Experience of North-South collaboration for capacity building in

HIV prevention research in francophone Africa

Zannou DM1, Minani I2, Labbé AC3, Anagonou SY1, Massinga Loembé M2, Ndjoyi A4, Darveau A5, Guedou F2, Ouendo M6, Belleau M2, Alary

M2.

1Faculté des sciences de la santé, Cotonou, Bénin; 2Centre hospitalier affilié universitaire de Québec, Canada; 3Hôpital

Maisonneuve-Rosemont, Montréal, Canada; 4Faculté de médecine, Université des Sciences de la Santé, Libreville, Gabon; 5Faculté des

sciences & Génie, Université Laval, Québec, Canada; 6Institut régional de santé publique, Ouidah, Bénin.

Presented by Michel Alary, MD, Ph.D.

Professor, Université Laval, Québec

Afri-Can Synchronicity Forum

Entebbe, Janaury 17-19, 2013

Some specific information on the country

BENIN – WEST AFRICA

BENIN West Africa

Population : ~ 8,760,000

Gross National Income per capita : 690

USD Economic Ranking : 178/210 (World

Bank, 2009) Human development : 163/177 Annual expenses in health per capita :

46 USD Life expectancy : 54/55 (M/W) (WHO, 2008)

HIV in BENIN

HIV Prevalence, general population : ~1.2% (DHS, 2006)

High risk groups for transmission : Sex workers (20.4% in 2012 vs. 53.3% in 1993) Clients of Sex Workers (2.3% in 2012 vs. 8.4% in

1998)(Integrated behavioural and biological survey, 2012)

Epidemic largely concentrated (World Bank report, 2008)

ARV program established in 2002

Benin-Canada collaboration in HIV issues prior to GHRI

CIDA-funded projects from 1992 to 2006 Focus on sex workers and their male partners Behavioural, empowerment, clinical and structural

components CIHR research funding showed that it prevented

~40-50% of the overal HIV epidemic in Benin Studies evaluating the syndromic approach for

STIs and rapid diagnostics for NG (WHO-funded)

Site for 2 multicentre phase 3 microbicide trials Construction of a FSW-dedicated clinic in 1996

(UNAIDS funding)

Existing Laboratory structure - 2004

Laboratory Level CL2 Fine equipment for

molecular diagnosis (STD, SDA, PCR)

Transferred to the National Aids Control Programme (Ministry of Health) in 2008

GLOBAL HEALTH RESEARCH INITIATIVE (GHRI)

RENFORCEMENT DES CAPACITÉS DE RECHERCHE EN PRÉVENTION DU VIH EN

AFRIQUE FRANCOPHONE2007-2009

Collaboration : Benin, Canada, Gabon

IDRC grant # 104051-004

http://www.idrc.ca/en/ev-121546-201-1-DO_TOPIC.html

Partners

Centre hospitalier affilié universitaire de Québec & Laval University : Dr Michel Alary, Dre Marguerite M. Loembé,

Michelyne Belleau (Unité de recherche en santé des populations URESP, CHA)

Dr André Darveau (Département de Biochimie et de Microbiologie Faculté de Sciences et Génie)

University of Montreal : Dre Annie Claude Labbé (Département de

Microbiologie et d’infectiologie, Hôpital Maisonneuve-Rosemont (HMR) et Professeure adjointe de clinique, Université de Montréal)

Partners (2) Benin :

Université d’Abomey-CalaviPr Severin Anagonou & Pr Marcel Zannou

Institut Régional de santé publiqueDr Edgard M. Ouendo

GRAFED-ONGDr Fernand Guédou

Gabon : Université des Sciences de la Santé

Pr Angélique Ndjoyi

Strategies

Training of African researchers, clinical and technical resources

Support to the creation of the national Ethics Committee for health research

Creation of a HIV/STI Prevention Research Unit

Objectives

1. To provide Beninese investigators with training and support for the writing of grant applications

2. To increase the critical mass of highly competent medical and paramedical personnel for the implementation of preventive trials

3. To promote the creation of a Research Ethics Committee in Benin

4. To contribute to the establishment of a research unit in HIV and STIs prevention in Benin

RESULTS

Objective 1 : To provide Beninese investigators with training and support for the writing of grant applications

Two doctorate students and one Master’s student on epidemiology program at Laval University, Quebec, Canada (Dr Michel Alary, Responsible)

Two training sessions held on the writing of research protocols for grant applications (18 part. /8 women)

Two co-investigators of the project have fully completed the online training course on ethics for health research within a specific program at the University of Montreal

Results (2) : Objective1(continued) Participation in International Conferences:

Four African investigators attended ICASA conference held in Dakar, Senegal, December 2008

The Chairwoman of the EC participated to the “IIIèmes Rencontres Internationales Francophones en Bioéthique” that were held in Quebec, October 20-22, 2008

One physician attended the 17th Annual Canadian Conference on HIV/AIDS Research held in Montreal, April 2008

Two physicians attended the ATARAO Symposium that was held in Montreal in October 2008

One of them also participated to the 15th Annual Canadian Conference on International Health that was held in Ottawa, October 2008 and won an award for the excellence of his communication

Two of them participated to the Conference on Retroviruses and Opportunistic Infections (CROI), held in Montreal, winter 2009

One oral presented at the “  International Society for Sexually Transmitted Diseases Research ISSTDR  ” London, 2009

Results (3) : Objective 2

Objective 2 : To increase the critical mass of highly competent medical and paramedical personnel for the implementation of preventive trials

Participation of five physicians to a 4-week observational training session in clinical research in Canada

Participation of a Beninese sociologist collaborating with the CHA to a one month proficiency training session in April-May 2009 in the Social Sciences department at Laval University

Participation of three technicians to a 6-week laboratory training session in Canada

Two 2-week training sessions (theoretical and practical) in clinical research and laboratory work in Cotonou (19 part./7 women). Participants from Benin, Burkina-Faso, Togo, Gabon, Côte d’Ivoire and Mali.

Results (4) : Objective 2 (continued)

15 participants have obtained their Research Ethics Certificate after having completed the Ethics course proposed by Family Health International (FHI) on their website

Online course on “Introduction to quality assurance” completed by two Beninese laboratory technicians (3 months)

Results (5) : Objective 3

Objective 3 : To promote the creation of a Research Ethics Committee in Benin

Support for strengthening capacities in Ethics for health research Establishment of an Ethics Committee (EC) for health

research and its equipment (room, computer, printer, internet connection, and recruitment of a secretary)

Nine members (of ten) of this EC have fully completed the online training course on ethics for health research within a specific program at the University of Montreal

President of the Ethics Committee of the Centre hospitalier affilié universitaire de Québec (CHA), traveled to Benin for technical assistance to the newly established Ethics Committee in Benin

Results (6) : Objective 3 (continued)

Organization of meetings with research institutions in Benin to introduce the Ethics Committee

Organization of a meeting with lawyers in June 2008 to help in developing the law on ethics at the national level (prior to the legal recognition of the Ethics Committee)

International registration of the EC to the Office for Human Research Protection (USA)

The EC is totally functional and the budget of the ministry of health is planned to sustain the operations

Results (7) : Objective 4

Objective 4 : To contribute to the establishment of a research unit in HIV and STIs prevention in Benin

Creation and equipment of the Unité de recherche sur la prévention des ISTs et du VIH/Sida (UREPIV) One librarian have been hired. She is assisted by three

local co-investigators directly involved Subscription to the “ HINARI ” database allowing

access to several scientific journals Subscription to JAIDS, to the “ Médecine et maladies

infectieuses ” Journal and to the « Bulletin de la Société de Pathologie Exotique  ”

Affiliated with the “Institut des Sciences Biomédicales Appliquées de l’Université D’Abomey Calavi ”

IDRC synergy funding 2010-12 Did not get the funding in round 2 of capacity

building grants IDRC synergy funding allowed:

Support the completion of training for 2 Beninese Ph.D. students at Laval

Support the FSW cohort infrastucture for work on prevention issues and HLA-related resistance factors (collaboration with Drs. Cécile Tremblay and Michel Roger, Université de Montréal)

Grant termination: March 2012 Termination of cohort study: March 2013

CIHR Health Equity Grant 2011-16

Focus maintained on prevention among sex workers Broadening of focus from HIV to reproductive health

(contraception, pregnancy issues), violence and structural issues

Includes a global preventive intervention with its evaluation Involvement of knowledge users at government and NGO

levels in Benin Maintenance of capacity building activities:

5 graduate students at Université d’Abomey-Calavi 3 graduate students and one post-doc at Université Laval On site training on analytical methods for qualitative

studies

Acknowledgements

We wish to thank all the agencies that supported the Benin-Canada collaboration over the years: CIDA, WHO, UNAIDS, CONRAD, GHRI, IDRC, CIHR as well as all the collaborators in Benin, Canada and elsewhere who got involved in these various projects. Above all, we wish to thank the women and men who accepted to participate in the various studies we conducted in the field. Without them, all this work would not have been possible.

THANK YOU