Carbohydrate and Lipid Metabolism Research Unit
The focus of the Unit’s research includes the epidemiological, clinical and Biochemical aspects of common diseases affecting lipid, and glucose Metabolism in the different ethnic groups of southern Africa. These include familial hypercholesterolaemia and other dyslipidaemias, insulin resistance, diabetes mellitus as well as other related metabolic disorders.
The Unit is well recognised both nationally and internationally for their work on familial hypercholesterolaemia, and has one of the largest cohorts, if not the largest cohort, of homozygous FH patients in the world. The Unit has contributed, and continues to contribute to the management of these unfortunate patients.
The Unit reported in Circulation the reduction in mortality associated with advances lipid-lowering therapy, mainly statin therapy, in the largest cohort of subjects with homozygous familial hypercholesterolaemia described worldwide. This paper has been widely cited. The unit continues to research novel therapies such as antisense apo B-100 and PCSK9-inhibitor therapy in this patient group.
The results of such studies with Evolocumab, an inhibitor of PCSK9 given once or twice monthly by subcutaneous injection to subjects with either heterozygous or homozygous FH, were published as lead articles in the Lancet with Professor Raal as first author. Professor Raal was also co-author on two papers evaluating cardiovascular outcomes with PCSK9 inhibitor therapies published in the New England Journal of Medicine.
Clinical HIV Research Unit (CHRU)
The Clinical HIV Research Unit (CHRU), an internationally recognised research and technical assistance unit delivers excellence and quality clinical, epidemiologic and health economic research services in Johannesburg and ensures that this information is invested at operational level for the prevention, treatment and management of HIV and associated diseases.
Located at the Themba Lethu Clinic (TLC), HJH, it is one of the largest HIV and TB clinics in South Africa. The CHRU epidemiology division operates independentlyunder HE2RO located in Parktown.
The Health Economics and Epidemiology Research Office (HE²RO) is a division of the Wits Health Consortium (WHC) of Wits. It conducts applied, policy- and program-relevant research and evaluation on issues of public health importance in South Africa. HE²RO was established in 2004 as a collaboration between WHC and the Center for Global Health and Development at Boston University in the United States.
It focuses on understanding the economic andepidemiological consequences of the HIV and TB epidemics and the effectiveness, benefits, and costsof interventions. It responds directly to requests for information and technical assistance from the National Department of Health, National Health Laboratory Service (NHLS), provincial departments of health, PEPFAR partners, and healthcare providers, answering questions of immediate practical relevance to these stakeholders.
The CHRU’s research focus is HIV treatment in adults, HIV prevention, Tuberculosis (TB), Cervical Cancer and HIV related Malignancies such as Karposi Sarcoma has made significant contributions to these research disciplines, with over 250 publications since its inception in 1999. CHRU, in collaboration with Right to Care, offers an unique third line clinic to diagnose and treat third line patients. CHRU has completed over 66 antiretroviral therapy (ART) studies in phase I-III research. It was the first International AIDS Clinical Trials Group (ACTG) Site in 2002, and has since been one of the highest performing ACTG international site. CHRU implemented five new studies in 2014 and eleven in 2015.
Development Pathways for Health Research Unit
DPHRU addresses the national priorities of increasing life expectancy, decreasing maternal and child mortality and strengthening health system effectiveness. It investigates genetic, physiological, psycho-social, and lifestyle determinants of growth and development, obesity and risk of cardio-metabolic diseases, and healthy ageing. DPHRU adopts a multidisciplinary approach and associated methodologies to understand physical and mental health across the life course and the transgenerational effects and to identify possible interventions schemes to improve health outcomes.
The Unit also forms a unique research platform with substantial infrastructure and equipment, extensive longitudinal data and well-established links with the urban and rural South African communities. Using more than twenty years of longitudinal data from the Birth-to-Twenty cohort study and longitudinal statistical modelling, the growth and development from birth to 20 years of age of children born in 1990 in Soweto has been characterised.
DPHRU has recently launched the African Centre for Obesity Prevention (ACTION) which aims to raise awareness on obesity and associated diseases by providing evidence-based information on obesity, and to engage with the public through recommendations on how to engage in a healthy lifestyle.
Effective Care Research Unit (ECRU)
The Unit has sustained an active programme of randomized clinical trials to answer important intervention questions relating to maternal and perinatal health in low-resource settings.
The Calcium and Pre-eclampsia study is in the fifth year of recruitment, with 90% of the sample size recruited. ECRU is the lead institution in this placebo-controlled trial of calcium supplementation commencing before pregnancy in women with previous pre-eclampsia. The study sites are East London, CHBH, University of Cape Town, University of Stellenbosch, Harare University and several sites in Argentina.
Co-ordination is by World Health Organisation, and funding via the University of British Columbia, and Grantee of the Bill and Melinda Gates Foundation. In 2015, we commenced recruitment for the Gentle Assisted Pushing study to assess the benefits and risks of upright posture and upright posture with controlled manual fundal pressure, versus routine care in the second stage of labour. The study is coordinated and funded by the World Health Organization.
In the biennium, we continued preparations for participation in the ECHO study, a multi-centre randomized trial comparing pregnancy risk and HIV acquisition between three contraceptive options: Depot medroxyprogesterone acetate, levonorgestrel implants and the copper intrauterine device.
The Unit has continued to update and add to over fifty Cochrane systematic reviews published in the Cochrane Library.
A new method of management of shoulder dystocia called Posterior Axilla Sling Traction has been designed, which has been included in obstetric training programme in several countries.
Research methods courses, funded by World Health Organization, for researchers from South Africa and the WHO AFRO region are run on an annual basis.
The Unit received re-accreditation as a WHO Collaborating Centre for Research Synthesis in Reproductive Health in 2015.
Empilweni Services Research Unit
The Empilweni Services and Research Unit (ESRU) based within the Department of Paediatrics and Child Health at the RMMCH is one of the newest officially recognized members of the Faculty of Health Sciences at Wits. The unit obtained official recognition in late 2014. The unit is headed by its Director Professor Ashraf Coovadia and has a team of senior clinical researchers including Professor Gayle Sherman, Dr Karl Technau, Dr Renate Strehlau, Dr Gary Reubenson, Dr Gill Sorour and Prof. Joanne Potterton.
Historically, this unit grew out of a need to provide Antiretroviral access to HIV-infected children receiving care within the Department of Paediatrics at Wits. Professor Ashraf Coovadia along with Professor Tammy Meyers (Chris Hani Baragwanath Academic Hospital CHBAH) and Dr Dalo Ndiweni (Charlotte Maxeke Johannesburg Academic Hospital - CMJAH) initially created the Wits Paeds Group which was a network of Paediatric HIV clinics that provided state-of-the art services to infants and children who were HIV-exposed or HIV-infected. This group later called the Wits Paediatric HIV Clinics, continued to grow in staffing as well as began research projects at the Harriet Shezi Children’s HIV clinic at CHBAH. In 2000 clinical research began within the Paediatric HIV services at RMMCH which was later called the Empilweni Clinic. Empilweni was chosen as its name as it is translated from isiZulu as ‘a place of life’.
In 2010, the Empilweni Services and Research Unit was established as an entity within the Wits Health Consortium as the Harriet Shezi Children’s research unit had become part of the newly established Wits HIV Research Institute (WRHI). ESRU, which received funding from WRHI as a sub-recipient of the Presidential Plan for AIDS Relief (PEPFAR), continued to advance its services for HIV-infected children as well as HIV-infected mothers and their HIV-exposed infants as well as its research agenda.
Today ESRU boasts a staff compliment of more than 40 individuals involved in either research or service provision at the RMMCH. Its work spans advocacy, training, clinical research and, importantly, overseeing and managing the two important HIV programmes of the National Department of Health being the Prevention of Mother to Child Transmission of HIV (PMTCT) and the Paediatric HIV treatment programme. There are several NIH funded clinical research projects as well as pharma sponsored trails. ESRU remains one of few Paediatric research sites across the province and indeed the country.
The official recognition of the unit by the Faculty of Health Sciences in 2014 and the construction of the new three story building at RMMCH were major highlights during the review period.
Wits Reproductive Health and HIV Institute (Wits RHI)
The Wits Reproductive Health and HIV Institute (Wits RHI) is a leading African research institute focusing on HIV, sexual and reproductive health (SRH), and vaccine preventable diseases (VPD).
Who We Are
Wits RHI was established by Professor Helen Rees in 1994 to support the new South African government in formulating and implementing national policies around sexual and reproductive health. Today we are the largest research institute of the University of the Witwatersrand, and form part of the Faculty of Health Sciences. We are a UNAIDS and South African Medical Research Council (SA MRC) collaborating centre, World Health Organisation (WHO) collaboration centre, as well as a United Nations Population Fund (UNFPA) strategic partner.
What We Do
Our strength lies in our multi-disciplinary and holistic approach to improving health outcomes at a local and global level through research, technical assistance, advocacy, policy development and health systems strengthening. We identify health problems through sound epidemiological methods and qualitative research, use a range of analytic and research methods to generate evidence, and test and evaluate interventions in a real-world setting.
Our Strategic Enablers
- Population in need
We focus on target populations where the greatest impact of health interventions can be made
- Location focus
We maintain a strong body of work in South Africa and leverage it to support improvements in the region and globally
- Innovation and technology applications
We use innovative approaches and leverage technological solutions to improve health outcomes
- Collaboration for change
We leverage collaborations and partnerships to ensure broader impact
Our Focus Areas
Our work encompasses most aspects of HIV related work and it addresses most issues along the HIV continuum. Our focus ranges from HIV prevention technologies to improving approaches on HIV care and treatment, to optimising antiretroviral treatment, and developing models of care for key populations and marginalised groups. Our care and treatment implementation is divided into two categories: treatment optimisation and health systems interventions.
Our work on treatment optimisation explores the possibilities of reducing the cost of HIV treatment in order to make it possible to treat more patients. New, simpler, safer, more potent and potentially more cost-effective antiretroviral therapy (ART) regimens are needed. Our current projects are aimed at improving first and second ART regimens whilst maintaining efficacy.
Female controlled HIV prevention methods where women make independent decisions about their own health, not only empowers women but can safely help reduce new HIV infections. We are involved in the global search for biomedical interventions that allow women and young girls to address multiple sexual and reproductive health issues with one product.
Health Systems Interventions
Our health system interventions span the full spectrum of populations from infants to adolescents, adults, pregnant women and key populations. Health systems interventions encompass a range of programmes, studies and initiatives which are all intended to improve public health systems.
Sexual Reproductive Health (SRH)
We have established SRH portfolios relating to women’s health and STIs. We are committed to providing integrated SRH care that is informed by scientific research. Our strategy includes providing SRH information and services that encompasses family planning, prevention treatment and care of STIs including HIV.
Vaccine Preventable Diseases (VPD)
Vaccine preventable diseases (VPD) are a relatively new but increasingly important focus area for Wits RHI. We have been involved in vaccine clinical trials and implementation science on the sexually transmitted human papillomavirus (HPV), respiratory syncytial virus (RSV) and tuberculosis (TB) vaccines. We have published on the HPV vaccine implementation and programme feasibility, and have also evaluated the National Department of Health’s national HPV vaccine programme. We are also developing an adolescent platform for vaccines, and maternal-infant pair groups.
Who We Serve
Much of our work is with populations that are most in need, marginalised, or hard-to-reach and these include:
- Pregnant women and mother-infant pairs
- Adolescents (male and female)
- Adults and children living with HIV/TB
- Key Populations in particular female sex workers, men who have sex with men (MSM) and transgender people
Where We Work
Wits RHI’s head office is located in the Hugh Solomon Building, a heritage site within the Hillbrow Health Precinct (HHP). The vision of HHP is to tackle health and support urban renewal in Johannesburg’s inner city by providing the community with quality health care services.
Wits RHI works across all of South Africa’s nine provinces, with Wits RHI driven projects in six provinces: Gauteng, KwaZulu-Natal, North West, Northern Cape, Mpumalanga and Limpopo.
For more information contact:
Wits Reproductive Health & HIV Institute
Hillbrow Health Precinct
22 Esselen Street
- Population in need