New clinical trial for a HIV vaccine regimen commences

By Pacharo Munthali

A new experimental HIV vaccine trial has started at the UNC Project in Lilongwe; bringing hope to all as the world continues to strive for an HIV-free generation.
According to the UNC Project’s Co-Principal Investigator for this trial, Dr. Mitch Matoga, the study is taking place through a public-private partnership National Institute of Allergy and infectious Diseases (NIAID) under the National Institute of Health (NIH), HIV Vaccine Trials Network (HVTN), Janssen Vaccines and Prevention B.V. and the Bill & Melinda Gates Foundation.
The first participant in the new trial received vaccination at UNC Project clinical research site in Lilongwe in the afternoon of 10 May 2018. Since then Malawi through the study has registered 23 participants.
Matoga said the new large-scale study, which is also taking place in South Africa, Zambia, Zimbabwe and Mozambique “will evaluate whether the vaccine is safe and able to reduce the incidence of HIV infection among 2,600 HIV-negative women in sub-Saharan Africa.”
Despite the world registering tremendous advances in HIV treatment and prevention, many people are still contracting the virus every year.
Unfortunately, women are the most affected. According to UNAIDS, women and girls account for nearly 60 percent of people living with HIV in Eastern and Southern Africa and Malawi’s HIV epidemic remains “generalized and feminized”.  While the country just as the rest of the world has recorded a significant reduction in new HIV infections and AIDS related deaths; adolescent girls and young women among others are bearing “the highest burden of the epidemic.”
Around the world, there are over 2 million new HIV infections each year. In 2016, according to UNAIDS, “Malawi had 36 000 (31 000 - 45 000) new HIV infections and 24 000 (20 000 - 31 000) AIDS-related deaths.”
“No matter how many people we can get on ARVs, we cannot keep up with the pace of new infections,” Said Matoga, adding that “the search for an effective HIV vaccine is as important as ever if we want to achieve a world without AIDS.”
The search for an HIV vaccine has historically been daunting due, in part, to the unique properties of the virus, including its ability to rapidly mutate and create multiple strains and sub-types prevalent in different parts of the world.
Malawi is targeting 170 participants who will only come from within the city of Lilongwe. In Malawi, it’s only UNC Project Malawi that is conducting the study.

Is it time to revisit definition of a planet? Scientists think so…

The solar system is made up of planets. Earth is a planet. So is Pluto. This will never change. At least for now.
“It always has been, and it always will be,” Will Grundy of Lowell Observatory in Flagstaff, Arizona is quoted on Sciencenews.org. But he has a challenge. How will he convince the world? How will a forty year old man in Chitipa in Malawi be convinced otherwise.
Now he just has to convince the world of that.
For years, centuries, the word planet has meant “wanderer.” The wanderer had included the sun, the moon, Mercury, Venus, Mars, Jupiter and Saturn.
However over the years of debates, the moon and sun were dropped from the definition. But Pluto was included, after its discovery in 1930. That idea of a planet as a rocky or gaseous body that orbited the sun stuck, all the way up until 2006.
The challenge is the definition of the planet. The way it is defined and application of the definition has been varying.
The International Astronomical Union sensing the challenge described a planet as “any round object that orbits the sun and has moved any pesky neighbors out of its way, either by consuming them or flinging them off into space.” This is where Pluto fails to fit in. Especially when compared to the last part of the definition. It’s perhaps the reason it’s called a “dwarf planet.”
The definition has flaws.
It forgets and overlooks thousands of “exotic worlds that orbit other stars and also rogue ones with no star to call home.” Secondly, studies show that “it requires that a planet cut a clear path around the sun.” But no planet does that; Earth, Mars, Jupiter and Neptune share their paths with asteroids, and objects crisscross planets’ paths all the time.
Grundy and the team members of NASA’s New Horizons mission to Pluto have meticulously laid out these arguments against the IAU definition of a planet March 21 at the Lunar and Planetary Science Conference in The Woodlands, Texas.
There is need for a simple definition. Grundy says the definition should be “any round object in space that is smaller than a star.”
“There’d be about 110 known planets in our solar system,” Grundy quoted as saying.
The reason for the tweak is to maintain the focus on the features — the physics, the geology, the atmosphere — of the world itself, rather than worry about what’s going on around it, he says.
The New Horizons mission has shown that Pluto is an interesting world with active geology, an intricate atmosphere and other features associated with planets in the solar system. It makes no sense to write Pluto off because it doesn’t fit one criterion. Grundy seems convinced the public could easily readopt the small world as a planet. Though he admits astronomers might be a tougher sell.
“People have been using the word correctly all along,” Grundy says. He suggests we stick with the original definition. That’s his plan.
For Ipyana Mwaungulu in Chitipa, he still has to follow the debate.

Creating Demand for Male Circumcision 

Jhpiego has been working in Malawi since 1999. Its work has focused on a number of health interventions including the provision Voluntary Medical Male Circumcision (VMMC).. PacharoMunthali in this article follows up the Voluntary Medical Male Circumcision (VMMC) work that Jhpiego has been carrying out in Zomba. In the article he explores the successes registered so far. He strives to find out gaps that as a nation we need to address.  

 It’s morning. Precisely, it is three minutes after 9 hours. Since arriving at the health centre, apart from meeting the medical personnel and being briefed on the procedure that is followed, he uttered nothing. For ten minutes it seemed as if he would say nothing.

 He is Village Headman Mzazira II has been waiting outside Chipini Health Centre. It is a symbolic wait, at least he knows. It’s not just his wait. Once he gets circumcised he believes his subjects will follow suit. He is at Chipini Health Centre for his screening and Voluntary Medical Male Circumcision (VMMC) procedure.

 Chipini Health Centre is a Chingale -based health facility in Zomba district. The district with 2014 population estimates hovering above 600,000; the district has high HIV prevalence rate.  

HIV prevalence is around 15. That’s alarming. The District Medical Officer, Dr Vanessa Kandole early this year was quoted by Malawi News agency, describing the situation as “pathetic.”

"As a key component of prevention of HIV, Voluntary Male Medical Circumcision (VMMC) is important in Zomba as one way of reducing the prevalence rate which currently is on the higher side," Kandole had explained in the media.

Kandole has stated that VMMC campaigns have been conducted since 2013 in Zomba. As a result at least 18 thousand males have gotten the smart cut. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS); an estimated 5.8 million males had undergone VMMC by the end of 2013 in 14 priority countries in East and southern Africa.

The effort towards attain such cuts has been collaborative. Being led by Ministry of Health, Jhpiego has been one of the players. The presence of Jhpiego in areas around Chipini Health Centre has been one instance.

Today at Chipini Health Centre, male community members are waiting anxiously. In numbers, so far there is presence of eleven individuals – men and of course adolescent boys. All these mortals want to be subjected to the meticulous procedures of male circumcision. Voluntarily medically sound of course. All this is being done for a good reason – HIV prevention.

 When his turn comes, he will undergo counseling. After counseling he will go through the screening process. It is after screening that he will submit himself to the actual VMMC procedure. It’s a process.

 “You see this is symbolic. I am a village headman, and I want to lead by example,” Village headman Mzazira 2 says as goes inside the clinic.

 “I want my people to appreciate, and soberly understand that this is life,” he grins.

Chipini is just one area in which Jhpiego is carrying out its intervention. Jhpiego has been in Malawi since 1999. From 2010 to 2011 Jhpiego, under MCHIP, facilitated the development of national standard operating procedures for voluntary medical male circumcision (VMMC).  During that period Jhpiego implemented Malawi’s first pilot initiative on VMMC for HIV prevention in Mulanje, resulting in provision of male circumcision services to 4,348 men.

 In 2012, Jhpiego received additional funding through Maternal and child health integrated program to provide VMMC services to more than 8,000 males in Thyolo District. As Jhpiego expands its work the foot prints that it has marked are indelible. Since 2011 to date 115647 males have undergone voluntary medical male circumcision.

 Jhpiego has a number of advocacy approaches. One of them is through the use of chiefs. After conducting advocacy meetings with chiefs in the target districts, the Ministry of Health requested MCHIP to offer VMMC services in vulnerable and hard to reach health centres only to ensure the procedure is recognized as a medical intervention and is not confused with traditional rites of initiation.

“Our work especially on promotional activities have focused mainly on inter and intrapersonal communication at the local level. The approach has yielded enormous success,” says Samson Jali, Community Mobilisation Assistant.  

Jhpiego is working in a number of districts. The VMMC project called Sankhani has spread from Chikwawa, Zomba to Thyolo.

 Why choosing these districts?

“Ministry of Health and USAID after World Health Organization (WHO) recommendation identified some districts which were a priority due to high HIV prevalence. The three are among the priority districts,” says Lionel Chipeta, Communications and Demand Creation Manager.

As Chipeta shows the figures of the number of clients that have received smart cut, he reveals that they foster demand creation through interpersonal communication.

“Mostly we are using Interpersonal communication which triggers honest discussions with individuals and groups. We also have events like pool tournament, bawo tournament, football bonanzas which are simply crowd pullers and then we engage them into discussions using Community Mobilizers,” he adds.

Two main obstacles are apparent so far. In the three districts where implementation work is being carried out, Chipeta says, they “still haven’t registered a lot more of the older population.”  Those that are above 15 haven’t been forth comingas expected.  

“At national level, Malawi has done about 7% of the modelled targeted number while countries like Tanzania have reached about 90% of their target, Botswana is at 41% while Zambia is around 53%. As a nation, we is still very low in reaching our expected target to halt more HIV cases as desired.”Adds Chipeta.

“We still have people failing to comprehend and understand the science behind VMMC,” he adds.

So far, as they look forward to next year, Chipeta believes progress has been admirable. They only need to strengthen the approaches to reach out to more young adults, especially those between ages of 15-29. This group is at high risk as it is very sexually active.

Jhpiego’s approach has embraced the enormous involvement of community leaders such chiefs.  

“Chiefs are custodians of culture and they are in authority in the districts we are currently working. It is credible to involve them so that this intervention is not seen as an alien intervention. At all levels people have to understand the science behind VMMC and how it works,” Chipeta concludes.

 VMMC is a Ministry of health intervention. For its success, the Ministry is working with a number of partners. Jhpiego is one of them. Jhpiego is implementing partner with funding from Presidents Emergency Plan for AIDS Relief (PEPFAR) and United States Agency for International Development (USAID).  

Blind but still Stepping on

It all started with a rumour making rounds. It was said that in Nthole Village in Nsanje district, there is a woman. Edna Gerald was the name of the woman, and something was happening to her. She is blind too. Another challenge too…

The rumour had it that a husband to Edna Gerald didn’t like her due to her status for being HIV positive. The fact that she had been put on a life prolonging drugs treatment didn’t go well with her husband.

When Gerald was put on life prolonging drugs, the husband went to the extent of throwing drugs into the toilet. He didn’t want her to be taking drugs.

What made the situation heart tingling was the fact that the woman was and is still blind.

“It really pained us when we got wind of the rumour says,” Eunice Ngolombe, chairperson of COWLHA in Nsanje district says.

As Edna Gerald staggers with her walking stick and being assisted by Eunice Ngolombe, she looks so quite…silent. But out of that silence she has a tale to tell.

At a time that Coalition of Women Living with HIV and AIDS is striving to reach out to as many women as possible, the most vulnerable and easily forgotten groups like the blind are not being left behind.

Edna Gerald is one such woman.

Gerald says after getting ill, her parents took her home to Fatima. And when she got tested it was found that she was HIV positive.

But things became worse when she came back to Nsanje. Her husband didn’t want to see her wife to be taking life prolonging drugs.

“When people see you taking life prolonging drugs, what will I say?” she remembers his quizzical expression at the time.

“He was throwing them [drugs] in toilets. I mean drugs,” says Gerald. “Yet it’s him who brought me the virus.”

She never had the much needed care.

Stepping Stones members heard about the rumour. They had to intervene. And they stepped in.

“Together with Mai Mtima Bii, District Coordinator for COWLHA, we visited her home. And asked what happened,” says Ngolombe, adding that after being told the whole ordeal we urged her husband to go and have HIV test.

But how did they convince the husband to go for HIV test?

“We told him about the benefits of having an HIV test to himself, the wife as well as the dependents,” she says.

Whenever members of Stepping Stones are meeting, Edna Gerald is always involved.

“With Tiwoloke, I have a family,” Gerald finishes.