No dicks in the Ring: A few experiences about the microbicide ring study

By Morenike Oluwatoyin Folayan
 
At the 2018 Partners Forum held on the 13th to 15th of February, 2018 at the Crowne Plaza, Johannesburg, South Africa, Lisa Rossi of the Microbicide Trials Network and Leonard Solai of the International Partnership for Microbicides led a session discussing about the microbicide ring study with participants.
The Microbicide Trials Network and the International Partnership for Microbicides led studies to assess if the use of an antiretroviral named Dapivarine (a product not available for oral use) placed into a flexible ring found compatible with the vagina, and inserted and left into the vagina for one month, will reduce the risk of acquiring HIV infection through sexual intercourse. Dapivarine is slowly released from the flexible into the vagina over the course of a month.
Leonard explained that the study on the efficacy of the microbicide showed that women who were provided with the ring containing Dapivarine have a 30% lower risk of HIV infection than those who received a ring that did not contain Dapivarine. Further data analysis showed that women who used the product consistently throughout the study period had a 75% lower risk of HIV infection. Also the product was more effective in women older than 21 years.
‘Modeling studies show that microbicides like the dapivirine ring would be cost-effective and have a significant public health impact as part of a broader toolkit that could avert tens of millions of HIV infections over time in regions with high HIV infection like Southern Africa’ Leonard notes.
Lisa noted that a lot of follow up studies are being conducted to understand a lot more about the attitude of past study participants about the use of the ring for HIV prevention; to learn more about the safety and acceptability of the ring in young women and adolescents; to learn about its safety when used by pregnant and breastfeeding women; and to learn more about the safety and effectiveness of the ring when used for three months, or when it is used for both HIV and prevention of unwanted pregnancies.
Participants at the meeting asked multiple questions about the ring one of which was the potential for men having vaginal sex with a woman using the ring to have the ring displaced by the penis. Lisa responded noting that there has been only one of such report during the study trial. However, for most part, no penis will get to touch the ring as it is located very high up in the vagina away from contact with the penis when having sexual intercourse. ‘So really, no dick in the ring’ says Manju Chatani-Gada.
People were curious about the possibility for reactions from the use of the ring, interactions with contraception, challenges with the insertion of the ring because of its size, possibility of use of the ring for anal sex, and possible associated challenges with use of the ring for partners who practice oral sex. From the responses to the questions by Liza and Leonard, it seems the ring is quiet safe with lots of potential for use for topical application of microbicide for women.
Applications for regulatory approval for public access to the rings in Southern and Eastern Africa are ongoing. Regulatory approval of the ring by the FDA of the United States will increase the prospect of the ring being accessible through PEPFAR-funded projects in Africa. Hopefully, then, women in West and Central Africa may also have access to the product.
Folayan is of the New HIV Vaccine and Microbicide Advocacy Society.

Expanding medical practitioner’s interest’ll impact public health

 
Concerned health practitioners committed to improving health outcomes beyond the clinical area for patients, have urged medical practitioners to diversify into other areas of interest that could ultimately promote public health.
 
The practitioners who met during the 2018 Nigeria Global Health Trials Conference which took place in in Lagos recently, discussed the conduct of health research and health practice in Nigeria with a view to improving health outcomes for patients generally.
 
The conference was tagged, “Collaborations, Networks and Partnership for Conduct of Health Research in Nigeria.”
 
Speaking on the Implications of Global Health and Health Practice in Nigeria, the Chief Pathologist and and Associate Professor at the Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa, Akin Abayomi specifically emphasised the place of policy making on environmental health.
 
He declared that there were many loopholes in certain environmental policies that do not support good health in the country and therefore called on the government to review such policies. Citing some examples, Abayomi noted that the existing traffic laws in the country do not prohibit smoking vehicles from plying the roads; this, in turn, would be inhaled by pedestrians and other motorists, which would pose a threat to their well-being.
 
“In Britain, if you light a fire on the  street, fire brigade would come and somebody would be arrested, but in Nigeria, you would not see such things. “Here in Nigeria, there is fire everywhere. The environmental laws in Nigeria do not condemn some things.”
 
He, however directed his colleagues in the medical profession to look beyond their duty posts- clinics and wards, to outside constituencies, which allow for broader option for influencing policies that border on health challenges in the country.
 
Abayomi, believes that diversification of interest by practitioners would make their impact felt in the society at large as this would enable them to be part of policy makers on issues bordering on health. He identified research areas, which would help health practitioners to  re-direct their focus on issues that are of local and global significance.
 
These include the psychology of leadership, environment, advocacy, policy, globalisation, social science and anthropology.
 The associate professor further pointed out five biological catastrophes, which should be a source of concern to practitioners among which are deforestation, disruption of ecosystem balance, increased human encroachment, and power shortage.
 
These, according to him have devastating implications, a typical one being the current era of zoonotic infections such as Ebola, Lassa fever, Monkeypox, among others. “These diseases came from improper maintenance of the ecosystem. We need to rise up and do something to save our ecosystem,” he said.

First Ladies from Africa draw a six-point agenda to combat HIV/Aids across the continent

First Ladies from Africa draw a six-point agenda to combat HIV/Aids across the continent

January 29, 2018
Renewed campaigns to combat HIV/AIDS in Africa were the major highlights when the Organization of African First Ladies against HIV/AIDS (OAFLA)  20th Ordinary General Assembly closed in Addis Ababa today.
At the end of the three-day OAFLA meeting that brought together First Ladies from 16 countries including Kenya and host Ethiopia, the members drew a six-point agenda aimed at driving a re-energized campaign against the AIDS/HIV menace across the continent..
The OAFLA meeting was held concurrently with the 30th Ordinary Session of the African Union (AU) Summit.
Kenya’s  First Lady Margaret Kenyatta-who had earlier talked of her commitment to see a generation free of HIV/Aids in her lifetime-read the joint communiqué” endorsed by all OAFLA members in attendance.
In their communication, the First Ladies agreed to champion the Free to Shine initiative– a continental campaign spearheaded by OAFLA and the AU to end Childhood AIDS in Africa by 2030 and keep mothers safe.
OAFLA members also committed themselves to advocate for resources and prioritization of the delivery and sustainable  HIV and AIDS health services that are accessible to all who need them.
The First Ladies  further recommitted themselves to increase understanding of how to prevent HIV and AIDS in Children by keeping mothers healthy, preventing mother-to-child transmission and ensuring a fast and effective identification and treatment of HIV infected children.
The OAFLA members also pledged to advocate the removal of barriers that prevent children, women and mothers affected by HIV/Aids from accessing health services.
They are also  calling on  AU Member States, Heads of States, Health and Finance Ministers, Media,  NGOs and religious  groups to unite and support personal and collective understanding of the actions to be taken to end childhood HIV/Aids
The OAFLA members additionally reaffirmed their commitment to leverage on their unique position to support the implementation of the Stay Free, AIDS free and State of the African Woman Campaign aimed at securing and extending the rights of young women and adolescents in AU policies.
Why social disruption is needed for the research enterprise in Nigeria

Why social disruption is needed for the research enterprise in Nigeria

By Morenike Folayan
At the just concluded 5th Nigeria Global Health Trials Conference which held on the 30th and 31st of January 2018 at the Sickle Cell Foundation Centre, Idi-Araba Lagos, Dr Pelumi Adebiyi  challenged the over 250 participants present at the meeting to encourage social disruption of the research enterprise in Nigeria.
Just like many speakers who had made presentations before him, he challenged participants – many of whom were young researchers from multiple fields of practice – to promote inter-disciplinary collaborative research to redress health issues. This implies embracing diversity.
Unlike the drive to think outside the box, Dr Pelumi Adebiyi sees merit in thinking within the box. However, within the box, one has to learn to think deeper. Thinking within the box is shifting the current paradigm of thinking outside the box.  It is like ‘questioning the question’ like he continually reiterated throughout the meeting.
Questioning the question often results in the disruption of norms. It results in conduct of research that addresses specific needs. It moves people from convention to identifying more efficient and productive ways of getting things done. There will be shake ups, challenges, innovation and change.
For Dr Adebiyi, researchers in Nigeria will have to do things differently!
One of such new ways of doing things is moving from siloed research practices to research practices that embrace international collaborations (North- South; and South-South), multi-disciplinary collaborations, multi-site collaborations and academic-corporate collaboration.
Meanwhile, this same change had earlier being iterated by other speakers at the session.
Prof Folasade Ogunsola, one of the three Deputy Vice Chancellors of the University of Lagos, while speaking on North-South research collaboration, explained to participants how researchers can ensure such collaboration will be beneficial for the local community and country even when the agenda is driven by the North that brings the funding.
Funding is not all it takes to do good research- Ogunsola

Funding is not all it takes to do good research- Ogunsola

http://posteritymediang.com/funding-is-not-all-it-takes-to-do-good-research-ogunsola/
By Morenike Oluwatoyin Folayan.
 
Professor Folasade Ogunsola, the Deputy Vice-Chancellor, Development Services, University of Lagos, and one of Nigeria’s leading researchers, has said that funding is not all it takes to be a good researcher.
 
Ogunsola spoke during the just concluded 5th Nigeria Global Health Trials Conference which held between January 30 and 31st, at the Sickle Cell Foundation Centre, Idi-Araba, Surulere, Lagos and attracted over 250 participants comprising doctors, medical researchers and scientists from within and outside the country.
During her presentation titled ‘Health research and global health: Potentials and Promises of North-South Collaboration,’ Professor Ogunsola shared her experience concerning how she grew up the ladder to become an equitable partner with her Northern collaborators.
She also highlighted the importance of passion for the work you do, as well as trust being an essential ingredient for sustainable collaboration and partnership.
Professor Ogunsola further reiterated her point by sharing the story of the ninth graders who conducted some research based on awareness of events happening to them. Their extremely low cost experiment is now drawing the attention of renowned scientists to further explore their findings.
“Research requires you to be conscious about what is happening around you, develop evidence to substantiate your assumptions and looking for solutions applicable to your environment. Without the passion and the eye to address local needs, the funds will often not be put to efficient use,” she noted.
Participants identified the need to ensure subsequent meetings have policy makers attend the meetings. They also get to interact and learn. This was a missing target population at the conference. For future conferences, it was agreed that this should be rectified.
The role of effective communication, need to ensure research results are disseminated beyond the use of journal publication and the role of the media in disseminating research results were also noted.
The conference came to an end with participants feeling extremely motivated to do things differently. Hopefully, new networks, partnerships and collaborations had been formed at the end of the two-day meeting.

International research: How competent are local investigators named as collaborators?

http://posteritymediang.com/how-competent-are-local-investigators-named-as-collaborators-on-international-research/
By Morenike Oluwatoyin Folayan and Elhadji Mbaye
Countries in West Africa often require that international researchers have local collaborators as co-researchers for many good reasons. The local investigator can help ensure the design of the study is culturally sensitive and locally appropriate.
The investigator also gains knowledge and skills that can be used for planning and conduct of locally-relevant research. The local investigator also serves as the local contact on the management of the research.
Many of the 24 participants at the 3-day training on the review of research protocols during infectious disease epidemics organized by the West African Task Force for the Control of Emerging and Re-emerging Infectious diseases (WATER) agreed that this goal is often not achieved.
Local investigators often become data collectors with little or no significant inputs into the design of the study protocols. Many do not have capacity built: despite being local investigators for multiple studies, they still cannot independently write an award-winning grant. They therefore serve as tools for entry into the country rather than resources being developed for country relevance.
Participants therefore advocated that for all research protocols submitted for review, it is important to ask that the curriculum vitae of the local investigator be submitted along with the research protocols.
Often times, the same big-wigs in the industry are invited as local investigators. They simply become too busy to adequately play their roles. Institutional review boards need to review their curriculum vitae and query their ability to make out time to play their roles on researches they serve as investigators for.
This is in addition to reviewing the curriculum vitae to identify if they have the competency to play the role for that protocol.
The implication of such review was however, not defined.
Can institutional review boards not approve a research study protocol because they feel the local investigator may not be competent enough to handle the role because (s)he has too many ongoing studies?
Can ethics committee members ask that a research be suspended if they find the local investigator not adequately playing the oversight role during field visits?
The newly established Network for Ethics Committees operating in West Africa seem to have a big role to play in helping to define guidelines for ethics committee operations on the continent.
The future will tell the impact of this committee on improving competency for protocol review and monitoring in the sub-region.
Morenike Oluwatoyin Folayan is of New HIV Vaccine and Microbicide Advocacy Society (NHVMAS), Nigeria.
Elhadji Mbaye is of IRESSEF, Senegal.