As an infectious diseases fellow at the University of Virginia in the 1980s, Robert Salata, MD, remembers treating patients who were driving between one and two hours to Charlottesville for HIV care.
“Because of the stigma surrounding HIV, patients would drive to us from Richmond and Washington, DC,” he says. “It was really sad to see such young people dying. But through research, we were able to begin identifying treatments that kept people alive.”
Salata is an Investigator at the AIDS Clinical Trials Group (ACTG) Network’s Case Western Reserve University site. His research career has not only taken him to different collaborations around the United States, but also to sites in Africa.
“I was especially drawn to research because of the ability to work in the international arena,” Salata says. “In fact, what I like best about being a part of the ACTG Network is the global collaboration and exchange of ideas. Everyone brings a different idea to the table. It is enriching and drives me.”
Salata is the Liaison Investigator to the ACTG’s Joint Clinical Research Center (JCRC) in Kampala, Uganda. He travels there three times a year and works directly with the site’s leader Peter Mugyenyi, MB ChB, F.R.C.P., D.Sc.
“Peter is incredible. I remember when President Bush announced PEPFAR (the President’s Emergency Plan For AIDS Relief) in 2003. The TV cameras panned the crowd and right next to Laura Bush was Peter. He really is a force unto himself,” Salata says. “Together, he and I choose studies that are scientifically relevant to the population and will enroll enough patients to yield meaningful results.”
Since the JCRC’s founding in 1991, approximately 800,000 Ugandans living with HIV have begun taking antiretroviral therapy (ART), Salata says. JCRC is the number one enrolling site for the ACTG’s A5225, A5264 and A5288 studies.
“Bob has done a tremendous job as a scientist and mentor to establish and strengthen ACTG research collaboration in Uganda and other sites throughout sub-Saharan Africa,” says Mugyenyi.
Mugyenyi is Co-Chair and Salata is Vice Co-Chair of enrolling ACTG study A5288. This trial is focused on people living with HIV in a resource-limited setting who have had to change their treatment regimens at least twice. Using innovative anti-HIV medications, resistance testing and text messaging, the study team is hopeful participants will respond well to treatment and remain adherent.
“A5288 introduces several novel therapies like genotype resistance testing, which is not something most international sites have the ability to do. Our site in Johannesburg, South Africa, is helping with that and raising the level of technology available to our Africa sites,” Salata says. “A5288 also employs a new approach to adherence through cell phone text messaging. Most people have mobile phones and it will be interesting to see if this pans out. It’s a challenging and satisfying protocol.”
Another member of the A5288 team is Beatriz Grinsztejn, MD, PhD, who serves as the study’s Co-Chair. She is Principal Investigator at the ACTG’s FIOCRUZ Therapeutic and Prevention HIV/AIDS Clinical Trials Unit in Rio de Janeiro, Brazil.
“Bob is both an outstanding scientist and mentor who is always willing to provide input and insight,” says Grinsztejn. “Bob’s enthusiasm for HIV research is contagious and I truly value the guidance and support that he has provided over the years.”
As A5288 continues enrolling participants, Salata speaks proudly about the studies conducted in Africa that have led to research breakthroughs. The ACTG’s A5221 study proved the earlier people living with the HIV-tuberculosis co-infection begin ART, the less likely they are to develop AIDS or die. The majority of study participants were from the ACTG’s international locations, including the JCRC site.
“Our research informs clinical care, especially in Uganda where we have made presentations to the Ministry of Health,” Salata says. “As a researcher, it’s moments like these that reaffirm my career.”
Looking toward the future of HIV research, Salata hopes resources are concentrated on finding a cure, controlling inflammation and treating co-infections like tuberculosis and hepatitis.
“We need to ensure we relate this work to our international sites because that’s where the burden of HIV is and our international sites want to contribute to our research agenda,” Salata says. “We should also think about expanding the number of international sites as appropriate.”
The JCRC site has assisted in this expansion by mentoring the Uganda Cancer Institute (UCI) site. In order to get the UCI equipped to participate in a study of advanced Kaposi’s sarcoma, JCRC assisted with site training, lab shipments and establishing a research pharmacy. Salata is proud the JCRC site has grown from an ART dispensary to a cutting-edge research center, and now, as a model for other African sites. It makes him think about those days long ago at the University of Virginia.
“Now it is the quality of care that is drawing people to our sites,” he says.