Abstract #220  -  Who should drive solutions to the AIDS epidemic in southern Africa: Lessons from the African Development of AIDS Trial Capacity (ADAPT) Network
Authors:   Presenting Author:   Prof Neil Andersson - CIET Trust Botswana
Additional Authors:  Dr Anne Cockcroft, Dr Beverley Shea, Dr Lehana Thabane,
Aim: The ADAPT objective is to strengthen institutional RCT development capacity in southern African national governments, universities and research NGOs. The research framework and capacities will also be appropriate for several types of large-scale AIDS prevention trials, including vaccines.
Method / Issue: Of 83 trials registered in May 2009 with a International Standard Randomised Controlled Trial Number as addressing HIV, only nine are in Africa, four have have a principle investigator with an address in Africa, and eight address primary or secondary HIV prevention. The ability to design and to conduct randomised controlled trials (RCTs) is central to setting the prevention agenda. As time passes and the huge prevention investment to date continues in its very partial successes to control the epidemic, there is increasing emphasis on the quality of evidence for proposed solutions. HIV risk in southern Africa has been linked to choice disability, multiple partners and inter-generational sex; all these are strongly embedded in local cultures and ways seeing things, especially ways of weighing up short term benefits against longer term risks. African researchers in close proximity to the social infrastructure that generates new HIV cases stand the best chance of understanding and implementing the appropriate research.
Results / Comments: A cohort of 22 trainees from 10 African countries (Botswana, Lesotho, Namibia, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe) participated in an eight-week intensive course on RCT design and implementation in 2007, with a one week refresher in early 2009. Participants came from government, universities and NGOs across the region. Several will go on to postgraduate studies, building a cohort of African trialists and RCT knowledge translation specialists. Practical survey work complemented classroom teaching on design and analysis of AIDS prevention trials. ADAPT fellows from each country participated in two 10-country surveys in 2007, one involving schools and another of households in nationally representative sentinel communities. In 2008, ADAPT fellows from three countries (Botswana, Namibia and Swaziland) began a multi-arm RCT of AIDS prevention in continuation of their practical training.
Discussion: African researchers and institutions have welcomed the initiative, which has retained most of the original cohort despite the inevitable staff turnover, especially in government departments. Shorter training modules will help more people to participate. The mix of theory and practice has been important to success; but participants need ongoing support and mentoring.
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