When I woke up on Friday morning the 6th December 2013, I was shocked and saddened to hear that Nelson Mandela had died at the age of 95. In the days and weeks that followed his death, I was deeply moved by the stories that emerged of how Madiba had touched the lives of millions of people around the world in a million different ways. Nelson Mandela touched my life and had a profound impact on the Aurum Institute. I had the privilege of meeting Madiba when he came to the International AIDS Conference in 2004 in Bangkok. Madiba had graciously agreed to launch a newly funded Consortium to Respond Effectively to the AIDS-TB Epidemic (CREATE), that sought to conduct large, innovative, studies that evaluated the use of existing tools to improve tuberculosis control at a population level. The Thibela TB study was one of the three CREATE studies and aimed to evaluate the impact of community-wide tuberculosis preventive therapy on tuberculosis control among 80,000 gold miners in South Africa. Madiba had tuberculosis while in prison and so could empathise with those persons who had suffered from tuberculosis. During his speech, Madiba said, “The world has made defeating AIDS a top priority. This is a blessing. But TB remains ignored. Today we are calling on the world to recognise that we can’t fight AIDS unless we do much more to fight TB as well.”
Following Madiba’s speech, the world's media picked up on his call to action to do more to fight tuberculosis, thereby highlighting the global TB epidemic and the need to massively increase resources in the fight against TB. Madiba’s support of the Thibela TB study was key to us obtaining the necessary approvals from government, labour and mining companies. Even though the Thibela TB study did not improve TB control in the mines, we learnt and great deal and we will continue to do more in the fight against TB.
Grants are the lifeblood of the Aurum Institute to do its vital work in fighting tuberculosis and HIV, thereby improving the health of individuals and communities. The Aurum Institute invested a great deal of time writing many grants in 2013, with mixed success. The Aurum Institute was successful in being funded to be part of the Vaccine Trials Evaluation Network, under the leadership of Prof Dan Hoft, University of St Louis. For the past seven years, the Aurum Institute was funded by the United States National Institutes of Health, Division of AIDS (DAIDS) to do HIV prevention trials. In 2013 the Clinical Trials Units (CTU) were recompeted, but despite getting a good score the clinical trial sites were not funded, which was unexpected. The Aurum Institute played a leadership role in two Tuberculosis Research Unit (TBRU) grant , neither of which was successful. Although we were very disappointed not to be successful in the CTU and TBRU grants, we never the less did what Nelson Mandela suggested we do, we got back up and carried on. The Aurum Institute was subsequently successful in applying to be a network expansion site of the DAIDS funded HIV Vaccine Trials Network Uhombo programme of HIV vaccine trials to be conducted in Southern Africa and will also continue to play a leadership role in the Network. We have also taken some of the concepts from the TBRU application and been successful in getting them funded through other grants.
The Aurum Institute prides itself on playing a leadership role in tuberculosis and HIV research that provides evidence to transform policy at a national and international level. Although progress has been made in controlling tuberculosis and HIV nationally and globally, a great deal more needs to be done. I had the privilege of playing a leadership role in developing global TB policy in 2013. I contributed to developing the World Health Organisation’s Global TB programme, Post 2015 strategy, which aims to accelerate progress towards tuberculosis elimination by 2050 by exploring “new directions” in the fight against TB. I also contributed to developing the WHO guidelines for TB screening, International Standards for TB control and Xpert MTB/ RIF. I chaired the WHO Task Force for developing a policy for new TB drugs and regimens and I am a member of the WHO Strategic Technical Advisory Group for TB. I continued to serve as a vice Chair of the NIH AIDS Clinical Trials Group, Transformative Science Group for TB and as the co-Chair of the NIH HIV Vaccine Trials Network-TB vaccine working group. The Aurum Institute will align itself with the Global TB Programmes Post 2015 strategy and commit itself to doing transformative research and providing the technical support and service delivery needed to achieve the Post 2015 targets.
In the recent past, we have seen major advances in developing new TB diagnostics and drugs. However, the pipeline for new TB drugs is limited. Furthermore, the first new TB vaccine evaluated in an efficacy trial was not successful. We need to explore “new directions” in treating and preventing TB if we are to accelerate progress towards TB elimination. The journal “Science” in December 2013 celebrated cancer immunotherapy as the breakthrough of the year in 2013. Host-Directed Therapy (immunotherapy) for TB is a newly emerging field that similarly holds great promise for shortening the duration of TB treatment and improving treatment outcomes. In anticipation of this emerging field in tuberculosis, Dr Robert Wallis, who is an international expert in the area of host-directed therapy for TB, was appointed at the end of 2013 as the Aurum Institute’s Chief Scientific Officer. Dr Wallis will be responsible for developing a new programme of research in host-directed therapy for TB.
The Aurum Institute has proudly provided technical support for TB and HIV to the South African Department of Correctional Services. In 2013, Aurum played a leadership role in developing the first TB and HIV guidelines for correctional facilities. The Aurum Institute is actively working to expand its role in supporting the Department of Correctional Services in the coming year, thereby contributing to the health of inmates.
Nelson Mandela was a global icon for justice and civil rights and he was an enthusiastic advocate for HIV and TB treatment and care for those living in resource-poor countries. We will always remember Madiba for his principled leadership. The Aurum Institute will continue to derive inspiration from his exemplary life and strive tirelessly to improve the health of individuals and communities that are burdened with TB and HIV.
Prof. Gavin Churchyard
Chief Executive Officer