Summary of research over last five years
The research of Tobias Rinke de Wit can be characterised as multi-disciplinary, always directed towards public health in Africa. Tobias is molecular biologist by training and as such he performs research in the area of affordable laboratory diagnostics for resource-poor applications. In this area, he worked on affordable tests for HIV viral load, HIV drug resistance determination, NVP drug level measurement in saliva, HIV testing on saliva. Tobias has a firm history and background in HIV research: in Ethiopia he performed prospective cohort studies on the natural history of HIV infection with an emphasis on immunology and virology. At PharmAccess, Tobias performed operational research around HIV treatment programs in Africa (workplace HIV/AIDS programs, pharma-industry supported ART access programs, HIV insurance programs, etc.). Over the past years Tobias leads pioneering research in the area of HIV drug resistance: monitoring of acquired HIV drug resistance, surveillance of transmitted drug resistance, drug resistance modelling studies, pediatric drug resistance work, etc. HIV drug resistance research findings are conveyed to African healthcare policy makers. Tobias supports 5
PhD students (2 Dutch, 2 South African 1 Kenyan) in these areas. Tobias also performs operational research in the areas of private sector workplace programs for HIV, wellness surveys and basic primary healthcare delivery to private customers. The operational research around the implementation of a pan-African workplace AIDS treatment and prevention program with Heineken has resulted in the PhD of the Heineken Chief Medical Officer, under Tobias’ supervision. In Namibia Tobias supervises operational and impact evaluation research on mobile HIV testing at workplaces, introduction of affordable healthcare insurances, mobile wellness screening and primary healthcare delivery. These programs support the PhD of a student from Namibia. Tobias performs research in the area of quality of healthcare delivery through analysis of healthcare facility assessment data as provided by the PharmAccess SafeCare program. Healthcare facility quality assessment through certification and accreditation is evaluated against medical outputs and outcomes in Nigeria. Finally, Tobias is PI on a project in Ghana that evaluated the client-experience of healthcare services by the Ghana national health insurance
and its network of facilities (1 PhD student).
Outline of plans for research in the next five years
Tobias’ HIV drug resistance research lines will be continued and expanded. In this area Tobias has recently secured funding from 5 different donors to continue monitoring drug resistance in Uganda, Nigeria, Zimbabwe, Zambia and South Africa. This will generate invaluable long-term follow-up data that are unique in Africa. In addition, recently several research proposals have been submitted by Tobias to evaluate “option B+” (HIV drug resistance consequences of early HIV treatment in pregnant women, independent of CD4 counts) in Kenya. Pending final approval, it is expected that Tobias will expand the research on productizing affordable HIV resistance tests for Africa, in collaboration with the Joint Clinical Research Centre in Uganda. Tobias is actively liaising with South African scientists in the area of HIV drug resistance research (in particular the SATuRN drug resistance network), which is facilitated by Tobias’ (temporary) move to Cape Town, South Africa. The health insurance research program in Ghana will be continued and Tobias is co-applicant on a new proposal with WOTRO to expand the Ghanaian insurance findings to community-based insurance projects in Ethiopia. The above
7 PhD students will defend their respective theses under Tobias’ supervision. Progress is expected in the area of SafeCare (https://c8-pts5h4f75ef3wa-isk.sec.amc.nl/) healthcare quality research, since baseline assessment data of hundreds of facilities in several African countries will in the coming years be complemented with follow-up assessment data, thus allowing for measuring quality improvement over time. This quality improvement will be analysed in the context of the various innovative healthcare financing projects that PharmAccess is involved in (Medical Credit Fund, Health Insurance Fund) and a PhD proposal in this area is currently being prepared by a Nigerian hospital owner, who could qualify for funding. Also, the validation of SafeCare methodologies in terms of improved medical outputs and outcomes is expected to take place over the next years in Nigeria, Kenya and possibly Tanzania. It is Tobias’ intention (after return from South Africa) to continue and expand above research and contribute more to teaching through a formal position at the Dept of Global Health at the AMC.
Secured grants
2013 Second price Amsterdam Municipality contest for an Applied Technology Institute in Amsterdam (budget under negotiation)
2013 WHO consultancy assignment for scientific support to HIVResNet with respect to HIV drug resistance in resource-poor settings ($69,035, 1 year)
2013 WHO Agreement for Performance of Work at JCRC, Uganda ($ 194,212; 6 months)
2013 European Union support to HIVDR program Southern Africa, via SATuRN grant (€ 110,757; 1 year)
2012 Netherlands Organization for Scientific Research (NWO). NACCAP. Affordable resistance test for Africa, phase II (€ 1,473,862; 3 years, principal investigator; 3 years)
2012 Embassy of Kingdom of the Netherlands Regional AIDS Program. HIV drug resistance monitoring and evaluation in Southern Africa (€1,191,245; principal investigator; 3 years)
2012 Jura Foundation. HIV drug resistance research in Uganda (€125,000, principal investigator; 1 year).
2011 AIDS Fonds, the Netherlands. Operational Research grant for affordable HIV viral load test + P24 evaluation Zimbabwe (€ 199,485; principal investigator; 1 year).
2011 Heineken Africa Fund. Continued HIV drug resistance monitoring in adults and children in Lagos, Nigeria (€333,000, principal investigator; 3 years).
2010 NACCAP. Managerial capacity grant JCRC (€ 75,000, principal investigator; 1 year)
2010 CORDAID. Support budget for health insurance research in Ghana (€ 35,000, principal investigator; 1 year)
2010 NWO-WOTRO. Towards a client-oriented health insurance system in Ghana. Research Grant (€ 849,568; principal investigator; 4 years).
2009 AIDS Fonds, the Netherlands. Operational Research grant for Affordable Diagnostics in Africa (€ 199,856; principal investigator; 1 year).
2009 EDCTP fellowship. Evaluating Antiretroviral Drug Resistance in HIV Infected Children in Africa (€ 199,100; co-applicant; 2 years)
2008 Schokland Fonds. Intellectual property rights Africa Case Study ARTA (€ 420,000, co-investigator; 2 years).
2007 AIDS Fonds, the Netherlands. Operational Research grant for Affordable Diagnostics in Africa (€ 130,318; principal investigator; 1 year).
2007 Netherlands Organization for Scientific Research (NWO). NACCAP grant: affordable HIV drug resistance test for Africa (€ 2,969,402; principal investigator; 3 years).
2006 Netherlands Ministry of Development Cooperation. The socio-economic and bio-medical impact of introduction of affordable health insurances (including AIDS treatment) in Africa (€ 1,565,387; co-applicant; 3 years).
2006 Netherlands Ministry of Development Cooperation. Creating an international network on HIV drug resistance in Africa (€ 10,244,462; principal investigator; 6 years)
2004 Heineken International. Access to HAART program for 6 operations in Africa; PhD program Dr van der Borght (€ 500,000; 5 years, promotor).
2003 Dutch AIDS Fonds: Determination of HIV prevalence among Heineken employees and dependents in Rwanda ($ 35,440; principal investigator; 1 year).