The seeds that Mike Chirenje, MD, planted through the University of Zimbabwe Clinical Trials Unit thirty years ago have grown deep roots, changing the landscape of HIV treatment and prevention in Zimbabwe and around the world.

The program started soon after Dr. Chirenje returned from his ob-gyn residency in the UK, where he had noticed how much lower the rates of cervical cancer were than in his home country. He and his team quickly set up a program to screen for cervical cancer. They were exploring alternatives to pap smears, which were too expensive for low-resource settings. They developed a simple test called visual inspection with acetic acid that became the gold standard for cervical cancer screening in low-resource countries.  

During those early studies, he recognized a pattern with women who had precancer cells and received treatment. If they were infected with HIV, the disease just came back and it was very difficult to treat. Dr. Chirenje quickly learned that the program had to have a focus on HIV whether that was their specialty or not.

In the early 1990s in Zimbabwe, there were no drugs to treat the disease. It was distressing to care for pregnant women with HIV who would die after delivery. Thirty to forty percent of their babies were born with HIV and most wouldn’t make it to a year. HIV was spreading rapidly. “Everybody had lost someone,” he said. “You were living in a community where disease was around every corner.”

The CTU started small, hiring 2 nurses and later applying for an NIH grant to become part of the HIV Prevention Trials Network. The program has blossomed beyond what they could have imagined, now with a team of 250 people and continuous funding for their work over several decades.

The program has focused on 3 major pillars: testing drug combinations for HIV treatment, led by Dr. James Hakim; preventing transmission of HIV from pregnant women to their babies, led by Dr. Lynda Stranix-Chibanda and Dr. Tsungai Chipato; and conducting biomedical studies for preventing HIV, led by Dr. Chirenje and Dr. Nyaradzo Mgodi. Dr. Chirenje was one of the first scientists to sit in Washington, DC, in 2000 to design microbicides research for HIV prevention. His expertise in colposcopy was essential to ensuring that the products were safe, linking back to his start in cervical cancer screening work.

The CTU’s research has transformed policy and practices around the world that have helped turn the tide of the HIV epidemic. Their research on HIV prevention led to the implementation of new evidence-based policies in Zimbabwe’s Ministry of Health and the wider region. The recommendations based on testing antiretroviral drugs influenced the approach to prevention of mother-to-child transmission, with the program’s researchers serving on policy committees to shape World Health Organization recommendations.

Dr. Chirenje takes pride in the many ways the unit has provided services to the community in addition to their big-picture research and policy impacts. The community members who participate in the studies are grateful for the high-quality health care they receive. They know they’ll get good service, free screenings, vaccinations, and have their needs taken care of without having to pay. “Every time the community outreach team has a new study, the queues are huge because they know they’re going to get very good service, qualified doctors, nurses, pharmacists, and state-of-the-art equipment.” 

These roots that have grown in the past three decades help to ensure sustainability for decades in the future. Dr. Chirenje has mentored early-stage investigators who are now leading research and attracting funding to the unit. There’s infrastructure to assist communities with research and emerging infections that may come. The CTU’s jobs have created stability for employees and their families through tumultuous decades in Zimbabwe’s economy. 

Looking ahead, Dr. Chirenje has big ideas for what the CTU can achieve next. He’s looking toward a future where they eliminate mother-to-child HIV infections completely. The CTU is assisting in the research to identify an HIV vaccine, which would be a huge step forward for HIV prevention around the world. His work has also come full circle with the CTU joining the National Cancer Institute’s CASCADE Network working on clinical trials to optimize cervical cancer screening, management, and precancer treatment for women living with HIV.

“The HIV epidemic will most likely evolve, and I am optimistic that, shortly, HIV will become increasingly endemic and much more manageable, and we will see better control of cervical cancer among women living with HIV in Zimbabwe.”