History
Where it all Started
The PHRU was established in 1996 by Professors Glenda Gray and James McIntyre, initially as a perinatal clinic that provided care for HIV-infected pregnant woman and their infants. At that stage, there were no interventions against HIV, and most of the work was supportive.
Gray was researching preventing breast milk transmission, funded by the Medical Research Council: women would self-select into breastfeeding or formula feeding, and the impact of not breastfeeding on transmission was studied.
Gray and McIntyre were pioneers in the understanding of vertical transmission of HIV, and they rapidly moved on to provide access to antiretrovirals for adults. Around 1996, the first effective regimens were being rolled out, but in South Africa – and in other developing countries – there was a passivity about providing antiretrovirals to people living with HIV at that time.
Gray and McIntyre were activists in this area, and the PHRU was one of the first places on the continent to provide antiretrovirals for people living with HIV, funded by foreign governments.
From the outset, the PHRU has been involved in several studies and groundbreaking clinical trials looking at the benefits of antivirals and ensuring that people could get access to them. This included, in its early history, being part of a court case to compel the government to provide nevirapine to pregnant women to reduce the risk of transmission from mother to infant. The PHRU was also the first site in South Africa to implement this policy.
As the unit’s success grew, it expanded and moved into other areas of clinical research – looking at vaccines and better treatment for adults and children, with a great deal of funding from PEPFAR at the outset. However, PHRU remains a community-focused research unit – its history, development and current focus ensure that it is always grounded in the needs of the communities it serves.
Our Soweto-Bara CRS has been pivotal to South African HIV vaccine development history, and we spearheaded local processes required for the successful execution of randomised controlled HIV vaccine trials.
Ours was the first site to commence an HIV vaccine trial in South Africa and our success means we serve as a model and training ground for other sites in the region.
In 2001, the PHRU established an HIV Vaccine Clinical Trials Unit with funding from the International AIDS Vaccine Initiative (IAVI) and South African AIDS Vaccine Initiative (SAAVI), and through a subcontract with Division of AIDS (DAIDS), it became an HIV Vaccines Network clinical trial site.
The unit also began testing novel agents to prevent TB, and its clinical trial repertoire – and geographical footprint – began to expand. In 2007, the Matlosana site in Klerksdorp was set up, and has grown dramatically over the years from two recruiters in 2007 to about 90 staff members today, conducting cutting-edge clinical research primarily in TB diagnosis and treatment of drug-resistant TB.
In Soweto, the unit runs a world-class pharmacy with all the equipment required to conduct primarily vaccine trials, but also clinical trials of other agents that require gentle handling and reconstitution of the agents being tested. The pharmacy has four levels of power back-up and disaster plans to ensure material for trials is maintained at the correct temperature. A second pharmacy runs at our Aeroton site, which was previously located in Kliptown.
The PHRU also boasts an impressive list of publications. In 2023 alone, about 100, and many continue to positively influence policy changes. It’s also fully grant-funded.
The PHRU continues to expand its research focus, particularly since the health horizon is constantly changing. Neurocognitive research, for instance, is a new area of focus because of the ageing population globally and also, because of the effects on the developing brain in infants and children. There is also some work being done on type 2 diabetes and body mass index in people living with HIV, given the high incidence of non-communicable diseases in South Africa, as well as studies aiming towards ultimately achieving a cure for HIV.
