1
|
Mahomed S, Garrett N, Karim QA, Zuma NY, Capparelli E, Baxter C, Gengiah T, Archary D, Samsunder N, Doria-Rose N, Moore P, Williamson C, Barouch DH, Fast PE, Pozzetto B, Hankins C, Carlton K, Ledgerwood J, Morris L, Mascola J, Abdool Karim S. Assessing the safety and pharmacokinetics of the anti-HIV monoclonal antibody CAP256V2LS alone and in combination with VRC07-523LS and PGT121 in South African women: study protocol for the first-in-human CAPRISA 012B phase I clinical trial. BMJ Open 2020; 10:e042247. [PMID: 33243815 PMCID: PMC7692975 DOI: 10.1136/bmjopen-2020-042247] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 11/03/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION New HIV prevention strategies are urgently required. The discovery of broadly neutralising antibodies (bNAbs) has provided the opportunity to evaluate passive immunisation as a potential prevention strategy and facilitate vaccine development. Since 2014, several bNAbs have been isolated from a clade C-infected South African donor, CAPRISA 256. One particular bNAb, CAP256-VRC26.25, was found to be extremely potent, with good coverage against clade C viruses, the dominant HIV clade in sub-Saharan Africa. Challenge studies in non-human primates demonstrated that this antibody was fully protective even at extremely low doses. This bNAb was subsequently structurally engineered and the clinical variant is now referred to as CAP256V2LS. METHODS AND ANALYSIS CAPRISA 012B is the second of three trials in the CAPRISA 012 bNAb trial programme. It is a first-in-human, phase I study to assess the safety and pharmacokinetics of CAP256V2LS. The study is divided into four groups. Group 1 is a dose escalation of CAP256V2LS administered intravenously to HIV-negative and HIV-positive women. Group 2 is a dose escalation of CAP256V2LS administered subcutaneously (SC), with and without the dispersing agent recombinant human hyaluronidase (rHuPH20) as single or repeat doses in HIV-negative women. Groups 3 and 4 are randomised placebo controlled to assess two (CAP256V2LS+VRC07-523LS; CAP256V2LS+PGT121) and three (CAP256V2LS+VRC07-523LS+PGT121) bNAb combinations administered SC to HIV-negative women. Safety will be assessed by the frequency of reactogenicity and adverse events related to the study product. Pharmacokinetic disposition of CAP256V2LS alone and in combination with VRC07-523LS and PGT121 will be assessed via dose subgroups and route of administration. ETHICS AND DISSEMINATION The University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC) and the South African Health Products Regulatory Authority (SAHPRA) have granted regulatory approval (trial reference numbers: BREC00000857/2019 and SAHPRA 20200123). Trial results will be disseminated through conference presentations, peer-reviewed publications and the clinical trial registry. TRIAL REGISTRATION NUMBER PACTR202003767867253; Pre-results.
Collapse
Affiliation(s)
- Sharana Mahomed
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Quarraisha A Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columba University, New York, New York, USA
| | - Nonhlanhla Y Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | | | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Tanuja Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nicole Doria-Rose
- Vaccine Research Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Penny Moore
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Carolyn Williamson
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Health Laboratory Services of South Africa, Johannesburg, South Africa
- Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patricia E Fast
- International Aids Vaccine Initiative, New York, New York, USA
| | - Bruno Pozzetto
- GIMAP (EA3064), University of Saint-Etienne/University of Lyon, Saint-Etienne, France
| | - Catherine Hankins
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Kevin Carlton
- Vaccine Research Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Julie Ledgerwood
- Vaccine Research Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lynn Morris
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - John Mascola
- Vaccine Research Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Salim Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columba University, New York, New York, USA
| |
Collapse
|
2
|
Kharsany AB, Karim QA. HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities. Open AIDS J 2016; 10:34-48. [PMID: 27347270 PMCID: PMC4893541 DOI: 10.2174/1874613601610010034] [Citation(s) in RCA: 486] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/18/2015] [Accepted: 10/08/2015] [Indexed: 12/13/2022] Open
Abstract
Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.
Collapse
Affiliation(s)
- Ayesha B.M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, Durban, South Africa
| | - Quarraisha A. Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, Durban, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| |
Collapse
|
3
|
Phili R, Karim QA. Acceptability of neonatal circumcision by pregnant women in KwaZulu-Natal, South Africa. Curationis 2015; 38. [PMID: 26018569 PMCID: PMC6091734 DOI: 10.4102/curationis.v38i1.1433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Studies on voluntary medical male circumcision (VMMC) have provided convincing evidence on its efficacy to provide partial protection against female-to-male HIV transmission in circumcised men. The World Health Organization and UNAIDS subsequently formulated recommendations for VMMC implementation that included implementation of neonatal medical male circumcision (NMMC) to all infants up to two months old. Knowledge regarding the acceptability of NMMC by pregnant women who are candidates for granting of consents for NMMC procedures or its ideal placement within health programmes is low. OBJECTIVES We sought to establish NMMC acceptability by pregnant women and the feasibility of its integration within Maternal, Child and Women's Health (MCWH) programmes to inform implementation guidelines. METHOD Nurses and counsellors at two public health facilities were trained to provide NMMC counselling and offer NMMC to 1778 pregnant women presenting for antenatal care services. Univariate and bivariate analyses were performed on data collected on NMMC acceptance and refusals. Thematic analysis was also performed on qualitative reasons for refusals. RESULTS Acceptability of NMMC by women was high (82.9%). Refusals resulted from the need for consultations with partners and/or family members prior to consenting (41.3%), fear of the procedure (23.8%), cultural reasons (15.9%) and no reasons given (15.3%). CONCLUSION The acceptability of NMMC by pregnant women and its integration with MCWH services was feasible. However socio-cultural factors, including the need for further consultation prior to consenting for NMMC procedures and preference of traditional circumcision by some women, need to be addressed in order to increase uptakes.
Collapse
Affiliation(s)
- Rogerio Phili
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal.
| | | |
Collapse
|
4
|
Mantell JE, Hoffman S, Weiss E, Adeokun L, Delano G, Jagha T, Exner TM, Stein ZA, Karim QA, Scheepers E, Atkins K, Weiss E. The acceptability of the female condom: perspectives of family planning providers in New York City, South Africa, and Nigeria. J Urban Health 2001; 78:658-68. [PMID: 11796812 PMCID: PMC3455873 DOI: 10.1093/jurban/78.4.658] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This article seeks to fill the gap in female condom acceptability research by examining family planning (FP) providers' attitudes and experiences regarding the female condom in three countries (South Africa, the US, and Nigeria) to highlight providers' potential integral role in the introduction of the female condom. The case studies used data drawn from three independent projects, each of which was designed to study or to change FP providers' attitudes and practices in relation to the female condom. The case study for New York City used data from semistructured interviews with providers in one FP consortium in which no special female condom training had been undertaken. The data from South Africa were drawn from transcripts and observations of a female condom training program and from interviews conducted in preparation for the training. The Nigerian study used observations of client visits before and after providers were trained concerning the female condom. In New York City, providers were skeptical about the contraceptive efficacy of the female condom, with only 8 of 22 providers (36%) reporting they would recommend it as a primary contraceptive. In South Africa, providers who had practiced insertion of the female condom as part of their training expressed concern about its physical appearance and effects on sexual pleasure. However, they also saw the female condom as a tool to empower clients to increase their capacity for self-protection. Structured observations of providers' counseling interactions with clients following training indicated that Nigerian providers discussed the female condom with clients in 80% of the visits observed. Despite the lack of a uniform methodology, the three case studies illuminate various dimensions of FP providers' perceptions of the acceptability of the female condom. FP providers must be viewed as a critical factor in female condom acceptability, uptake, and continued use. Designing training programs and other interventions that address sources of provider resistance and enhance providers' skills in teaching female condom negotiation strategies may help to increase clients' use of the female condom.
Collapse
Affiliation(s)
- J E Mantell
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York 10032, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
The successful implementation of new public health policy is influenced by provider preparedness and user acceptability of the new intervention. This paper describes the development and implementation of a participatory Training of Trainers (TOT) programme as a precursor to launch the South African government's female-initiated HIV prevention strategies in public health clinics. Three hundred peer-trainees from throughout South Africa were trained through a comprehensive, modular and interactive three-day workshop. The workshop content included: HIV/AIDS knowledge, beliefs and attitudes; values clarification regarding HIV infection and sexuality; sexual desensitization; 'hands-on' training in the use of and introduction of the female condom; and counselling, communication and programme planning skills. The TOT generated a cadre of knowledgeable health care workers for training others and provided a support structure at the service delivery level for ensuring potential users' access to the female condom within each province. Qualitative assessments of the training and trainer debriefing sessions suggest that the training was successful in increasing knowledge and promoting positive attitudes about female condoms. In addition, the expanded repertoire of problem-solving approaches left providers feeling confident about recommending this method to clients.
Collapse
Affiliation(s)
- J E Mantell
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, New York, USA.
| | | | | |
Collapse
|
8
|
Abstract
OBJECTIVES The social context within which women engaged in sex work at a popular truck stop in South Africa are placed at risk of human immunodeficiency virus (HIV) infection and the factors that influence their ability to reduce their risk were assessed. METHODS Using qualitative and quantitative techniques, an elected sex worker from within the group collected all data. RESULTS Given the various pressing needs for basic survival, the risk of HIV infection is viewed as one more burden imposed on these women by their lack of social, legal, and economic power. Violence, or the threat thereof, plays an important role in their disempowerment. In the few instances in which sex workers were able to insist on condom use, it resulted in a decrease in earnings, loss of clients, and physical abuse. CONCLUSIONS Recommendations to reduce the sex workers' risk for HIV infection include negotiation and communication skills to enable them to persuade their clients to use condoms; development of strategies through which they can maximally use their group strength to facilitate unified action; and accessibility of protective methods they can use and control, such as intravaginal microbicides.
Collapse
Affiliation(s)
- Q A Karim
- Centre for Epidemiological Research in South Africa (CERSA), South African Medical Research Council, Durban, South Africa
| | | | | | | |
Collapse
|