Africa Health Research Institute’s vision is the optimal health and well-being of under-resourced populations. AHRI is an independent, transdisciplinary scientific research institute based in KwaZulu-Natal (KZN), South Africa. AHRI’s research combines population, basic and translational, social, and clinical sciences to understand and intervene in the health and well-being of South African communities. AHRI works in partnership with local communities and South African academic, governmental, and other policy stakeholders and collaborates with over 60 institutions globally. The work lives of AHRI’s ~700 scientists, students and staff members are driven by our values: ubuntu, transformation, leadership, innovation, excellence, and collaboration.
Historically population-based research at the Africa Health Research Institute centred on a demographic surveillance system referred to as the Africa Centre Demographic Information System (ACDIS). ACDIS was established in 2000 to describe the demographic, social and health impact of the HIV epidemic in a population going through the health transition, and to monitor the impact of intervention strategies on the epidemic. The Demographic Surveillance Area (DSA) is situated in the Mtubatuba local municipality in the uMkhanyakude district of KwaZulu-Natal and within the Hlabisa health sub-district. The HDSS incorporates an area of 845 km² and has followed >100,000 participants longitudinally for ~20 years and there are approximately 150,000 (100,000 resident) household members of 21,000 households in this area. Three primary subjects are observed longitudinally in the HDSS: physical structures (e.g., homesteads, clinics, and schools), households and individuals.
The institute has two campuses: AHRI-Somkhele is in an under-resourced rural area of northern KZN. AHRI-Durban is based at the University of KwaZulu-Natal’s Nelson R. Mandela School of Medicine. At AHRI-Somkhele’s core is a health and demographic surveillance site, which aims to describe the demographic, social, and health impact of the HIV epidemic in a population going through a health transition, and to monitor the impact of intervention strategies on the epidemic. The institute’s basic and translational science programme is supported by superb laboratory infrastructure at AHRI-Durban. The labs incorporate over 600m² of biosafety level 3 (BSL-3) space, and a South African National Accreditation System/ISO 15189 accredited clinical laboratory.
The eligible population are members of households’ resident within the programme area. The boundary of the programme area is shown below and comprises the areas indicated as the household surveillance and Treatment as Prevention intervention areas on the map.
The purpose of the four research departments is to provide an efficient and integrated environment to maximise research productivity. The research departments organise and manage people with the requisite skills to support the research, implement optimal and accredited (where required) standard operating procedures, operate shared equipment, and provide integrated research data management. The research departments will evolve over time and be responsive to the research agenda.
AHRI’s research is organised into four divisions - population, basic and translational, social, and clinical sciences - and around four intersecting scientific content areas: HIV, TB, emergent or re-emergent infection, and adolescent mental health. AHRI’s 28 faculty members have the freedom to pursue their own research agendas within the institute’s broader strategy.
AHRI’s HIV research strategy is focussed on prevention, with discovery of biological and social drivers of transmission, and translation of findings into interventions; surveillance, to discover critical trends in the HIV epidemic and understand the longer-term impact of health policy and interventions; and understanding the HIV reservoir, or HIV persistence, in adults and children, followed by testing of tailored interventions in clinical trials.
TB research at AHRI is organised around four components: TB pathogenesis through examining excised human lung, accessed via long-term collaborations with local hospitals; surveillance for TB via our HDSS, with the aim to understand transmission on a population basis; understanding, diagnosing, and intervening in subclinical, or asymptomatic TB disease; and finally, targeted clinical trials of novel TB drugs and vaccines.
AHRI’s emergent or re-emergent infection research area uses the institute’s SARS-CoV-2/Covid-19 strategy as a model to rapidly mobilise our population and laboratory infrastructure to understand short- and long-term consequences of an emergent or re-emergent infection, particularly within the context of HIV immune dysfunction and prevalent TB. It additionally harnesses world-leading, South Africa-driven collaborative structures, AHRI’s clinical trials unit and HDSS infrastructure to conduct clinical trials of novel drugs and vaccines.
AHRI’s adolescent mental health research area builds on the institute’s current studies of depression in pregnancy, and on well-established implementation research programmes in adolescent health. AHRI is uniquely placed to explore adverse childhood events, prolonged exposure to violence and economic hardship, as well as the effect of parenting and social protection in childhood against poor mental health outcome.
Multiple scientific platforms and core business structures support AHRI’s research endeavours, including a data science unit, and a clinical trials unit. AHRI’s public and community engagement model encourages research participants to be active partners in the development of a research agenda that is meaningful and directly relevant to their lives.
AHRI offers an academic training programme that facilitates skills development and career progression for masters and PhD students, and postdoctoral and clinical fellows. The institute’s leadership development training offers modules including biostatistics, scientific citizenship, academic writing, and training in core skills such as setting up collaborations, project and time management, and strategic career planning. Travel awards are also made available to support additional training needs. AHRI’s flagship programme, the sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), focuses on African and global collaborations to enhance research and capacity building in HIV, TB, and associated comorbidities.
A Wellcome Trust Africa and Asia Programme core grant provides ~30% of AHRI’s total budget, with the remaining funding generated through individual investigator-initiated grants. Major funders include the National Institutes of Health, Bill & Melinda Gates Foundation, Medical Research Council (UK), among others.
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