Fellowship Site Directors:
Susan Allen, MD, MPH, DTM&H, Emory University
Etienne Karita MD, MSPH, MSc,
Project San Francisco, Rwanda
William Kilembe, Zambia
Site Contact: Mark Hutcheson
Site Specialties: HIV/ID, maternal-child health, social/behavioral science, vaccines
- Project San Francisco (PSF) was one of the earliest and is now the longest-standing and largest heterosexual HIV-discordant couples’ cohort in the world. PSF has offered couples’ voluntary counseling and testing (CVCT) services to >17,000 Rwandan couples since 1988 and has been funded to conduct operational research to expend CVCT throughout Rwanda (two CDC U2GPS grants). PSF is also a site for important HIV and TB vaccine research studies.
- The project’s second main research site, the Zambia-Emory HIV Research Project (ZEHRP) in Lusaka, Zambia, maintains the next largest cohort.
- RZHRG has pioneered couples’ voluntary counseling and testing (CVCT) allowing for the identification of discordant couples critical in research by Drs. Eric Hunter and Cynthia Derdeyn in the biology of HIV transmission (R37 and two R01s) and in intervention studies to prevent HIV transmission.
- The technique of CVCT developed for heterosexual couples by the RZHRG has been adopted to other countries and to other populations like MSM in Africa and the US (R03, R01, and R34).
- RZHRG has provided internships to more than 85 US and European trainees at its sites including hosting a FICRS Scholar (Dr. Jodie Dionne-Odom) in 2008-09.
- Through FIC AITRP support, 19 African trainees have received MPH or Masters in Clinical Trials degrees from the US and the LSHTM.
The Rwanda Zambia HIV Research Group (RZHRG) has been a global leader in the fight against HIV/AIDS for more than 25 years, supporting Couples’ Voluntary Counseling and
Testing (CVCT) throughout sub-Saharan Africa. CVCT is proven to reduce the transmission of HIV by more than two-thirds among those couples who do not share the same HIV status. In the RZHRG model, HIV test results are shared with the partners together, and counselors work with them to develop a plan to help them address the impact of HIV/AIDS in their lives. In addition, RZHRG is committed to the research of HIV incidence and predictors, behavior change, the natural history and manifestations of HIV, and promotion of long-acting user-independent methods of fertility control in couples with HIV. For more than 25 years, RZHRG research has been at the forefront of research on the epidemiology, behavior and biomedical prevention of HIV/AIDS in African adults.
The Rwanda Zambia HIV Research Group (RZHRG) has been a global leader in the fight against HIV/AIDS for more than 25 years, supporting Couples’ Voluntary Counseling and Testing (CVCT) throughout sub-Saharan Africa. CVCT is proven to reduce the transmission of HIV by more than two-thirds among those couples who do not share the same HIV status. In the RZHRG model, HIV test results are shared with the partners together, and counselors work with them to develop a plan to help them address the impact of HIV/AIDS in their lives. In addition, RZHRG is committed to the research of HIV incidence and predictors, behavior change, the natural history and manifestations of HIV, and promotion of long-acting user-independent methods of fertility control in couples with HIV. For more than 25 years, RZHRG research has been at the forefront of research on the epidemiology, behavior and biomedical prevention of HIV/AIDS in African adults.Project San Francisco (PSF) was established in Kigali, Rwanda in 1986 by Dr. Susan Allen. PSF was one of the earliest and now longest-standing HIV cohort studies in Africa.
Project San Francisco (PSF) is located in the nation’s capital and is the center for administrative, financial, and commercial business. Rwanda is Africa’s most densely populated country; the city of Kigali is home to more than 1,000,000 inhabitants. The three official languages spoken in Kigali are Kinyarwanda, French and English. PSF fully transitioned its Couples Voluntary Counseling and Testing services into government district clinics and is now the standard of care for the country. PSF continues to host one CVCT clinic in Gitega neighborhood which is staffed by project employees. As part of a CDC awarded training grant, PSF nurse counselors conduct country wide training for CVCT services in the Rwandan government clinics. Additionally, PSF staff work closely with the Treatment Research and AIDS Center (TRAC) in Kigali. Together, they develop training materials and tools for implementation of CVCT throughout the country. The Rwandan government manages all CVCT data collected at the sites and oversees M&E of these services.
Rwandan government clinics have the capacity to support CVCT services which are standard of care throughout the country as well as the grant specific IUD training interventions. Clinics are equipped with private exam rooms, specula, availability of high level disinfectant or autoclaves, and ability to rule out pregnancy either through HCG testing or WHO recommended checklists which are also standard of care. PSF nurses have been trained, with documented competency assessment, to insert IUDs and conduct both practical and didactic training sessions.
The PSF main research site is located in Gitega neighborhood of Kigali. It is comprised of three buildings which house a filing unit, medical enrollment, medical clinic, pharmacy, phlebotomy, GCLP accredited laboratory (serology, microscopy, ELISAs, hematology, immunology, clinical chemistry, flow cytometry and PCR), administration, data unit and archive. Both the laboratory and pharmacy are equipped to conduct HIV vaccine clinical trials and continue on this endeavor through awarded support from the International AIDS Vaccine Initiative (IAVI). All departments are equipped with appropriate materials to carry out the scope of work including a server and back-up server, over 30 computers, 10 printers, 2 photocopiers,
PSF is directed by Etienne Karita MD MSPH MSc who is supported by a team of study physicians, senior research nurses, laboratory scientists, data technicians, administrative assistants, filers, general workers, interns (MPH or MD/MPH) and project coordinators. All medical, data and lab staff are Human Subjects trained and Good Clinical Practice (GCP) certified. In addition, lab staff are Good Clinical Laboratory Practice (GCLP) certified. The site uses RZHRG standard operation procedures (SOPs) to conduct all scopes of work. SOP training and competency assessments occur annually with bi-annual SOP review.
The PSF site benefits from long standing relationships with local NGOs as well as government organizations such as the TRAC. Existing support from both CDC and IAVI leverage the costs of infrastructure as well provide physical, financial and intellectual resources. Furthermore, the RZHRG Emory team provides additional technical assistance to the site including scientific support, M&E, data management and supply procurement.
The Center for Treatment and Research of AIDS Plus (TRAC) is an autonomous Ministry of Health (MOH) supervised research center that in 2007, combined multi-disciplinary research programs country wide including AIDS, malaria, tuberculosis, STIs, leprosy and other endemic infectious disease in Rwanda. TRAC Plus is a “Center of Excellence” for all disease research, prevention and control endeavors in Rwanda. TRAC Plus is able to use existing research and that of its partners to define and establish national needs, priorities, and policies in line with international development goals. PSF works closely with members of TRAC Plus to share research findings which guide national CVCT policy. Additionally, PSF and TRAC Plus develop country wide training manuals for CVCT implementation and monitoring and evaluation. RZHRG has provided internships to more than 85 US and European trainees.
The PSF laboratory is externally audited three times a year for technical competence and GCLP adherence and internally monitored by study sponsor (IAVI) twice annually. Additionally, the laboratory is enrolled in external quality assurance (EQA) programs for all diagnostic testing done onsite (HIV/RPR serology, urine & clinical chemistry, hematology, pregnancy, and flow cytometry). The site is internally monitored by IAVI; quarterly for medical and data and twice annually for administration/finance compliance.
1R01MH095503-01 (PI: Allen)
VCT with Primary and Concurrent Parnters to Prevent HIV Transmission
National Institutes of Mental Health
The goal of this project is to conduct community based interventions to increase couples’ voluntary HIV counseling and testing, follow-up behavioral assessments of structural factors in HIV discordant couples, and systematic inclusion of community influence networks, policymakers, and funding agencies in the development and implementation of the interventions.
IAVI-PSF-2011 (PI: Allen)
Vaccine feasibility studies (Protocols C, D, E, F)
International AIDS Vaccine Initiative
The goal of this study is a preventive vaccine efficacy trial, including recruitment, retention, counseling, HIV testing, collection of demographic, risk and health data, drawing, processing, storage and shipping of blood samples, cryopreservation and shipping of viable lymphocytes (PBMCs) and recording and analysis of data.
3U2GPS001904-02S1 (PI: Allen)
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Rwanda Zambia HIV Research Group Center of Excellence for the Expansion of CHCT Services
The goal of this study is to expand voluntary couples HIV counseling services in Rwanda and Zambia.
Trainee Housing & Safety:
Housing is provided in rented homes within a short walk from the project site, fully equipped with several bedrooms, bathrooms, hot running water, electricity and wireless internet. Hot lunch is available at the site for about $2 a day and local grocery stores are a 10 minute walk (or very short taxi ride) with almost all food options that you would want. Malaria prophylaxis is recommended, especially for risk during the rainy season. Normal clean water and food precautions should be followed. Yellow Fever vaccination is required for entry. Rwanda is a very safe country, even to walk at nighttime. It is a very walkable city with little need to take other transportation unless you’d like to travel outside the city.
Debby Basu, PhD
Nurilign Ahmed, MPH
Photos by Birgit Bolton