Each year we celebrate world TB day on March 24th and World AIDS day on December 1st. The theme of world TB day this year was “On the march against TB, transforming the fight towards elimination, through innovation in research and care”.
There was a strong call to develop new tools in the fight against TB, namely new diagnostics, drugs and vaccines and also to strengthen health programmes to ensure universal access to TB care. The Theme of World AIDS Day was ‘Getting to Zero’, in which the global community committed to focusing on achieving 3 targets: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.
These visionary targets were also articulated in the new South African National Strategic Plan for HIV, TB and STIs: 2012-2016. In 2011 the Ministers of Health for South Africa, Swaziland and Lesotho highlighted the problem of TB in the mines at the Stop TB partnership Board meeting in Johannesburg.
The South African Minister of Health said that if TB was a snake then the head of the snake was in the mines. Minister Motsoaledi called for the global community to support initiatives to address the problem.
The Aurum Institutes aims to improve the health of individuals and communities through health programme support, service delivery and transformative research with a focus on TB and HIV.
Aurum’s work during 2011 was closely aligned to the themes of world TB and AIDS day. In my report, I highlight events and activities that defined Aurum’s role in promoting universal access to HIV and TB treatment and care and conducting transformative research to accelerate progress to eliminating TB and HIV as public health threats.
Aurum’s revenue in 2011 grew to more than R250 million per annum and the human resource complement reached almost 500. In order to achieve sustainable growth, Aurum introduced a new organisational structure in October 2010 to enhance synergies and efficiencies between the health and research programmes and support departments.
During 2011 the organisational structure was further refined and the roll out of the new structure completed. We believe that the new structure will provide a strong basis for sustainable growth.
The Research department is comprised of the Clinical Trials and Epidemiological Research Units that are responsible for implementing the various studies. The Science Core is comprised of senior researchers that are responsible for conceiving research projects and overseeing their implementation. The four programmes of research are HIV prevention (HIV vaccines, microbicides, behavioural and epidemiology); HIV treatment (Operational research, HIV vaccines, second-line treatment, Hepatitis); TB/HIV implementation research; and new products (diagnostics, drugs and vaccines).
Aurum expanded the clinical trial infrastructure at the Tembisa site to accommodate large clinical trials. Aurum had a full pipeline of clinical trials and epidemiological research in 2011 that were closely aligned to the themes of the 2011 Wold TB and HIV days.
The following Aurum defining projects are worth highlighting. The Thibela TB study that evaluated the effectiveness of community-wide isoniazid preventive therapy among approximately 80,000 gold miners completed all study activities. In keeping with Minister Motsoaledi’s call to action, the results of this trial will identify an innovative solution to address TB in the mines.
South Africa is currently rolling out Xpert MTB/RIF as a replacement for sputum smear microscopy for TB diagnosis. Aurum is playing a leading role in the evaluation of the national roll-out of Xpert MTB/Rif funded by the Bill and Melinda Gates Foundation.
Other Aurum defining studies started in 2011 include the MERGE study (evaluating the use of TB/HIV integration officers to improve treatment outcomes) and the Aurum102/THYB05 SSI TB vaccine trial in people with HIV.
The Health Programme activities in 2011 were aligned to world TB and HIV days through innovation in care and by contributing to activities that would accelerate progress towards zero new infections and deaths. The health programme was successful in being funded for its final year of the PEPFAR grant, which required that the health programme changed its focus from service delivery to health system strengthening.
The Health Programme is to be congratulated for achieving the transition to its new mandate of health system strengthening and technical support despite the many challenges in refocusing the programme. The Health Programme also established a Male Medical Circumcision clinic in Tembisa that uses innovative approaches towards recruitment, education, risk assessment, consenting and follow-up of circumcision clients.
Under the leadership of Dr Dave Clark, Aurum was successful in securing a large grant to provide human resource support to the Department of Health over the next five years and another grant to implement home-based TB and HIV case finding, isoniazid preventive therapy and referral for treatment and care, funded by the Sanofi Espoir Foundation.
Aurum contributed to national and international policy through membership on the World Health Organisation Strategic Technical Advisory Group for TB, the WHO expert committee for TB screening and the WHO task force for developing a policy for new TB drugs and chairing the WHO/TDR Disease Reference Group for TB, leprosy and buruli ulcer. Aurum also contributed to international leadership on TB research. Prof Churchyard was elected as the vice-Chair of the AIDS Clinical Trials Group Transformative Science Group on TB and the co-Chair of the Vaccine Trials Network TB working group. Aurum through its transformative research and innovative care made a significant contribution to the fight against TB and HIV in 2011 and will endeavour to strengthen its activities in 2012.
The Board and sub-committees of Aurum have played a central role in reviewing the strategy of Aurum whilst also giving attention to the proper review and management of the risks facing the organisation, both strategically and with respect to particular details of the core sustainability issues at play. I am grateful to them for their guidance and leadership as well as their willingness to freely give of their time to our mission.
No organisation like Aurum can survive without the generous support of its funders. On behalf of all the staff at Aurum, I would like to acknowledge the funders and donors of Aurum who have made the work reported in this volume possible. Their contribution goes beyond just funding into providing guidance and encouragement in the fight against TB and HIV. And then, our staff! Without their ongoing efforts and great patience, we would not be able to take up the leading role in research and health systems support that has been demonstrated in the TB/HIV field. It is an honour to work with people who hold our values so highly and who strive to make a difference to the people and communities we serve.
Prof. Gavin Churchyard
Chief Executive Officer