Research Sites

CAPRISA’s clinical research is undertaken at five well established clinical research sites; two of which are sites developed by CAPRISA partners with assistance from CAPRISA.

1.    eThekwini Clinical Research Site
The CAPRISA eThekwini Site is adjacent and attached to the Prince Cyril Zulu Communicable Disease Center a Primary Health Care Clinic dedicated to treatment of TB and sexually transmitted infections (STI).  This facility is conveniently located in central Durban in the transport hub for public commuters by rail, bus or minibus taxis. The Prince Cyril Zulu clinic is one of the largest out-patient TB facilities in South Africa with a sophisticated computerized patient record system.  In 2004, 8580 patients were diagnosed with TB at this clinic. Of these 5390 (62.8%) patients were self referred, and 3190 were referred from other clinics or hospitals.  Of the self referred patients, 4532 (84.1%) patients had pulmonary TB.  A total of 3568 (78.7%) were smear positive.  The majority (94%) of TB patients are black, and 37% female, with average age of 34 years (range 5 to 72 years).  The majority of patients (56%) are unemployed. The HIV prevalence in TB patients is estimated to be between 64.6% and 80%.

Annually, approximately 40 000 cases of sexually transmitted infections (STIs) are treated at this clinic. The majority of the STI patients accessing these facilities are self-referred presenting with genital ulceration and/or vaginal discharge syndrome or as contacts of patients with a diagnosis of a STI. Between July and December 2005, as part of a provider initiated HIV testing programme, 1190 women were tested for HIV infection. The HIV prevalence was 54.7% with the highest prevalence in the 30-34 (78.3%) and 35-39 (68.8%) year age groups.

The CAPRISA eThekwini site comprises two sections, a Treatment Clinic for HIV-TB co-infected patients and a Prevention Clinic with a high risk population of STI clients.  

2.    Umbilo Clinical Research Site
The CAPRISA Umbilo Clinical Research site is located in the Doris Duke Medical Research Institute on the campus of the Nelson R Mandela School of Medicine. This Site was custom designed for the conduct of clinical trials and has the capacity to see 30 research participants a day at good clinical practice standards.  It is ideally located to undertake phase I, and II safety and pharmacokinetic trials since it is attached to the Institute’s and CAPRISA’s laboratories, the Medical School and King Edward VIII Hospital, which ensures efficient and rapid access to a full range of specialist care for research participants if indicated, at this major academic hospital in KwaZulu-Natal.

The surrounding community of about 80,000 people includes both high risk hostel dwellers and low risk stable communities. The CAPRISA 002 Acute Infection study is being conducted at this site currently.  After screening 775 individuals, a cohort of 245 HIV uninfected high-risk women was established. HIV-prevalence at screening was 59.6% (95% CI: 55.9 to 62.8%). The majority of women (78.8%) were self-identified as sex-workers with a median of 2 clients per day. HIV incidence rate in this cohort was 7.9 per 100 women-years (95% CI: 4.1 to 9.6 per 100 women-years)
 

3. Vulindlela Clinical Research Site
Vulindlela is a predominantly Zulu-speaking rural community of about 400,000 people located 90 minutes west of Durban. The district has 8 Primary Health Care clinics where nurses provide comprehensive primary care, including family planning services, voluntary HIV counseling and testing, sexually transmitted infection treatment, antenatal care, treatment of opportunistic infections and minor ailments.  They are linked by ambulance to the regional referral hospitals, Grey’s Hospital (about 30 minutes away), and Edendale Hospital (about 20 minutes away).

The CAPRISA Vulindlela Clinical Research Site was established by invitation from the two traditional chiefs, Nkosi Sondelani Zondi and Nkosi Nsikayezwe Zondi.  The partnership between the CAPRISA researchers, community organizations, community leadership and health service providers in this district is now well established based with significant joint efforts to deal with the unfolding AIDS epidemic in Vulindlela.  In addition, there are about 60 community based organizations in the district representing a variety of civic interests such as youth, women, religion, politics, and housing. Several of these organizations are currently providing HIV prevention and home-based care services to this community and have links with the CAPRISA facility.

HIV prevalence in pregnant women in Vulindlela was 32.4% (95%CI 27.6-37.6) in 2001 and 34.4% (95% CI 29.4-39.2) in 2007.  The HIV epidemic in this district is being fuelled by high incidence rates, estimated at 8.5% (CI: 4.0-12.9%) per annum in young women under the age of 30 years.  Between 2001-2007, most of the prenatal clinic attendees were less than 25 years of age; with 56.9% in this age range in 2001, and 63.2% in 2007. The impact of HIV infection in this community was assessed as part of a community-based demographic and health survey, which revealed an overall mortality rate of 2.9 per 100 person-years (CI: 2.5 - 3.3 per 100 person-years).  AIDS-related mortality, mainly from pulmonary conditions was disproportionately high in young women in this rural community.


4. Umlazi Clinical Research Site
The Umlazi site of the University of KwaZulu-Natal’s Women’s Health Research Unit is a partner site within the UKZN-CAPRISA Clinical Trials Unit. The Umlazi Site, which is situated in the Prince Mshiyeni Memorial Hospital in Umlazi Township about 17km southwest of the Durban city center, conducts research on the prevention of mother-to-child transmission of HIV.

More than 40% of prenatal clinic attenders in Umlazi are HIV positive.  An estimated 12,000 pregnancies and deliveries are managed each year at this facility, with an HIV prevalence of 42%. The current mother-to-child transmission (MTCT) rate is 6% at birth, 15% at 6 weeks and 20% at 9 months.


5. KOSH Clinical Research Site
The KOSH Clinical Research Site of the Aurum Institute for Health Research is a partner site within the UKZN-CAPRISA Clinical Trials Unit. It is siuated adjacent to Klerksdorp Hospital in the KOSH (Klerksdorp, Orkney, Stilfontein and Hartebeesfontein) District which as a total population of 350,000. Gold mining is the principal economic activity in the KOSH District. This site conducts mainly HIV vaccine trials and HIV-TB co-infection studies among the male mineworkers and their female sexual partners.  

The prevalence of HIV infection among mineworkers in the KOSH district in 2000/1 was 30.7% (95% CI: 28.5–32.9%) rising to 32.1% (95% CI: 29.4–34.9%) in 2003/2004. The incidence rate of HIV infection in this group was 4.1% (95% CI: 3.3%–5.1%) in 2004.  HIV-infected mineworkers have about a 5-fold higher risk of developing TB compared to HIV-uninfected mineworkers (risk ratio: 5.5, 95% CI: 3.5–8.6). The prevalence of HIV among mineworkers treated for TB increased from 15% in 1993 to 85% in 2004.

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