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Kenya

For more than 45 years, the US Military has maintained a substantial program for infectious disease research in Kenya. In 1999, MHRP launched an international HIV vaccine research program in collaboration with the Kenyan Medical Research Institute (KEMRI) known locally as part of the Walter Reed Project (WRP).  

Originally integrated within a community at a local tea plantation in Kericho, the WRP HIV Program has developed expertise and infrastructure to support HIV vaccine, therapeutic and other infectious diseases research. In 2004, the program expanded to offer PEPFAR-supported HIV prevention, care, and treatment program and was one of the first programs in Africa to provide ART.

All WRP activities in Kenya are conducted under the U.S. Army Medical Research Unit–Kenya (USAMRU-K), which is on the campus of KEMRI in Nairobi. The HIV research and care programs are mutually synergistic with long-term capacity building and sustainability.

HIV Research

WRP has conducted diverse studies including randomized, double-blind, placebo-controlled and IND/FDA-regulated studies. These studies include two vaccine trials and 12 HIV/AIDS and related opportunistic infections therapeutic studies, acute HIV infections, high- and a low-risk HIV infection cohort studies and four HIV/AIDS health economics studies in collaboration with Boston University.

WRP conducted a 36-month, prospective study aimed at estimating HIV prevalence, incidence, and molecular epidemiology called RV142. This study resulted in several publications including local populations lab reference ranges, circulating HIV clades, HIV incidence, risk factors, malaria and molecular epidemiology.  Ongoing studies include:

  • RV217 (ECHO): HIV-1 Prevalence, Incidence, Cohort Retention, and Host Genetics and Viral Diversity in High Risk Cohorts in East Africa
  • An Immune Reconstitution Inflammatory Syndrome (IRIS) study, cinducted in collaboration with the Infectious Diseases Clinical Research Program (IDCRP)


AIDS Clinical Trials Group (ACTG)

The Kericho site started doing the National Institute of Health (NIH), Division of AIDS (DAIDS)/ AIDS Clinical trials Group (ACTG) funded studies in 2006 as a Clinical Research Site (CRS). In 2008, Kericho and Moi University in Eldoret became ACTG CRSs under the MHRP Clinical Trials Unit NIH. The Kericho site has participated in studies focusing on HIV treatment and management of co-morbidities such as TB, fungal infections and Kaposi's sarcoma.

IMPAACT (ACTG)
National Institute of Child Health and Human Development (NICHD) is sponsoring new studies focusing on prevention and management of HIV infection in mothers, pediatrics and adolescents.

Program Highlights

  • Conducted the first HIV vaccine study in Kericho to be held outside of Nairobi and the largest to date in Kenya
  • Established Kenya’s first and only College of American Pathologist (CAP)-accredited laboratory
  • Participated in a study that found starting antiretroviral therapy (ART) soon after beginning tuberculosis treatment can significantly reduce the onset of new AIDS-defining illness and death in those with advanced HIV. Results were published in NEJM in 2011
  • Participated in the OCTANE Study, which was published in the NEJM in 2010 and influenced revision of WHO guidelines for treating some HIV-infected women
  • Will begin a new Phase II Ebola vaccine study in 2017 (RV 456)

State-of-the-art Clinical Research Center

The state-of-the-art Kenya Medical Research Institute/Walter Reed Project Clinical Research Center opened in 2012. The CRC has three integrated main components: 1) HIV vaccine and therapeutics research, 2) HIV care, treatment and prevention and 3) enteric and microbiology research.

 

In 2004, WRP began providing PEPFAR-supported services in Kericho, and it has expanded throughout the South Rift Valley region and into Kisumu and Kombewa.  By working with local partners throughout the South Rift Valley, WRP focuses on developing the capacity of partner health facilities and local organizations and covers a population of 2.7 million people.

Through PEPFAR, the KEMRI/WRP has developed a very close working relationship with the more than 420 health facilities in the region, and has conducted several research studies in six of the largest hospitals.

Mil-Mil Program

MHRP’s PEPFAR program also supports the Kenya Defence Forces (KDF), providing comprehensive HIV prevention, care, and treatment services. The KDF serves a catchment population of 135,000, inclusive of active duty soldiers, their dependents, and civilian employees. The focal location of operations is Nairobi at the Defense Forces Memorial Hospital, with services extended to 10 HIV comprehensive care centers and one community outreach clinic, located in Mtwonge, which serves surrounding civilian populations.

Highlights

Prevention of Mother-to-Child Transmission

Kericho’s Prevention of Mother-to-Child Transmission (PMTCT) program, initiated in 2001, has been the foundation for HIV care and treatment activities in the region, reaching 90% of all HIV-exposed infants.

Inventive Prevention Programs

One of the supported NGOs, the Kericho Youth Center (KYC), has been instrumental in ensuring that young people in the district learn their HIV status—an important aspect to prevention and access to care and treatment. The center offers a dynamic approach to behavior change and HIV prevention by combining recreational services with HIV counseling and testing. Of key importance are KYC staff efforts to go beyond static voluntary counseling and testing (VCT) and reach out to the larger community via mobile and moonlight VCT initiatives.

Community Engagement

WRP-K has developed a novel approach for HIV prevention and education that builds on Kenya’s tribal rites of passage tradition of male circumcision. By working with and obtaining approval from key village elders, WRP-K brought peer educators into villages, creating an opportunity to discuss HIV prevention and sexual and reproductive health. It is the engagement of the community that is key to determining the most appropriate and effective delivery of HIV prevention messages.

PEPFAR Research

  • New in 2016: PEPFAR-funded study (RV292) to examine Malaria and TB HIV co-infection in Kenya Defence Forces
  • RV329 – AFRICOS – a 15-year study called the African Cohort Study, a longitudinal study to assess the impact of clinical practices, biological factors and socio-behavioral issues on HIV infection and disease progression in an African context.
  • WRP conducted a Public Health Evaluation called the “Clic-based ART Diagnostic Evaluation Study,” or CLADE. It is an unblinded, randomized prospective, observational, cohort public health evaluation aimed at determining the superiority and cost-effectiveness of two recommended Ministry of Health ART diagnostic evaluation approaches: routine care and viral load guided care.
  • A Cost-Outcomes Analysis of the provision of Antiretroviral Therapy at maternal and child health clinics through 18 months post-partum and then referral to a general adult ART clinic