Prof. Max Essex came, saw and conquered HIV/AIDS

During the early 1990’s HIV/AIDS was a monster sweeping across the entire African continent killing adults, youth, children as well as infants. While the whole continent was in despair, American health researcher, Professor Max Essex arrived as a ‘messiah’ to save the continent from the plague.

Professor Essex, the founder and Chair of Botswana Havard Aids Institute Partnership (BHP) came to Botswana in 1996 and established the HIV research and training partnership between Botswana and United States of America. He partnered with the Ministry of Health to form the BHP. In 1986 Professor Essex was awarded the Lasker Award for research that directly led to the discovery of HIV as the cause of AIDS. His research demonstrated transmission of HIV by blood and the first evidence of its transmission through heterosexual sex. He and his colleagues identified the envelope protein of HIV (gp120) which is still used to this day for HIV diagnosis.

Speaking during Prof. Essex’s farewell ceremony last Thursday at Masa Hotel in Gaborone’s opulent Central Business District - Former President Dr. Festus Mogae highlighted that the African continent was seriously affected by HIV in those early days and many people were dying every single day.  “Botswana was seriously affected by HIV/AIDS and I went around looking for help and Professor Essex and his collaborators from Harvard came to rescue our country,” he said. He said through Essex’s research many lives were saved and many Batswana have been trained in the field. “We now have our children and our own scientists and doctors in this field. “I want to thank Essex for his support to our country because what he has done to us has saved the whole world. I acknowledge all his team because our people has survived from HIV/AIDS,” said Mogae.

According to the Global Information and Education on HIV and AIDS report, Botswana is still one of the countries most affected by HIV in the world, despite its provision of universal free antiretroviral treatment to all people living with HIV. 
Statistics recorded in 2017 indicates that 380 000 people are living with HIV. “At 21.9 percent Botswana has the third highest HIV prevalence in the world, after Lesotho and eSwatini. In 2005, prevalence stood at 25.4 percent suggesting some signs of improvement over the last decade,” reads the report.

Available figures also indicate that young women aged between 15 and 24 who have HIV in Botswana outnumber young men with HIV by more than two-to-one. The national incidence rate is 1.5 per cent, or more than 15,000 new infections per year.
Speaking at the same function BHP official, Rodger Shapiro said BHP has now become more than just the premier HIV research site in Africa as many young scientists have been and are being trained. “We have become part of the larger community in Botswana and we have made lifelong friendships with that community and with each other. Substantial and long-lasting capacity has been built in doing high quality, ethical science that is dedicated to improving the health of the people of Botswana and elsewhere. All of this too was part of Professor Max’s plan,” said Shapiro.

Botswana government has been in partnership with BHP since establishment in 1996 and the institution has been leading the research on HIV/AIDS advancing Botswana to become a world leader on the HIV/AIDS disease management.  BHP has also undertaken relevant country specific and regional HIV/AIDS research training and capacity building, which is important in providing evidence-based policy and programming. Dr. Shapiro highlighted that in 1999 when HIV epidemic was out of control and there was no Anti Retroviral Therapy (ART), Professor Essex sent him and another researcher to Botswana. He said BHP was just very small with a team of just five researchers at the time.

He said Professor Essex was in this partnership with the government of Botswana for the right reasons. “Yes he was a scientist and asking scientific questions. But he also knew to go straight to Botswana leaders and listen to them.  “Every time he was here, he asked President Mogae and President Masire before him: ‘how can we help? What can we do to help?’ That was how BHP started and it remains at the heart of BHP’s mission today,” said Dr. Shapiro. For his part Minister of Health and Wellness Dr Alfred Madigele said Professor Essex has been a strong advocate for capacity building and has mentored many Batswana scientists who trained under his direct supervision to attain their PhDs and special laboratory skills through the forgatory grant and other support.
“These scientists have contributed to the acceleration of the decentralisation of our Laboratory capacity and support of our strategic national laboratory plans. I am happy that the MoHW and BHP are committed to continuing the partnership and collaboration beyond his retirement,” said Dr. Madigele.

BHP Excellence
Recently the institution commensurate increase in research output resulted in publications increasing from 24 during 2017 to 29 in the first six months of 2018 making a total of 53 peer reviewed publications during the reporting period. 
The highlight of the scientific endeavour was the successful conclusion of the Botswana Combination Prevention Project whose Primary analysis results were presented at the IAS meeting held in Amsterdam from 23rd to 27th July 2018.
The study results revealed that community HIV incidence can be reduced by at least 30% by implementing a package of proven HIV intervention strategies. The other significant results were from the Tsepamo Study - an Infant Birth Outcomes study monitoring infant birth outcomes for mothers on antiretroviral during pregnancy.  

Preliminary data analysis shows a signal of neural tube defects among infants born to mothers who become pregnant while on Dolutegravir or have Dolutegravir exposure during very early pregnancy. The study is ongoing and scheduled to end in May 2019.
The CTU grant continues to anchor BHP network related research. During this period there were 10 active CTU protocols, five of which have subsequently been closed. The current grant is in year 12 and is due for recompetition for another seven year cycle in 2020. The CTU offers a constant pipeline of research study opportunities from which BHP identifies relevant protocols for its context and region thus also enabling continued funding for BHP research activities.

CTU Protocols include among others, HPTN 081, a study to evaluate the safety and efficacy of VRC01 broadly neutralising monoclonal antibody in reducing acquisition of HIV-1 infection in women in sub-Saharan Africa”; there is also protocols P1093 “Phase I/II, Multi-Center, Open-Label Pharmacokinetic Safety, Tolerability and Antiviral Activity of GSK1349572, a Novel Integrase Inhibitor, in Combination Regimens in HIV-1 Infected Infants, Children and Adolescents.Others are IMPAACT P1026s “Pharmacokinetic Properties of Antiretroviral Therapy during Pregnancy”’; IMPAACT 2010 “a Phase III study to compare the virologic efficacy and safety of three antiretroviral regimens for HIV-1 infected pregnant women and their infants”.

Training and Capacity Building
The BHP Research Laboratory is currently a hub of activities with five PhD, seven MPhil and 10 Research Fellows involved in various projects. There are also three Harvard University undergraduates one student under Forgarty and two students hosted through the malignancy programme who are doing a project entitled “Validation of contrast enhanced microholography (CEM) device for lymphoma diagnosis”. All these outputs are directly linked to the pioneering work of Prof Max Essex, who is now returning to his native country – USA, to concentrate on his passion – writing. Hopefuly, he will still find time to visit and check upon progress on what he started in Botswana.