Epidemiologist probing HIV epidemic in SA
Professor Quarraisha Abdool-Karim, respected as one of the world’s leading HIV and AIDS researchers, is unequivocal in her approach to HIV/AIDS. “We need a vaccine and a cure to end AIDS. In the meantime, we have to do our best to implement what we have available,” she says.
Abdool-Karim is an infectious diseases epidemiologist whose main research is into understanding the evolving HIV epidemic in South Africa, including factors influencing HIV infection in adolescent girls and sustainable strategies to introduce antiretroviral (ARV) therapy in disadvantaged communities. Her research contributions span 27 years, focused particularly on pre-exposure prophylaxis (PrEP), a treatment that can be given to prevent infection with the HIV virus. “We need to further innovate and expand on our PrEP options and to address the daily adherence challenges,” she says. “We have done a great job of increasing the numbers of HIV infected people initiated on ARV treatment and reducing transmission rates from infected mothers and infants. We have done less well on prevention especially in adolescent girls and young women, or in getting men to test and enter prevention or treatment programmes,” she says.
Abdool-Karim ’s most important scientific contribution to HIV prevention is the CAPRISA 004 Tenofovir gel trial, hailed as one of the top 10 scientific breakthroughs in 2010. The trial showed that tenofovir gel, applied before and after sex, reduced HIV incidence by 39%, providing proof-of-concept that an antiretroviral agent can prevent sexual transmission of HIV in women. In 2015, the World Health Organisation, in its ARV guidelines, recommended Tenofovir plus Emtricitabine, an antiviral drug that reduces the amount of HIV in the body, be taken orally or topically as a vaginal gel in cases of high risk.
Abdool-Karim ’s research on HIV epidemiology in young women has been widely used in developing responses to the HIV epidemic in southern Africa. She was part of the team, initially as its leader, that conducted the ‘Starting Antiretroviral Therapy at Three Points in Tuberculosis’ (SAPIT) trial on TB-HIV treatment, which has shaped international treatment guidelines on the clinical management of co-infected patients.
Abdool-Karim did her BSc at the University of Durban-Westville, then went on to do her honours degree in Biochemistry at Wits University. For her master’s degree, Abdool-Karim moved to the US, gaining her master’s in Parasitology in 1988 from Columbia University. In 2000, she completed her PhD in Medicine from the University of KwaZulu-Natal, where she is now an honorary professor in public health and also African Health Pro Vice-Chancellor.
Abdool-Karim began her socio-behavioural studies in relation to HIV in the 1990’s, when SA had an HIV epidemic. She conducted population-based surveys, aiming to understand the spread of the epidemic in women, as well as researching additional factors such as gender, age, and migration. In 1992, she published a paper highlighting women were more vulnerable to HIV infection. The study also found a correlation between migration and HIV.
Today, Abdool-Karim is a consultant to the World Health Organisation, UNAIDS and the UN Development Programme on AIDS-related committees on gender, ethics, treatment and research capacity-building. “Women in Africa are unwavering in their hope that HIV will be controlled and eradicated through innovative research and the development of effective medical technologies. They continue to inspire me to persist with my scientific endeavours. While some progress has been made, more remains to be done to ensure a non-sexist and just society,” says Abdool-Karim.
Her work is focused on evaluating an annual ARV-based implant, and a six-monthly combination of broadly neutralising antibodies.