Masters study provided editorial and technical support female condoms. This conference was being supervised by MRU researchers. for the development of a KwaZulu-Natal also used as an opportunity by MRU (KZN) DoH Contraception Counselling to network with established and new During 2016, MRU hosted students Tool for Healthcare Providers. collaborators. from the London School of Hygiene and Tropical Medicine (UK), from the Professor Smit and Dr Beksinska led Pivotal research in 2016: MRU engaged University of British Columbia (Canada), the contraception section of The in pivotal research conducted with from Berkley University (US), from the Reproductive Health Chapter for vulnerable populations, including University of Washington (US), and from the special edition of the national youth, sex workers and recreational the University of KwaZulu-Natal in South yearly South African Publication: The ARV users. Africa. District Health Barometer, submitted in November 2016. A key focus was on areas such as contraception, fertility choices for HIV Research in 2016: In the year under positive and negative women and men review, we continued research around (in collaboration with Harvard and the testing the performance, integrity and Massachusetts General Hospital). acceptability of new female condom We also conducted formative research prototypes. to determine views and opinions of a new device “the Smart Diaphragm” The National SA Female Condom (FC) designed to detect early signs of Evaluation project, funded by USAID, preterm birth (in collaboration with completed data collection in 2016, and Perinatal Services at UCSFs Foetal disseminations have been conducted Treatment Center). nationally and in every province. The FC In our post-partum depression project was a comprehensive mixed- programme we aim to decrease method study to identify strategies to depression and increase adherence enhance the FC’s acceptability, and to HIV and SRH care for HIV-
34 Major Research Units Wits Respiratory and Meningeal Pathogens Research Unit The Wits MRC Respiratory & Meningeal Pathogens Research Unit (RMPRU) aims to conduct epidemiological, clinical and basic science research into respiratory and meningeal infections. The unit seeks to improve the diagnosis, management and prevention of these diseases. Who we are: The RMPRU is focused on Our mission: RMPRU conducts research aimed at reducing morbidity epidemiological, clinical and and mortality from common bacterial basic science research on vaccine and respiratory viral pathogens. More preventable disease aimed at specifically, we prioritize research on enhancing the health and survival of vaccine preventable disease that African children. are major contributors to under-5 Professor Shabir Madhi childhood mortality. Furthermore, we Research in 2016: In the year under Executive Director of the Wits have established ourselves to being review, the Prof Madhi and his MRC Respiratory & Meningeal at the forefront of research aimed colleagues published 42 publications, Pathogens Research Unit & at vaccination of pregnant women, including multiple publications in the DST/NRF SARCHI Chair: Vaccine too protect the mother, her fetus and highest-ranking infectious diseases Preventable Diseases young infant from vaccine preventable journals. The Research Chair was Head Office Contact Details: diseases. a senior author on many of these Chris Hani Baragwanath publications and much of the research Academic Hospital Global leadership: RMPRU is which was based on outputs of post- Chris Hani Road internationally recognized for the role it graduate students under his supervision. Soweto has played in the clinical development 2013 of live saving vaccines such as Rotavirus Vaccine Studies: The Unit, Tel: +27 11 983 4283 / 4277 rotavirus vaccine and pneumococcal under Dr Michelle Groome, undertook Email: madhis@rmpru.cco.za conjugate vaccine. Furthermore, the first study on a sub-unit rotavirus Web: www.nicd.ac.za it has been at the fore of vaccine vaccine, which is being developed as studies aimed at pregnant women, a possible improvement to the current including reporting on the first placebo- live attenuated rotavirus vaccine, controlled randomized trial of influenza the clinical development of which vaccine in pregnant women It has also was spearheaded in Africa at also undertaken the first studies of an RMPRU. These results were published investigational multi-component Group in Lancet Infectious Diseases. Since the B streptococcus conjugate vaccine introduction of rotavirus vaccine into in pregnant women; a portfolio of the South African public immunization research that is ongoing- including program, it has been estimated to discovery research on other potential prevent 3000 fewer diarrhea related GBS vaccine epitopes. This is pertinent deaths in South Africa each year, as to Africa and South Africa, which well as approximately 39,000 fewer has reported the highest incidence hospitalizations. of invasive GBS disease globally. The unit also does important work on Pneumococcal vaccine studies: The vaccines and their impact on Vaccine Unit continues undertaking studies Preventable Diseases (VPDs). on prevention of pneumococcal disease through vaccination with the pneumococcal conjugate vaccine.
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