Perinatal HIV Research Unit

Responsible: Prof. McIntyre and Dr. Gray (Perinatal HIV Clinic)

The Perinatal HIV Research was established in 1996, developing from the Perinatal HIV Clinic at the hospital, which has functioned since 1991. The Co-Directors, Prof. James McIntyre and Dr Glenda Gray have worked in the field of HIV/AIDS in women and children for over ten years, and have been at the forefront of this field in South Africa. The Perinatal HIV Research Unit has been involved in research, training, policy formation and advocacy in issues concerning HIV-positive women and their children.

In recent years the work of the unit has expanded beyond the original focus of mother-to-child transmission of HIV, to include treatment trials in adults and children, prevention research, psychosocial research and policy development. In addition the unit has recently received funding to develop an HIV vaccine clinical trials unit (HVCTU) and started preparing for HIV vaccine trials in the first quarter of 2001.

The unit is recognised nationally and internationally as a leader in the field of research and policy in the area of mother-to-child transmission of HIV. It has also developed a reputation as a leading African research unit for clinical trials in adults and children with HIV, with one of the largest cohorts of adults enrolled in HIV pharmaceutical treatment trials in the developing world.

The Unit was one of eleven international HIVNET sites for HIV prevention research, and is an international site for the Pediatric AIDS Clinical Trial Group (PACTG). The unit is at the forefront of HIV vaccine research in South Africa, which has been identified as a priority by the government and is collaborating with both the International AIDS Vaccine Initiative (IAVI) and the South African AIDS Vaccine Initiative (SAAVI). A TB and HIV research programme has been established in collaboration with Johns Hopkins University.

In February 2002, Professor McIntyre and Dr. Gray received the Nelson Mandela Health and Human Rights Award for their outstanding dedication and commitment to improving the lives of the women and children in the Soweto Community.

Current Activities

The Perinatal HIV Research Unit is based in and linked to the Perinatal HIV Clinic at the Chris Hani Baragwanath Hospital (CHBH).

Prof. McIntyre and Dr Gray formed the Perinatal HIV Clinic in 1991, to co-ordinate the care and counselling of pregnant women identified as HIV-positive. As of this year (2002), all pregnant women who receive antenatal care at Baragwanath Hospital or at any of the midwifery clinics in Soweto are offered routine HIV testing. Uptake of the test is over 90%, and the HIV seroprevalence in early 2002 was over 29%. Identified HIV-positive women are then referred through to the Perinatal HIV Clinic for counselling and further management.

• The Perinatal HIV clinic at the CHBH provides obstetric care for mothers and paediatric follow up of children born to HIV-positive women, with nurse counselling, group education, peer counselling and social support. Income generation projects are undertaken by community organisations and a group of HIV-positive workers. This combined approach to the care of HIV infected women and their children has been very successful and has been cited as a model for other African settings.


• The Clinic provides antenatal and postnatal care for women, family planning advice and access to community organisations and support groups. Counselling and testing is provided for male partners and women are encouraged to bring partners in for couple counselling. Children born to infected mothers are followed up at the clinic for 18 months, and have repeat HIV tests during this period to determine their serostatus. Children identified as being HIV infected are followed up to determine the natural history of HIV disease in this perinatal cohort.


• The Research Unit works from this clinical base to undertake research on mother-to-child transmission (MTCT) of HIV, obstetrical and gynaecological aspects of HIV infection, social and psychological factors associated with fertility in HIV infected women, growth and development of HIV infected children, medical problems of HIV infected children and trials on drug therapy for both adults and children. Over 40% of paediatric admissions to Baragwanath Hospital at present are HIV-related, and the Unit is promoting and assisting research in the field of paediatric HIV, in addition to the perinatal issues. The Unit is conducting clinical trials of new antiretroviral drugs for both adults and children, in association with international researchers and pharmaceutical companies. These trials include Phase 1 and 2 work as well as extensive Phase 3 clinical trials

The PHRU established its HIV vaccine trials in 2000. In September 2001, Dr Gray became the Principle Investigator for the South African HIV Vaccine Trials Network. She is currently preparing for a candidate vaccine study, this trial will be conducted in Durban and Soweto and is involved in vaccine preparedness in rural and urban sites.

Research for Policy & Advocacy

The Unit is also involved in research activities contributing to provincial, national and international policy development in HIV issues.

Both Prof. McIntyre and Dr Gray have worked as consultants to the World Health Organisation and UNAIDS on perinatal transmission of HIV. Prof. McIntyre is the author of a comprehensive WHO scientific review on the subject of HIV in pregnancy and is a consultant to WHO and UNICEF on the implementation of operational research projects for perinatal transmission. The Co-Directors of the unit participate in a number of international working groups on the subject and have presented at many international conferences.

• Prof. McIntyre and Dr Gray are working with UNAIDS, WHO and other collaborators on the development of cost effectiveness models and policy development for interventions to reduce mother to child transmission of HIV, and on guidelines for policy makers on the issues of pregnancy management in HIV-positive women, breastfeeding and anti-retroviral therapy in pregnancy. Dr Gray has assiste UNAIDS internationally on the development and dissemination of guidelines for prophylaxis of opportunistic infections.


• The Unit is working closely with the National AIDS Programme in South Africa on the prevention of mother-to-child transmission of HIV and has co-ordinated a consultative process and national working group on this issue. The Perinatal HIV Research Unit has been central to the development of a provincial and national policy for the care of HIV infected children.


• The unit has been involved in providing scientific leadership for wider policy development on HIV/AIDS in South Africa. Prof. McIntyre was a member of the National AIDS Plan team, which wrote the National AIDS Plan for the country, and both he and Dr Gray contributed the section of the plan on perinatal HIV. Both directors have been members of the AIDS Advisory Committee of the Department of Health and have worked with the provincial national government. The Unit contributed to the Government's Maternal, Child and Women's Health Policy, in the sections on HIV in women and children. Policy has been developed for the care of children in institutions. The Directors sit on the University of the Witwatersrand Faculty of Health Sciences AIDS advisory committee.

Dr Gray and Prof McIntyre were invited members of the Presidential Review Committee on AIDS and are members of the South African National AIDS Council Prevention Technical Task Team and both the National and Gauteng Provincial Steering Committees for MTCT prevention implementation.

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