Breaking New Ground at the Nexus of HIV and TB

Two HHMI scientists couldn’t ignore a staggering problem: a devastating co-epidemic in South Africa of tuberculosis (TB) and HIV. Bruce D. Walker, an HIV/AIDS specialist at Massachusetts General Hospital, and William Jacobs, a TB expert at Albert Einstein College of Medicine in New York City, encouraged HHMI to think creatively about how it could have an impact at the heart of this deadly outbreak.

And HHMI has taken up the challenge. The Institute has joined in a partnership with the University of KwaZulu-Natal in Durban, South Africa, to build a research center on the campus of the Nelson R. Mandela School of Medicine. The KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH) will be a major research facility with laboratories equipped to safely handle TB and HIV. HHMI has committed $60 million over 10 years.

K-RITH will be located at the center of the TB and HIV co-epidemic in South Africa’s KwaZulu-Natal province. South Africa is home to about one-third of the cases of HIV/TB co-infection worldwide, and the situation is more dire still in KwaZulu-Natal province. In the rural village of Tugela Ferry, where extremely drug-resistant TB was first identified, up to 40 percent of adults are infected with HIV and a staggering 80 percent of TB-infected adults also have HIV.

By working near the heart of the co-epidemic, K-RITH scientists are poised to identify and respond to emerging changes in HIV and TB. Already, the Institute has identified areas where new knowledge is urgently needed, including research on the immune system’s response to TB and HIV, and the causes of TB recurrence.

Jacobs and Walker have joined with two South African scientists—A. Willem Sturm, dean of the Nelson R. Mandela School of Medicine and K-RITH’s interim director, and Salim S. Abdool Karim, pro vice-chancellor for research at the University of KwaZulu-Natal—to create a scientific steering committee for K-RITH and to jump start the initial research program. As part of that effort, HHMI is supporting the renovation of existing laboratory space so that research involving extensively drug-resistant strains of TB can move ahead before the new building is complete.

Return to Top

Breaking New Ground at the
Nexus of HIV and TB

Aerial photograph of the village of Tugela Ferry

All photography by Paul Fetters

At the Church of Scotland Hospital in Tugela Ferry, more than 460 patients have been diagnosed with drug-resistant TB since an initial outbreak there in February 2005. Overcrowded and poorly ventilated waiting areas full of HIV-infected patients with weak immune systems contribute to the spread of TB in KwaZulu-Natal province.

Photograph of B. Mazibuko of Tugela Ferry Photograph of N. Bgcob of Edendale

Living in rural areas, patients like B. Mazibuko of Tugela Ferry and N. Bgcob of Edendale have a hard time maintaining the grueling TB treatment regimen, which involves six months of daily injections followed by 12 to 24 months of pills. Only about 40 percent of patients in KwaZulu-Natal live to complete treatment.

Photograph of rural KwaZulu-Natal province

Community is vital in rural KwaZulu-Natal province, where subsistence living is the norm. Health care workers join with tribal leaders and traditional healers to introduce Western medical treatments and promote education about HIV/AIDS and TB. More than 200 HIV-positive babies are born every day.

Photograph of the Prince Cyril Zulu Communicable Disease Center

At the Prince Cyril Zulu Communicable Disease Center in the bustling port city of Durban, patients who typically come in complaining of a persistent cough leave with a diagnosis of both TB and HIV. The center, known to locals as the Durban Chest Clinic, will be linked to K-RITH.

Photograph of health care workers at the Durban Chest Clinic

To lend support and help ensure treatment compliance, health care workers at the Durban Chest Clinic ask patients with TB to return weekly for progress reports and to pick up their supply of medications. Completing the regimen is essential to curing the disease and stopping its spread.

Photograph of Durban’s McCord Hospital exterior

Even at private facilities such as Durban’s McCord Hospital, founded by missionaries a century ago, research operations lack adequate resources. According to administrators, the biggest challenges are a lack of space, money, and trained researchers as well as meeting the psychosocial needs of patients and the community.

Photograph of physician Doug Wilson

In addition to treating patients, physician Doug Wilson at state-run Edendale Hospital is working to develop a TB test for cases that cannot be diagnosed by X-ray and other means. The 900-bed hospital saw more than 10,000 patients in 2009, up from 3,000 patients in 2005. Of the patients admitted to the hospital, 50 percent are HIV-positive. Of those, half are also infected with TB.

Photograph of a researcher's erasable board with notes. Photograph of a petri dish containing a TB sample.

K-RITH will lend support to existing research programs in KwaZulu-Natal province. These programs include the development of a rapid diagnostic test for TB, the effort to identify whether certain people are more susceptible to TB or HIV infection, and the search for better treatments for HIV/TB co-infection.

Photograph of researcher Thumbi NDung’u

A major goal of K-RITH is to train African scientists in cutting-edge lab techniques. As native Kenyan Thumbi NDung’u points out, it is vital that Africans be part of the process. NDung’u is a Harvard-trained researcher at the Nelson Mandela School of Medicine in Durban.

Photograph of an HHMI discussion panel.

K-RITH was officially launched on March 19, 2009, with a press conference held in Washington, D.C., and televised simultaneously at the University of KwaZulu-Natal. Salim S. Abdool Karim, pro vice-chancellor for research at the University of KwaZulu-Natal, talks about his efforts to find out whether TB recurrence in HIV patients is caused by a new infection or an old infection that has been reactivated. Abdool Karim and other scientists gave presentations and took questions from the audience.

Photograph of HHMI President Thomas Cech

Journalists who attended the press conference were given opportunities to interview the participants, including then HHMI President Thomas Cech, who helped spearhead development of the international research center.

His Excellency Welile Nhlapo shakes hands with Professor Malegapuru William Makgoba and Cech

At the press conference, His Excellency Welile Nhlapo, the South African Ambassador to the United States, and Professor Malegapuru William Makgoba, vice-chancellor of the University of KwaZulu-Natal, joined with Cech in sealing the partnership with a handshake.