Motswana woman enhancing HIV/AIDS cure research
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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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ENVIRONMENT ISSUES: Masisi asks Virginia for help
President Mokgweetsi Masisi says the issue of sustainable natural resources management has always been an important part of Botswana’s national development agenda.
Masisi was speaking this week on the occasion of a public lecture at Virginia Polytechnic, under theme, “Merging Conservation, Democracy and Sustainable Development in Botswana.”
Botswana, according to Masisi, holds the view that the environment is fragile and as such, must be managed and given the utmost protection to enable the achievement of Sustainable Development Goals (SDGs).
“It is necessary that we engage one another in the interchange of ideas, perspectives, visualizations of social futures, and considerations of possible strategies and courses of action for sustainable development,” said Masisi.
On the other hand, dialogue, in the form of rigorous democratic discourse among stakeholders presents another basis for reconfiguring how people act on their environments, with a view to conserving its resources that “we require to meet our socio-economic development needs on a sustainable basis,” Masisi told attendees at the public lecture.
He said government has a keen interest in understanding the epidemiology and ecology of diseases of both domestic and wild animals. “It is our national interest to forestall the dire consequences of animal diseases on our communities livelihoods.”
President Masisi hoped that both Botswana and Virginia could help each other in curbing contagious diseases of wildlife.
“We believe that Virginia Tech can reasonably share their experiences, research insights and advances in veterinary sciences and medicines, to help us build capacity for knowledge creation and improve efforts of managing and containing contagious diseases of wildlife. The ground is fertile for entering into such a mutually beneficial partnership.”
When explaining environmental issues further, Masisi said efforts of conservation and sustainable development might at times be hampered by the emergence and recurrence of diseases when pathogens mutate and take host of more than one species.
“Water pollution also kills aquatic life, such as fish, which is one of humanity’s much deserved sources of food. In this regard, One Health Approach imposes ecological responsibility upon all of us to care for the environment and the bio-diversity therein.”
He said the production and use of animal vaccines is an important space and tool for conservation, particularly to deal with trans-border animal diseases.
“In Botswana, our 43-year-old national premier pharmaceutical institution called Botswana Vaccine Institute has played its role well. Through its successful production of highly efficacious Foot and Mouth vaccines, the country is able to contain this disease as well as supply vaccines to other countries in the sub-region.:
He has however declared that there is need for more help, saying “We need more capacitation to deal with and contain other types of microbial that affect both animals and human health.”
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Masisi saddened by deaths of elephant attacks
President Mokgweetsi Masisi has expressed a strong worry over elephants killing people in Botswana. When speaking in Virginia this week, Masisi said it is unfortunate that Batswana have paid a price with their own blood through being attacked by elephants.
“Communities also suffer unimaginable economic losses yearly when their crops are eaten by the elephants. In spite of such incidents of human-elephant conflict, our people embrace living together with the animals. They fully understand wildlife conservation and its economic benefits in tourism.”
In 2018, Nthobogang Samokwase’s father was attacked by an elephant when travelling from the fields, where he stayed during the cropping season.
It was reported that the man couldn’t run because of his age. He was found trampled by the elephant and was pronounced dead upon arrival at the hospital.
In the same year, in Maun, a 57-year-old British woman was attacked by an elephant at Boro and died upon arrival at the hospital. The woman was with her Motswana partner, and were walking dogs in the evening.
Last month, a Durban woman named Carly Marshall survived an elephant attack while on holiday in the bush in Botswana. She was stabbed by one of the elephant’s tucks through the chest and was left with bruises. Marshall also suffered several fractured ribs from the ordeal.
President Masisi Botswana has the largest population of African elephants in the world, totaling more than 130 000. “This has been possible due to progressive conservation policies, partnerships with the communities, and investment in wildlife management programmes.”
In order to benefit further from wildlife, Masisi indicated that government has re-introduced controlled hunting in 2019 after a four-year pause. “The re-introduction of hunting was done in an open, transparent and democratic way, giving the communities an opportunity to air their views. The funds from the sale of hunting quota goes towards community development and elephant conservation.”
He stressed that for conservation to succeed, the local people must be involved and derive benefits from the natural resources within their localities.
“There must be open and transparent consultations which involve all sectors of the society. It is against this backdrop that as a country, we lead the continent on merging conservation, democracy and sustainable development.”
Masisi stated that Botswana is open to collaborative opportunities, “particularly with identifiable partners such as Virginia Tech, in other essential areas such as conservation, and the study of the interplay among the ecology of diseases of wild animals and plants, and their effects on human health and socio-economic development.”
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Gov’t commit to injecting more funds in fighting HIV
Minister for State President Kabo Morwaeng says government will continue to make resources available in terms of financial allocations and human capital to ensure that Botswana achieves the ideal of eradicating HIV and AIDS as a public health threat by 2030.
Morwaeng was speaking this morning in Gaborone at the High-Level Advocacy event to accelerate HIV Prevention in Botswana. He said the National AIDS and Health Promotion Agency (NAPHA), in partnership with UNAIDS, UN agencies, the Global Fund and PEPFAR, have started a process of developing transition readiness plan for sustainability of HIV prevention and treatment programmes.
“It is important for us, as a country that has had a fair share of donor support in the response to an epidemic such as HIV and AIDS, to look beyond the period when the level of assistance would have reduced, or ceased, thus calling for domestic financing for all areas which were on donor support.”
Morwaeng said this is important as the such a plan will guarantee that all the gains accrued from the response with donor support will be sustained until the end when “we reach the elimination of HIV and AIDS as a public health threat by 20230,” he said.
“I commit to continue support efforts towards strengthened HIV prevention, accentuating HIV primary prevention and treatment as prevention towards Zero New Infections, Zero Stigma, Discrimination and Zero AIDS related death, to end AIDS in Botswana.”
He reiterated that government commits to tackle legislative, policy and programming challenges that act as barriers to the achievement of the goal of ending AIDS as a public health threat.
In the financial year 2022/2023, a total of 119 Civil Society Organizations, including Faith Based Organizations, were contracted with an amount of P100 million to implement HIV and NCDs prevention activities throughout the country, and the money was drawn from the Consolidated Fund.
Through an upcoming HIV Prevention Symposium, technical stakeholders will use outcomes to develop the Botswana HIV Prevention Acceleration Road Map for 2023-2025.
Morwaeng stated that government will support and ensure that Botswana plays its part achieving the road map. He said there is need to put hands on the deck to ensure that Botswana sustains progress made so far in the fight against HIV and AIDS.
“There are tremendous achievements thus far to, reach and surpass the UNAIDS fast track targets of 95%- 95%- 95% by the year 2025. As reflected by the BAIS preliminary results of 2021, we now stand at 95- 98- 98 against the set targets.”
“These achievements challenge us to now shift our gears and strive to know who are the remaining 5% for those aware of their HIV status, 2% of enrolment on treatment by those aware of their status and 2% of viral suppression by those on treatment.”
Explaining this further, Morwaeng said shift in gears should extend to coming up with robust strategies of determining where these remaining people are as well as how they will be reached with the necessary services.
“These are just some of the many variables that are required to ensure that as a country, we are well positioned to reaching the last mile of our country’s response to the HIV and AIDS pandemic.”