Kenya
Site Established: Research, 1999; PEPFAR, April 2004
Innovative Field Services
MHRP utilizes tents to conduct cohort studies, extending its reach beyond the clinic.
The Walter Reed Project–Kenya (WRP), the Department of Defense's HIV program in Kenya, supports the MHRP mission through HIV research and vaccine development efforts, as well an expansive HIV prevention, care and treatment program. WRP integrates HIV research and comprehensive care, which enables the team to achieve critical research goals while improving HIV treatment services for the region.
Activities in Kenya are centered at the U.S. Army Medical Research Unit–Kenya (USAMRU-K) on the campus of the Kenyan Medical Research Institute (KEMRI) in Nairobi. The U.S. military has maintained a substantial program for infectious disease research in Kenya for nearly 40 years. Field site activities are based in Kericho, in the Southern Rift Valley, west of Nairobi.
Research Efforts
HIV-1 Diversity in Kenya
Mostly A and AD recombinant
Cohort development and surveillance are being conducted by WRP–Kenya. Efforts also include blood bank HIV surveillance of general populations, genetic subtypes and recombinants, plasma and cell samples to support vaccine research, and the evaluation of potential cohorts for Phase III clinical studies.
A Phase I/II Clinical Trial to Evaluate the Safety and Immunogenicity of a Multiclade HIV-1 DNA Plasmid Vaccine Boosted by a Multiclade HIV-1 Recombinant Adenovirus-5 Vector Vaccine in HIV Uninfected Adult Volunteers in East Africa
- Initiated April 7, 2006
- First HIV vaccine study in Kenya outside of Nairobi
- Third HIV vaccine study in Kenya
HIV Cohort Research
A three year-study following 2,800 tea plantation workers and dependents that looked at HIV prevalence and incidence ended in December 2006. This program was the only prospective HIV cohort study in Kenya. The previous follow-up rate has been 84 percent over 24 months.
Optimal Combination Therapy After Nevirapine Exposure (OCTANE)
This therapeutic study was initiated in May 2006. This critical study for the Kericho area and for Africa systematically tested the hypothesis that women with prior single dose nevirapine in the context of Prevention of Mother-To-Child Transmission (PMTCT) of HIV had poor clinical outcomes in nevirapine-based antiretroviral therapy due to nevirapine resistance. The NIH/Division of AIDS/Therapeutics Research Program (TRP), AIDS Clinical Trials Group (ACTG), sponsored this study. The study was conducted in 10 sites in Africa, two of the site are located in Kenya.
Kericho quickly established itself as a viable participant in study by immediately enrolling women in the program, and for excellence in adherence to Good Clinical Practices (GCP).
A recent interim review of a large clinical study comparing anti-HIV treatment regimens that contain either nevirapine (NVP) or ritonavir-boosted lopinavir (LPV/RTV) has found LPV/RTV to be significantly more effective than NVP in HIV-infected women who previously took single-dose NVP to avoid transmitting HIV to their newborns (see related news story).
Kericho Prevention of Mother-to-Child Transmission Program (PMTCT)
Our program’s first pediatric ART patient in Kericho, Kenya.
The Kericho PMTCT program, initiated in 2001, has been the foundation for HIV care and treatment activities in the region. Director Fredrick Sawe, MBChB, MMED, has built the program to include 60 clinics. The team has counseled more than 60,000 women. This is the second largest PMTCT program in Kenya.
Employee Productivity Research
The Kenya team has been involved in a four-year prospective cohort study in collaboration with Boston University. The program evaluates the impact of anti-retroviral therapy on labor productivity in 400 tea plantation workers. The study is in the second phase of the initial study evaluating the impact of HIV disease on labor productivity.
Planned Studies
- Kericho HIV Program Youth and Adult "High Incidence" HIV Cohort Study
- Phase I trial using DNA/Modified Vaccinia Virus Ankara (MVA) prime-boost vaccine strategy focusing on HIV subtype A
- Based upon existing expertise in HIV vaccine research and a strong PEPFAR program, staff in Kericho are participating in therapeutics research
- Both Eldoret and Kericho CRSs will be conducting additional ACTG studies and are being considered for a Pre-Exposure Prophylaxis (PrEP) study
Prevention, Care and Treatment
Efforts include working with local partners throughout the South Rift Valley and within the Kenyan Department of Defense. Since 2003, activities have focused on developing the capacity of health facilities at two tea plantations, Kericho District Hospital, several surrounding private hospitals and a large mission hospital 50km southwest of Kericho.
Services have expanded to 11 hospitals, with a number of services initiated at nearby smaller health centers. Expansion of care outside of health care facilities was undertaken in collaboration with local community-based organizations providing home-based care and support to Orphans and Vulnerable Children (OVC).
The SRV program is planning to expand activities to the Kombewa district located near Kisumu. Included in the expansion plans is the support of a voluntary counseling and testing program, as well as building renovations.
Partners include:
- Kericho District Hospital
- Tenwek Mission Hospital, Unilever Tea Plantation
- James Finlay Flowers Plantation
- Kapsabet District Hospital (DH)
- Kilgoris Transmara
- Nandi Hills District Hospital
- Kapkatet District Hospital
- Longisa District Hospital
- AIC Litein Hospital
- Live With Hope Center
- Samoei Community Response to OVC
- Mission for Essential Drugs & Supplies (MEDS)
- Kombewa District Hospital
- Kenya Department of Defense, as well as several national NGOs based in Nairobi
The Kericho team recently expanded its staff. A Community Programs Assistant was hired to focus on prevention activities, as well as pediatric counseling at Kericho District Hospital; and a Prevention Manager to serve as the head of OVC programming.
Facilities
Nairobi:
Activities in Kenya are centered at the U.S. Army Medical Research Unit-Kenya (USAMRU-K) on the campus of the Kenyan Medical Research Institute (KEMRI).
Kericho:
Comprehensive field site built around the Clinical Research Center (CRC). The Kenya Medical Research Institute/Walter Reed Project Clinical Research Center (KEMRI/WRP CRC) is located in Kericho, Kenya, and serves as the Kenyan laboratory MHRP. The facilities house a research clinic and pharmacy equipped for both vaccine and therapeutic studies.
Select Accomplishments
- In Spring of 2008, MHRP was asked to formally become a CTU by NIAID/DAIDS and ACTG.
- WRP Laboratory received recommendation for accreditation from the College of American Pathologists (CAP) in June 2008. This will be the only CAP-certified lab in Kenya.
- Site certified by NIH/DAIDS Therapeutics—the first Phase III therapeutic trial opened May 8, 2006.
- The HIV Program Research Laboratory received National Institutes of Health/Division of AIDS laboratory certification for supporting DAIDS-sponsored studies in January 2006.
- The HIV Program Research Laboratory supports the USAMRU-K malaria program by conducing laboratory analyses for an ongoing epidemiological study being conducted in Kericho by the malaria program.
Related Stories
Study in Africa has Implications for Treatment of HIV-Positive Women
10/30/2008
President's Emergency Plan for AIDS Relief (PEPFAR) Track 1.0 Anti-Retro Viral Therapy (ART) Meeting
08/13/2008
XVII International AIDS Conference Mexico City
08/09/2008
HIV Vaccine Awareness Day is marked in Kericho, Kenya
07/17/2008
Youth Centers Facilitate HIV Prevention Efforts in East Africa
05/28/2008
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