Site 101: JCRC Lubowa

Joint Clinical Research Centre- Lubowa (JCRC) is an autonomous organization established in 1991 by HE the President of Uganda to provide a scientific solution to the HIV/AIDS epidemic. JCRC is located approximately 9kms to the South of Kampala the capital city of Uganda.  JCRC Lubowa HIV clinic is one of the five JCRC Regional Centres of Excellence (RCEs). The oldest of the RCEs, it has been in existence since 1991 and was originally located in Bulange, Mengo in Kampala. .  JCRC Lubowa pioneered the introduction of AZT for the treatment of HIV/AIDS at a time when there was no available, proven therapeutic options.  In 2004, JCRC Lubowa became the first recipient of the first U.S President Emergency Plan for AIDS Relief (PEPFAR) grant. The PEPFAR grant supported the country-wide rollout of ART and this was implemented by the JCRC.

The site has over 350 staff members who are well trained and experienced in HIV/AIDS care, treatment and research. The site infrastructure for research includes adequate clinic and counselling rooms, an in-patient facility with a 20-bed capacity, a state-of-the-art laboratory with a test menu of more than 50 tests that is accredited by the College of American Pathologists (CAP) and certified by the  Division of AIDS (DAIDS), a division of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health.  In addition, the site has a well-established  radiology unit, a stand-alone TB clinic equipped with a sputum booth, a secure and adequate research pharmacy, a biorepository with over forty -800C freezers and 24-hour automatic power back-up system.  The site currently provides care and treatment services to over 13,000 people living with HIV.

It has been a wonderful experience being one of the CARES implementing sites and participating in a ground-breaking research study that will inform treatment policy especially for programs in low- and middle-income countries.

At the start, clients had mixed feeling about the treatment, most were excited about it but some had fears about the anticipated side effects of getting injections every two months. This perception has changed for many participants as a result of  continued counselling and from their lived experiences.

The majority of participants on the injectable arm are happy because they no longer have the burden of swallowing pills daily. 

one client narrated to me of how she had to travel away from home for a week, along the way, she noticed she had no pills in her luggage. She almost panicked but suddenly remembered that she had started receiving injectable ARVs the previous month. This greatly relieved her and she is happy now that she does not have to remember to carry pills everywhere she goes.

So far, the treatment is well tolerated by the clients, we have not had any major side effects to deal with. Most reported side effect is pain which usually resolves with minimal or no treatment. Most clients feel that the discomfort for a few hours to days outweighs the burden of swallowing a pill daily.

The biggest challenges faced during recruitment were the high screen out rate because of hepatitis B core antibody and handling the disappointment from those participants who were not randomized on the injectable arm.

Given the positive experiences from the study so far, injectable ART is likely to improve adherence to ARVs and ultimately the treatment outcomes and quality of life of people living with HIV.