Projet San Francisco

I’ve recently realized that even though I’ve been writing on a regular basis, I haven’t really explained Projet San Francisco (PSF) or the work that I do on a daily basis. I’ll start today with the project, which is easiest to explain by breaking it into three parts.

The first aspect of the project is couples’ voluntary counseling and testing (CVCT). PSF operates three centers throughout Kigali that provide services to married and cohabiting couples. The centers are open three days per week for couples to come to receive information, testing and counseling for HIV and syphilis. The project promotes these services in a number of ways. Sometimes radio announcements and billboards are used, but our predominant means of promotion involves recruiting community leaders (such as ministers, civic leaders, public officials, teachers and others) to publicize our services within the community and distribute information and invitations to couples interested in our services. I’ve already described what happens at CVCT in a posting on 13 September 2007, so I won’t repeat myself, but I will mention that lately we’ve been seeing approximately one hundred couples each week.

The second aspect of the project – observational studies – stems from CVCT. Of the couples who are tested at CVCT, couples who are discordant, meaning one partner is HIV-positive and one is HIV-negative, and who meet certain eligibility criteria are invited to join our study of heterosexual transmission of HIV, which we refer to as the HT study. This is an observational study to understand the behavioral, virologic, immunologic and immunogenetic correlates of HIV transmission, so these couples come to our main site every one to three months for follow-up and testing. We also have an observational study of a cohort of 85 long-term nonprogressors, many of whom have been HIV-positive for twenty years. These women are studied to identify why they remain healthy despite HIV infection and to analyze host and receiver genetics related to the progression of HIV. They come to the clinic every three months. All observational study participants receive some benefits for their time and effort. At each visit they are reimbursed for their transportation cost and are given lunch. They are also welcome to receive reproductive health care from PSF and are given mutuelle cards so that they are able to obtain free health care at their local clinic. Currently we have approximately 900 individuals in these observational studies, the largest cohort of discordant couples in the world (the second largest is our project’s cohort in Zambia), and we see forty to fifty individuals at the clinic each morning.

The third aspect consists of more specialized research, currently focusing vaccine feasibility studies and clinical trials. Participants in these studies are usually recruited from the HT study. Some recent and ongoing studies include a clinical trial to evaluate whether HIV-transmission could be reduced by suppressive treatment of genital herpes with acyclovir, the establishment of reference ranges for lab results to identify adverse events in a trial, studies of disease progression in newly-infected individuals and follow up of long term nonprogressors (a different study from the one I mentioned above). We were prepared to begin a clinical trial of an HIV vaccine this month, but with the disappointing results from the Merck trial, it’s been postponed.

I’ll try to write soon about my role within all of this, but let me know if you have any questions so far. Below is a picture of one of the project buildings and the road on which most of our offices are located.