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Motswana woman enhancing HIV/AIDS cure research

Thirty years on, the cure for HIV/AIDS remains elusive, but researchers from various corners of the world are making enormous efforts and as the quest ensues, one Motswana woman, Dr Catherine Koofhethile, an immunologist, is in the thick of things and among those in the forefront to enhancing HIV/AIDS Cure research, ANGELA MDLALANI writes.

Despite the fact that both the vaccine and cure for the Human Immunodeficiency Virus (HIV) have eluded the researchers’ inquisitive eye for three decades now, Dr. Catherine Koofhethile believes that a breakthrough for an HIV cure is nigh.
Having spent almost all her career life in HIV research, Koofhethile is of the strong view that more focus should be placed on cure research.

During her PhD studies, her research focussed more on the understanding  of the mechanisms of HIV control during the chronic stage of infection but the turning point was in 2014 when she was nominated to attend the 64th Lindau Nobel Laureate (Medicine and Physiology) meeting in Germany. There, she met and interviewed the esteemed Professor Barré-Sinoussi who received a Nobel Prize for co-discovery of HIV.

“That was big for me, as I was fortunate enough to be meeting this woman who has taken great strides in HIV work. We discussed a variety of topics with regards to HIV research. And when she gave her talk, she encouraged work towards cure research. Her talk motivated me and pushed me to think about having my post-PhD career be focused on cure research.” 

Further, she was propelled by revelations by Prof Barre-Sinoussi’s assertion that she had interacted with HIV infected people who had revealed that they were tired of taking medication and wanted to be cured. Today, Koofhethile is based in the United States in Boston, Massachussets at the Harvard T. H. Chan School of Public Health. Under the mentorship of Professor Max Essex and Dr. Vladimir Novitsky, she still researches on HIV.

Prof. Essex is among HIV experts who have been researching on HIV since the beginning of the epidemic. Currently, Koofhethile’s research focuses on understanding the architecture; size and structure of the proviral reservoir in HIV infected individuals undertaking antiretroviral treatment (ART) in Botswana.

She uses a combination of Immunological and Virological assays to monitor proviral reservoir in HIV infected individuals. She works in collaboration with a local Investigator, Dr. Sikhulile Moyo, a Virologist based at Botswana Havard AIDS Institute Partnership (BHP) in Botswana where she also holds a Research Associate position. Here, she is actively involved with research and also mentors and supervises some of the upcoming researchers and students who are attached at the lab.

“When HIV infects the cells, mostly CD4+ T cells, the majority of these infected cells eventually die but only a small proportion go in to a ‘resting state’ creating what we call ‘reservoir’. This is a situation where by the virus can sort of hide in different parts of the body. The reservoir sites can be in tissues such as the lymph nodes and spread across the body including central nervous system and the gastrointestinal track. This reservoir is the major obstacle to finding a cure for HIV,” she revealed.

“My current research therefore is focused on trying to understand this reservoir. In order to completely eradicate the virus from the body, we must eliminate the reservoir but in order to get rid of the reservoir, there is need to understand its dynamics.” 

Just last month, Koofhethile flew into the country and gave her first ever Public Lecture at the University of Botswana. And fittingly, it was hosted in her homeland. The Public Lecture addressed her previous PhD and current post doctoral research work, which she revealed to this publication, was going well. She also gave a summary of the current global HIV cure research – an update of where we are in terms of finding a cure.

The public lecture was well attended, including by her family who got to see firsthand the kind of work she does, since she is not based in Botswana. “It was very humbling to see my family and friends in the audience; they have greatly supported me throughout my career. And for them to see my progress meant a lot to me. They now understand the kind of work I am involved in and are very proud.”

The current study, she and Dr. Moyo started last year November will be completed hopefully at the end of this year (2018). The study involves teenagers who were born with HIV, started ART soon after diagnosis and have been on therapy for many years. “It is a very important project that will give us a better understanding of  the HIV reservoir and enhance HIV cure research. We are still recruiting for this study but already I am hopeful about it,” she said.

The making of the great Doctor

Koofhethile has almost always known she would end up in science. She grew up at a time when HIV had just been discovered, and the stigma and fear of AIDS was rife. She would go on to hear more about this monstrosity at school, although not much was known about the disease then. So curious was the young Koofhethile that she at that young age took a life decision that she would grow up to one day help end that epidemic.

Fast forward to some years later, now a qualified microbiologist and immunologist, the Harvard Post-doc Fellow is among those at the forefront of the worldwide effort working towards HIV cure research. Right from her primary school days, she had always performed well in Mathematics and Science, it was no surprise then when after the Junior Certificate she went on to do Pure Sciences and Add Maths.

She proceeded to do her Tirelo Sechaba (National Service) at the Botswana National Youth Council as an Admin Assistant and occassional peer educator on HIV/AIDS before proceeding to do her first year at the University of Botswana. She spent only her foundation year (formely known as BSc Part 1) at UB and she was then offered a scholarship for a four-year Bachelor of Science Degree with Honours in Medical Microbiology at the University of Surrey in the United Kingdom.

Upon graduating, she returned home and was offered a job at BHP as a Fogarty Fellow. After 2 years, she decided to go back to read for her Masters Degree in Immunology at the University of Birmingham, still in the UK, albeit this time as a self sponsored student. “My family contributed a lot towards my school fees and upkeep and I’ll forever be grateful for their unconditional support,” said Koofhethile.

All along, she was itching to get her hands on HIV research, but there were no dedicated research projects on HIV. Eventually, after her second degree, she decided to contact a Professor at Oxford University who was only impressed she would want to work with HIV research. The Professor in question is Phillip Goulder, whose work has had a major impact in the field of HIV research throughout the world. A renowned paediatrician and researcher, he is lauded for his great contributions towards HIV research.

Dr. Koofhethile spent 2 and half years at Prof. Goulder’s lab, working as a Graduate Research Assistant. “My time at the Goulder lab was fulfilling in many ways. Most of my research techniques I employ in my HIV research were learnt from the Goulder lab,” she said in an interview. She would want to continue studying under Goulder’s mentorship, but this time in Africa, at the “at the epi-centre of the epidemic”.

“During my time at Oxford, I already knew I wanted to proceed to a PhD and that I wanted to study in South Africa under the mentorship of both Prof. Goulder and Prof. Thumbi Ndung’u who used to work in Botswana. And I knew both professors would be fantastic mentors since they are experts in the field of HIV research.” In 1998, Goulder and some colleagues founded a state-of-the-art lab at the University of Kwazulu Natal (UKZN), in Durban South Africa, the university Koofhethile had in mind for her PhD.

“It really made sense for me to study in Africa than elsewhere because we are the hardest hit by HIV. When at home, you get to experience how people affected relate with the research,” she highlighted further. So, she decided to take up her studies, focusing on the Immunology of HIV. “I was basically trying to understand why some people get infected and do not fall sick and while some get infected and their health deteriorates very fast.”

Her PhD research entitled “Protective HLA Class I Alleles: Investigation of Viral Control and Lack of Control in Chronic HIV-1 Subtype C infection,” in fact, has brought scientists a step closer to understanding the phenomenon whereby a rare group of individuals control HIV-1 infection without antiretroviral therapy.

Her PhD studies were supported through scholarship from the Organisation for Women in Science for the Developing World (OWSD) and partly by some of Prof. Ndung’u’s grants. The OWSD is a non-profit making entity whose objective is to strengthen women scientists’ role in the development process and promoting their representation in scientific and technological leadership. 

Returning home?

As fulfilling as her work has been thus far, Koofhethile harbours plans to return home and do more with regards to HIV research, women’s development and science development. However, she believes that there is a great number of women involved in science and research in Botswana, but they are not celebrated enough. So, we need to celebrate these wonderful women in science in order to make science careers more attractive to the young girls.

This will increase the Global numbers of women in science. We also need our government to direct funding towards basic science research in Botswana to allow us to do research in our own country as Batswana and solve problems affecting us as a nation,” she asserted. She envisions an Africa that would be the hub of research, science and technology and be able to attract more research funding.

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Jackdish Shah loses interest in BDP

17th May 2022
Jackdish

As the preparations for the Botswana Democratic Party (BDP) congress are about to kick off, reports on the ground suggest that the party’s Deputy Treasurer Jackdish Shah will not defend the position in August as he contemplates relocation.

According to sources, the businessman who joined the BDP Central Committee in 2015 at the 36th Congress held in Mmadinare is ready to leave the party’s politburo. It is said he long made up his mind not to defend the position last year. A prominent businessman, Shah, when he won the position to assist Satar Dada in 2015 was expected to improve the party’s financial vibrancy. By then the party was under the leadership of Ian Khama.

According to close sources, Shah long decided not to contest because he has fallen out of favour with the party leadership. It is said he took the decision after some prominent businessmen who are BDP members and part of football syndicate decided to push him out and they used their proximity to President Mokgweetsi Masisi to badmouth him hence the decision.

“The fight at the Botswana Football Association (BFA) and Botswana Football League (BFL) has left him alone in the desert and some faces there used their close access to the President to isolate him,” said a source. Media reports say, Shah does not see eye to eye with BFA President MacLean Letshwiti who is also Masisi’s buddy hence the decision.

BFL Chairman Nicholas Zackhem is said to be not in good terms with Shah, who at one point Chaired the then Botswana Premier League (BPL). “He is seriously considering quitting because of what is unfolding at the team (Township Rollers) which is slowly not making financial gains and might be relegated and he wants to sell while it is still worth the investment,” said a highly placed source.

Shah is a renowned businessman who runs internet providing company Zebra net, H &G, game farm in Kasane, cattle farm in Ghanzi region and lot of properties in Gaborone. He also has two hotels in USA, his advisors have given him thumbs up on the possible decision of relocating provided he does not sell some of the investments that are doing well.

Asked about whether he will be contesting Shah could not confirm nor deny the reports. It is said for now it is too early as a public decision will have to be taken after the national council meeting and prior to the national congress. “As a BDP Central Committee member he cannot make that announcement now,” a BDP source said.

BDP is expected to assemble for the National Council during the July holidays while the National Congress is billed for August. It is then that the party will elect a new CC members. The last time BDP held elective congress was at Kang in 2019. The party is yet to issue writ.

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Govt ignores own agreements to improve public service

17th May 2022
Govt

The government has failed to implement some commitments and agreements that it had entered into with unions to improve conditions of public servants.

Three years after the government and public made commitments aimed at improving conditions of work and services it has emerged that the government has ignored and failed to implement all commitments on conditions of service emanating from the 2019 round of negotiations.

In its position paper that saw public service salaries being increased by 5%, the government the government has also signalled its intention to renege on some of the commitments it had made.
“Government aspires to look into all outstanding issues contained in the Labour Agreement signed between the Employer and recognised Trade Union on the 27th August 2019 and that it be reviewed, revised and delinked by both Parties with a view to agree on those whose implementation that can be realistically executed during the financial years 2022/23, 2023/24 and 2024/25 respectively,” the government said.

Furthermore, in addition to reviewing, revising and de-linking of the outstanding issues contained in the Collective Labour Agreement alluded to above and taking on a progressive proposal, government desires to review revise, develop and implement human resource policies as listed below during the financial year 2022/23,2023/24,2024/25

They include selection and appointment policy, learning and development policy, transfer guidelines, conditions of service, permanent and pensionable, temporary and part time, Foreign Service, expatriate and disciplinary procedures.

In their proposal paper, the unions which had proposed an 11 percent salary increase but eventually settled for 5% percent indicated that the government has not, and without explanation, acted on some of the key commitments from the 2019/2020 and 2021/22 round of negotiations.  The essential elements of these commitments include among others the remuneration Policy for the Public Service.

The paper states that a Remuneration Policy will be developed to inform decision making on remuneration in the Public Service. It is envisaged that consultations between the government and relevant key stakeholders on the policy was to start on 1st September 2019, and the development of the policy should be concluded by 30th June 2020.

The public sector unions said the Remuneration Policy is yet to be developed. The Cooperating Unions suggested that the process should commence without delay and that it should be as participatory as it was originally conceived. Another agreement relate to Medical Aid Contribution for employees on salary Grades A and B.

The employer contribution towards medical aid for employees on salary Grades A and B will be increased from 50% to 80% for the Standard Option of the Botswana Public
“Officers’ Medical Aid Scheme effective 1st October 2019; the cooperating unions insist that, in fulfilling this commitment, there should be no discrimination between those on the high benefit and those on the medium benefit plan,” the unions proposal paper says.

Another agreement involves the standardisation of gratuities across the Public Service. “Gratuities for all employees on fixed term contracts of 12 months but not exceeding 5 years, including former Industrial class employees be standardized at 30% across the Public Service in order to remove the existing inequalities and secure long-term financial security for Public Service Employees at lower grades with immediate effect,” the paper states.

The other agreement signed by the public sector unions and the government was the development of fan-shaped Salary Structure. The paper says the Public Service will adopt a best practice fan-shaped and overlapping structure, with modification to suit the Botswana context. The Parties (government and unions) to this agreement will jointly agree on the ranges of salary grades to allow for employees’ progression without a promotion to the available position on the next management level.

“The fan-shaped structure is envisaged to be in place by 1st June 2020, to enable factoring into the budgetary cycle for the financial year 2021/22,” the unions’ proposal paper states. It says the following steps are critical, capacity building of key stakeholders (September – December 2019), commission remuneration market survey (3 months from September to November 2019), design of the fan-shaped structure (2 to 3 months from January to March2020) and consultations with all key stakeholders (March to April 2020).

The unions and government had also signed an agreement on performance management and development: A rigorous performance management and reward system based on a 5-point rating system will be adopted as an integral part of the operationalization of the new Remuneration System.

Performance Management and Development (PMD) will be used to reward workers based on performance. The review of the Performance Management System was to be undertaken in order to close the gaps identified by PEMANDU and other previous reports on PMS between 1st September 2019 and 30th June 2020 as follows; internal process to update and revise the current Performance Management System by January 2020.

A job evaluation exercise in the Public Service will also be undertaken to among others establish internal equity, and will also cover the grading of all supervisory positions within the Public Service.
Another agreement included overtime Management. The Directorate of Public Service Management (DPSM) was to facilitate the conclusion of consultations on management of overtime, including consideration of the Overtime Management Task Team’s report on the same by 30th November 2019.

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Health Expert rejects ‘death rates’ links to low population growth

17th May 2022
Health-Expert

A public health expert, Dr Edward Maganu who is also the former Permanent Secretary in the Ministry of Health has said that unlike many who are expressing shock at the population census growth decline results, he is not, because the 2022 results represents his expectations.

He rushed to dismiss the position by Statistics Botswana in which thy partly attributes the low growth rates to mortality rates for the past ten years. “I don’t think there is any undercounting. I also don’t think death rates have much to do with it since the excessive deaths from HIV/AIDS have been controlled by ARVs and our life expectancy isn’t lower than it was in the 1990s,” he said in an interview with this publication post the release of the results.

Preliminary results released by Statistics Botswana this week indicated that Botswana’s population is now estimated to be 2,346,179 – a figure that the state owned data agency expressed worry over saying it’s below their projected growth. The general decline in the population growth rate is attributed to ‘fertility’ and ‘mortality’ rates that the country registered on the past ten years since the last census in 2011.

Maganu explained that with an enlightened or educated society and the country’s total fertility rate, there was no way the country’s population census was going to match the previous growth rates.
“The results of the census make sense and is exactly what I expected. Our Total Fertility Rate ( the average number of children born to a woman) is now around 2.

This is what happens as society develops and educates its women. The enlightened women don’t want to bear many children, they want to work and earn a living, have free time, and give their few children good care. So, there is no under- counting. Census procedures are standard so that results are comparable between countries.

That is why the UN is involved through UNFPA, the UN Agency responsible for population matters,” said Maganu who is also the former adviser to the World Health Organisation. Maganu ruled out undercounting concerns, “I see a lot of Batswana are worried about the census results. Above is what I have always stated.”

Given the disadvantages that accompany low population for countries, some have suggested that perhaps a time has come for the government to consider population growth policies or incentives, suggestions Maganu deems ineffective.

“It has never worked anywhere. The number of children born to a woman are a very private decision of the woman and the husband in an enlightened society. And as I indicated, the more the women of a society get educated, the higher the tendency to have fewer children. All developed countries have a problem of zero population growth or even negative growth.

The replacement level is regarded as 2 children per woman; once the fertility level falls below that, then the population stops growing. That’s why developed countries are depending so much on immigration,” he said.

According to him, a lot of developing countries that are educating their women are heading there, including ourselves-Botswana. “Countries that have had a policy of encouraging women to have more children have failed dismally. A good example is some countries of Eastern Europe (Romania is a good example) that wanted to grow their populations by rewarding women who had more children. It didn’t work. The number of children is a very private matter,” said Maganu

For those who may be worried about the impact of problems associated with low growth rate, Maganu said: “The challenge is to develop society so that it can take care of its dependency ratio, the children and the aged. In developed countries the ratio of people over 60 years is now more than 20%, ours is still less than 10%.”

The preliminary results show that Mogoditshane with (88,098) is now the biggest village in the country with Maun coming second (85,293) and Molepolole at third position with 74,719. Population growth is associated with many economic advantages because more people leads to greater human capital, higher economic growth, economies of scale, the efficiency of higher population density and the improved demographic structure of society, among many others.

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