Development of Mwanza Intervention Trials Unit as a centre of excellence in HIV/STI prevention research

Worldwide about 33 million adults and children are infected with the HIV virus that causes AIDS, and the number continues to grow each year. Sub-Saharan Africa continues to be the worst affected region, accounting for around two-thirds of all cases. Although there is no cure for HIV/AIDS, use of drugs called antiretrovirals can keep the infection under control and prevent it from developing into full-blown AIDS. A lot of progress has been made in the past five years in making such treatment available to more HIV-infected people in Africa who need it. However, there are still a lot of new HIV infections occurring each year, and this means that the number of people needing treatment will continue to increase. Unless we can find effective ways of preventing new infections, it is going to be very difficult and costly to provide lifelong treatment for an ever-increasing number of patients.

Only a few methods have been proven to be effective in preventing HIV infection and so we urgently need to find new methods. Several such methods are now in the pipeline and these will have to be tested carefully in well-designed trials to make sure they work. Scientists from the London School of Hygiene and Tropical Medicine have been doing research for many years with colleagues at the National Institute for Medical Research (NIMR) in Mwanza, Tanzania, to find effective ways of controlling HIV. In 2006, MRC provided initial funding to this group to set up a new trials unit in Mwanza, called the Mwanza Intervention Trials Unit. The aim of the unit is to develop as a centre of excellence in East Africa for trials of new methods to control HIV and other sexual health problems.

During the past three years, the unit has been set up and a building has been constructed to house it on the campus of NIMR in Mwanza. We have appointed a Scientific Director who is a respected Tanzanian scientist to lead the unit, and other senior staff have been recruited. We are now seeking funds to support the continued development of the unit. During the next few years we plan to carry out a range of trials looking at different methods of controlling HIV and other sexually transmitted infections. We will also be developing a comprehensive training programme so that the unit can help to develop capacity to conduct research in Africa.

The global HIV pandemic continues to grow and the number of new HIV infections each year greatly exceeds the number of HIV-infected patients starting antiretroviral treatment (ART). Unless effective HIV prevention efforts can reduce the incidence of new infections, it will become increasingly difficult to sustain treatment services for all who need them. New prevention methods of proven effectiveness are urgently needed but there is a dearth of clinical trial centres in Africa equipped to carry out trials of such interventions to the highest standards.

Recognising this need, the MRC made a special award to the London School of Hygiene and Tropical Medicine (LSHTM) in 2006 to support the establishment of the Mwanza Intervention Trials Unit (MITU) in Mwanza, Tanzania. This new trials facility was established as a joint initiative of LSHTM and the Tanzanian National Institute for Medical Research (NIMR), building on a long history of successful collaborative research between these two institutions on the prevention and control of HIV and other sexually transmitted infections (STIs). The MRC award funded the construction of purpose-built premises for the new unit and contributed to the initial core costs of the unit. Key senior staff of the unit have been appointed including a Scientific Director and Senior Research Administrator. The new unit was officially opened by the Tanzanian Minister of Health in July 2009.

The unit?s mission is to contribute to improving health through the development and evaluation of interventions against HIV and other health problems by conducting research, including clinical trials, to the highest international standards; to enhance the capacity to carry out such research in Tanzania and the East African region; and to contribute to the translation of research findings into health policy.

Although the unit aims to be self-sufficient with core costs supported through indirect cost recovery on research grants, some ongoing core support will be needed during the initial period of development. This application seeks funding for such support during the three years from the end of the initial award in April 2010. During this period, the unit will continue to conduct randomised trials of promising interventions against HIV and other STIs, including trials of vaginal microbicides, use of ART for HIV prevention, community-based behavioural interventions and human papillomavirus (HPV) vaccination. In addition, the unit will develop a comprehensive programme of capacity building including short courses, MSc and PhD training, staff mentoring and postdoctoral fellowships.