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THE NEWSLETTER OF THE BURNET INSTITUTE | SUMMER 2012MYANMAR:SUPPORTING AHEALTHIER FUTURENEW HORIZONS:CD4 TEST ON THEFRONTLINEREACHING OUT:WORKING WITHMELBOURNE’S MOSTVULNERABLEburnet.edu.au

DIRECTOR’S REPORTINSIDEFEATURES3 SIR ZELMAN COWENFELLOWSHIP FUND4 PHILANTHROPY IN ACTION6 NEW HORIZONS: OURLOW-COST CD4 TEST OUTON THE FRONTLINE8 SUPPORTING A HEALTHIERFUTURE IN MYANMAR10 REACHING OUT: WORKINGWITH MELBOURNE’S MOSTVULNERABLE12 iCRL: TAKING HIV TRAININGWHERE IT IS NEEDED MOST14 BURNET AT AIDS 201215 MAKING NEWSFRONT COVER IMAGE:This image depicts a motherand her child in Myanmar.Burnet Institute is anAustralian not-for-profit,unaligned and independentorganisation whose purposeis to improve the healthof disadvantaged, poor orotherwise vulnerable peoplethroughout the world.elcome to the summer edition of IMPACT, highlighting theincredible work undertaken by our talented scientific and publichealth staff at Burnet.Much has happened at the Institute and in the medical research andpublic health sectors over the past few months. Most importantly, a draftversion of the long-awaited McKeon Review into medical research wasreleased and welcomed as a powerful blueprint for the future of Australia’shealth and medical research sector. The Review focuses on the need tobetter target investment in the medical research sector to deliver improvedhealth and economic outcomes.The Review highlights the clear public benefits of a strong and globally competitive Australianmedical research sector and delivers a strong business case for continued and increasinginvestment in Australian medical research.Some of the key recommendations include a stronger connection between research andhealthcare, including; clinical practice being increasingly based on research evidence; increasinginvestment in research by two to three times over the next 10 years; and reform of the NationalHealth and Medical Research Council (NHMRC) to streamline, empower and better resource it as thenation’s leading research body. From a Burnet perspective, it was wonderful to see specific referenceto the importance of research to improve the health of people living in developing countries.It is the first in-depth strategic review of the sector in 15 years and so it’s crucial that we get theresponse right. We, and the rest of the research community, look forward to renewed and ongoingbipartisan government support of the Review’s recommendations.In a major new initiative, we launched the Sir Zelman Cowen Fellowship Fund at ParliamentHouse in Canberra. The Fellowship Fund aims to raise funds to provide our young researcherswith fellowships to focus on bold new research programs to address major global health issues.We urgently need to undertake research to identify the best ways to tackle problems such as theincredibly high numbers of women and children who still die in childbirth, the increasing threat tosociety from drug-resistant tuberculosis and malaria, and to reduce the spread of HIV from motherto child. We would welcome your support of the Fellowship Fund and I would be happy to personallydiscuss this with you should you wish to contact me.I would like to take this opportunity to thank you once again for your support of the Institute andon behalf of all at Burnet, to wish you and your family a safe and happy festive season.Best wishes,Professor Brendan Crabb,Director and CEOAll donations over $2 are fully tax deductible. Where possible people who appear in images included in this newsletter werephotographed with their permission. There is no implication that these people have any infectious diseases. If you would liketo discuss any issue from this edition of the Burnet Institute’s newsletter, IMPACT, please call Paul Rathbone on 03 9282 2113.Photo Credits: Ben Coghlan, Brett Balalas, Gillian Chamberlain, Soe Lin Htut, Stephanie Luketic, Stanley Luchters, CatherineSomerville, ©IAS Steve Shapiro Commercialimage, Adam Johnson, PRIME Awards, Marcus Flack – Liquid Creations, Paul Ritchard.2 IMPACT Summer 2012

THE LATE SIR ZELMAN COWENAK, GCMG, GCVO, QC, DCL,FORMER BURNET PATRON ANDFORMER GOVERNOR-GENERAL.Sir Zelman CowenFELLOWSHIP FUNDThe Fund named in honour offormer Burnet Institute Patronand former Governor-General,the late Sir Zelman CowenAK, GCMG, GCVO, QC, DCL,will raise money to provideParliament House in Canberra.Mr Ben Cowen, youngestson of Sir Zelman, encouragedthose who had been touchedby his father or his work andwant to remember him or hisPatron-in-Chief of the SirZelman Cowen Fellowship Fundis Her Excellency Ms QuentinBryce AC, CVO, GovernorGeneral of the Commonwealthof Australia, and Lady Anna“The Sir Zelman CowenFellowship Fund is animportant initiative of theBurnet Institute and willenhance its significantefforts to improve maternalfellowships for young Australiancontribution in a meaningfulCowen is supporting theand child health,”medical researchers to tacklemajor global health issues,especially those facing womenand children.Cabinet Secretary, the Hon.Mark Dreyfus QC, MP andway, to support the Sir ZelmanCowen Fellowship Fund.Burnet Institute Director andCEO, Professor Brendan Crabb,said the Fellowships wouldprovide a much-needed boostinitiative as Fund Ambassador.For further informationabout the Sir Zelman CowenFellowship Fund or to make adonation, go to our websitewww.zelmancowenfund.org.auPATRON IN CHIEF,HER EXCELLENCYMS QUENTIN BRYCE ACCVO, GOVERNOR-GENERALOF THE COMMONWEALTHOF AUSTRALIA.Leader of the Opposition thefor mid-career researchers whoor call Head of PublicHon. Tony Abbott MP wereface a significant lack of careerAffairs and Development,among the key speakers at thefunding opportunities.Paul Rathbone onrecent launch of the Fund at(03) 9282 2113.IMPACT Summer 2012 3

PHILANTHROPY IN ACTIONONLY$35,000TO GO!This microscope is a criticalpiece of equipment needed byour scientists.NEW MICROSCOPEIS VITAL TOOUR RESEARCHWe’ve almost reached ourtarget of $360,000 fora new super-resolutionmicroscope, one of themost critical pieces ofequipment needed byour research scientists.We’re just $35,000 short.The difference this newmachine will make to ourwork will be enormous.For the first time, ourscientists will be able to getdetailed close-up imagesof cells and microbes suchas HIV and malaria, anduse the information inthe development of newtherapies and vaccinesagainst infectious diseasesand cancers.We appreciate thesupport of all our donorsand the Harold and CoraBrennen Trust.BECOME A BURNET HEALTH CHAMPION TODAY!Making an affordable gift month-by-month is one of the best ways of helping Burnet achieve itsmission of improving the health of poor and vulnerable communities in Australia and internationally.Monthly giving is easy to set up, tax deductible and a great way of showing your commitmentto Burnet’s ongoing work to translate cutting-edge laboratory research into effective public healthprograms. Knowing we can count on these funds each month is crucial to our planning.As a Burnet Health Champion, you will also receive regular updates on our medical research andpublic health work, and invitations to our special supporter events.MEDICALSTUDENTSGET BEHINDBURNETBurnet Institute wouldlike to acknowledge thegenerous support ofASPIRE, the Universityof New England’sglobal health group formedical students, whoorganised a series ofevents to raise fundsfor the Institute’s work.The results exceeded allexpectations with morethan $3,500 donated.For more information about ways to support theBurnet Institute please contact Development Manager,Jason Smith on (03) 8506 2401 or visit burnet.edu.au.4 IMPACT Summer 2012

FIRST CHANCE FOR MOTHERS AND CHILDREN APPEALAppealHelp us save lives by giving today!A woman in Myanmaris 45 times more likelyto die due to pregnancycomplications than awoman in Australia,but you can help turnthings around.“With some of the worst health indicatorsglobally and a population of 50 million people,we simply cannot turn our backs and do nothing.It is our duty to do what we can to improve thehealth of Myanmar’s women and children,”– Professor Brendan Crabb.This is why we are seeking your support of the First Chance forMothers and Children Appeal.Burnet’s First Chance Appeal is about giving mothers andnewborns a first chance – to access improved health care, tohave a healthy pregnancy and to learn about good nutrition –all fundamental to a healthy community.Your gift will help us train local health workers, upgradelocal health facilities in desperate need of renovation, and buyequipment and medicines. All these activities are critical to give thewomen and children of Myanmar the healthy future they deserve.Please consider making a gift today by visitingwww.burnet.edu.au/appeals, or by completing thedonation coupon in this magazine.Khin Moe Kyi, midwife, Thanlyin township, Myanmar.IMPACT Summer 2012 5

RESEARCH TRANSLATIONNEW HORIZONS:CD4 TEST ON THE FRONTLINEProfessor Stanley Luchters(centre) in Africa.“It’s easy to diagnose HIVbut it’s hard to identifythose who need therapy.Our test will change that,providing cost-effectivetesting for up to 33 millionpatients worldwide.”— Associate Professor David Anderson,Burnet Institute6 IMPACT Summer 2012After six years of developmentin the laboratory, Burnetscientists have developed theVISITECT® CD4, an affordablepoint-of-care (POC) test aimedat reaching HIV patients aroundthe world.Burnet Institute DeputyDirector, Head of the Officefor Business Development,Innovation and Research, andpart of the brains trust behindVISITECT® CD4, AssociateProfessor David Anderson saidthe test development was a lotlike a relay race.“We had the technicalcapability of developing thetest in the lab, validating itwith help from The Alfredhospital, through to thebusiness development officeto identify the right partner tocommercialise, manufactureit and get it out into the field,”he said.The baton is now passedto Co-Head of the Centre forVirology and infectious diseasesphysician, Professor SuzanneCrowe AM and Professor StanleyLuchters, acting Co-head ofBurnet’s Centre for InternationalHealth, to undertake fieldvalidation studies to determinethe feasibility of the test.“What I really hope is that infive years time we could go intoa remote setting anywhere inAfrica and see people actuallybeing tested with the VISITECT®CD4 test and getting appropriatecare as a result,” AssociateProfessor Anderson said.

FROM LABTO VILLAGEProfessor Luchters, ProfessorCrowe AM and other Burnetpublic health specialistsare now rolling out researchprojects using the VISITECT®CD4 test in sub-Saharan Africaand Papua New Guinea.The first of these projectsto begin in 2013 is supportedby a USD$250,000 grantfrom the Grand ChallengesSaving Lives at Birth Initiative,jointly funded by USAID, theGovernment of Norway, the Bill& Melinda Gates Foundation,Grand Challenges Canadaand the UK’s Department forInternational Development(DFID). The VISITECT®CD4 test was one of 15innovations to receive theaward from more than 500applications worldwide.Over 15 months, the projectwill involve 275 HIV-infectedpregnant women, with 150women taking part from SouthAfrica and 125 from Kenya.Various types of healthfacilities will enrol studyparticipants including a largereference hospital in SouthAfrica with a high patient load,and in Kenya, a low-level,health centre-type facility, arural public district hospitaland a private health clinic.The project will gatherinformation from health careworkers about how feasible it isto use the test in the field, howwell it works in practice, howeasy it is to read the results,and then compare the results tothe highly technical referenceflow cytometry test.“In southern Africa,about half of maternalmortality and a thirdof infant mortalitycan be attributed toHIV infection. Nearlyhalf a million babiesare born each yearwith HIV – almostall children under 15with HIV have got itfrom their mothers,”Professor Luchters said.“If this new test is carriedout at the first antenatal visitafter HIV-infection has beendetected in pregnant women, itcould allow for rapid initiationof antiretroviral interventionsand save the lives of thousandsof HIV-infected pregnantwomen and prevent infection intheir newborn infants.”Professor Luchters saidin Sub-Saharan Africa HIVinfectedwomen usually comelate to antenatal clinics andoften only come once. Theyneed treatment to preventmother-to-baby transmissionbut many rural settings don’thave a laboratory close by so itcan take weeks for the resultsto come back, and you need torely on the mother to return tothe clinic.“Of course, discoveringa vaccine or a curewould be better, but inthe meantime we needto make best use ofthe antiviral drugs thatare available, and thatmeans CD4 testing,”Associate ProfessorDavid Anderson.WHAT’S AHEAD?Associate Professor Anderson and his team are now planningfor a test that can be used in a similar way to the VISITECT® CD4diagnostic to determine when hepatitis B-infected patients need togo on antiviral therapy.“In China there are about 250 million people suffering fromchronic hepatitis B with very few of them being regularly tested forthe amount of virus (viral load) or liver disease (ALT) because it’sjust too difficult,” he said.“At the moment the test for viral load and ALT need a lab– developing a viral load test for hepatitis B is going to bechallenging for us but we have a novel idea and given the time andsignificant funding this project is achievable in two years.”Hepatitis B is a blood-borne virus that attacks the liver causingboth acute and chronic disease. Two billion people worldwide areinfected with the virus, 350 million live with chronic infection and600,000 people die each year due to HBV related illness.BURNET LICENCES CD4 TESTBurnet has licensed the VISITECT® CD4 test to global diagnosticsorganisation, Omega Diagnostics Group PLC for its manufactureand sale throughout the world, and this relationship wasofficially announced at AIDS 2012, the International AIDS SocietyConference in Washington.Although VISITECT® CD4 is designed to be instrument-free,Burnet has developed a complementary test reader in collaborationwith Axxin Pty Ltd in Melbourne. The AX-2 reader allows the testresults to be stored and transferred electronically, as well asproviding training and objective test analysis, which will be veryuseful in the training of health-care workers and in validation trials.VISITECT® CD4 aims to reach millions ofHIV patients around the world currently notreceiving treatment.The team behind the development (back), Mary Garcia,Associate Professor David Anderson, (front)Professor Suzanne Crowe AM and Nadine Barnes.IMPACT Summer 2012 7

MYANMARSUPPORTINGA HEALTHIERFUTURE INMYANMARTeaching kids about health is one of the fundamentalbuilding blocks of a democratic society.In the year 2000, the WorldHealth Organization ranked thehealth systems of 190 countries– Myanmar (Burma) was amongthe lowest.For a nation with 50 millionpeople, the outlook was a majorglobal health concern, withwomen’s and children’s healthdemonstrating some of theworst outcomes in the world.Since then, health outcomeshave improved marginally, butit’s the monumental changesin the political landscape thatpaint a positive picture forMyanmar’s future.Burnet’s Myanmar CountryRepresentative, Dr Karl Dorningfirst started working there in1995 and says it is still in atransitional phase towardsdemocracy, but the possibilitiesare now more evident.“Back then, we were allthinking it would never changefor Burmese people. Now, theyhave a voice,” he said.“There is a real hunger thatpeople want to learn and I thinkBurnet is a conduit for bringinggood learning on public healthand generally continuing tohelp develop civil society that’sthoughtful, reflective andrespectful of people and theirdifferent needs.”The Burnet Institute MyanmarProgram has been in operationsince 2003, starting outin capacity building of HIVprevention, care and support,and more recently moving intomaternal and child health,and education.In the early years, there werevery few international, nongovernmentorganisations in thecountry and Burnet’s approachof working directly with localpartners was unique.“It was a very sensitive time,coupled with the fact thatthere wasn’t a lot of groupsindependent of the government,apart from local church groupsand Buddhist groups.“There was a newly emerginglocal NGO sector but it was verysmall,” Dr Dorning explained.“So we chose to workwith local partners from thebeginning and have sincebuilt on that approach, wenow have agreements with30 other organisations.“We are very much seenas one of the key agenciesthat builds local civil societyand capacity to respond notjust to HIV but in general topublic health.”8 IMPACT Summer 2012

RESPONDING TOCYCLONE NARGISOne of the many successstories of Burnet’s involvementin Myanmar was a project DrDorning helped set up as part ofthe response to the devastatingCyclone Nargis in 2008, the LocalResource Centre or LRC.Funded by AusAID, the LRCacted as a resourcing tool forlocal civil society groups todevelop healthcare capacity andhumanitarian assistance, andhas now become its own NGO.Burnet Institute Director andCEO, Professor Brendan Crabbsays the Institute is well acceptedand respected in Myanmar.“It’s a real testament to ourapproach that we have beenthere so long, through difficultyears, and I think the reason wehave stood the test of time is thatwe have always done just whatwe said we were going to do,”Professor Crabb said.“There is nothing else toBurnet, we are not there tomake money or to influence thepolitical or social agenda, we arethere to improve the well beingof the people by improving theiraccess to good health, that’s it.”Professor Crabb believeswith the shift in politicalcircumstances, organisationslike Burnet will have morefreedom to build better linksand capacity to strengthengovernment health systems,not just non-government.“Burnet is working closelywith government health staffutilising them as trainers inprograms, while also facilitatingpartnerships between privatesector businesses andgovernment health facilities toincrease the involvement of menin maternal and child health.These two elements would nothave been possible 12 monthsago,” he said.FOCUS ONEDUCATIONThe Institute has also beenheavily involved with theeducation sector, particularly theMonastic School system (similarto the Catholic school system inAustralia) since Cyclone Nargis.“We got involved with a lotof health-focused areas afterNargis, training teachers howto deal with trauma in theclassroom, and also helpingto re-build schools, makingsure they had good waterand sanitation systems,”Dr Dorning said.The Institute is also a memberof the Myanmar EducationConsortium, a multimilliondollar fund from AusAID andother donors, that will providesupport to non-state educationand will help scale up the schoolwater, sanitation, hygiene andnutrition program.Dr Dorning said from a publichealth perspective, teachingkids about health is one of thefundamental building blocks of ademocratic society.“So through training in basichygiene, sanitation and nutrition,teachers can be a real key inchanging the basic patterns ofpreventable diseases – simplethings like washing your handsafter you go to the toilet or beforeyou eat.”BURNET HELPSTRAIN MIDWIVESAND COMMUNITYWORKERS TO IMPROVEHEALTH OUTCOMESFOR MOTHERS ANDTHEIR CHILDREN.LOOKING AHEADBurnet will be working towardsengaging with a multi-donorfunding mechanism prioritising,maternal and child health, HIV,malaria and tuberculosis, andhealth systems strengthening.This opportunity will pavethe way for Burnet to make themost of the increased optionsfor capacity building and healthservice delivery.“We will be able to do somereally innovative work with thegovernment and local NGOsin new geographic areas,”Dr Dorning said.More access to funding andthe political changes has alsoopened the door for Burnet’sMyanmar office to develop itsresearch profile.“It’s been difficult in the pastto do research in the countrybecause it has been viewed assensitive, the government didn’twant information getting outthat could be viewed as critical,”he said.“We don’t want to criticise, wejust want to collect evidence todecide on the best way forward toachieve better health outcomesin Myanmar. We want to workwith government, so we’recollaborating with the Departmentof Medical Research on a numberof research programs.”CURRENT PROJECTSIMPROVING MATERNAL AND CHILDHEALTH (MCH) OUTCOMES THROUGHINCREASING HEALTH SEEKINGBEHAVIOURS AND ACCESS TOQUALITY MCH SERVICES.This project supports increasedcommunity demand for health servicesthrough better health knowledge ofmothers about pregnancy, delivery andpostpartum care by supporting facilitybasedcare, with essential equipmentand commodities.MALE PARTICIPATION IN IMPROVINGMATERNAL AND NEWBORN HEALTH:A COMMUNITY-BASED INTERVENTION.Increasing men’s knowledge about waysthey can support the health of theirpartners and children is vital. Men areencouraged to come to antenatal clinicsand the clinics are made more malefriendly,and health care workers are giventhe skills and confidence to engage withmen more effectively.IMPROVING COMMUNITY-BASEDNEONATAL CARE IN MYANMAR.Improving the skills of basic health staff,auxiliary midwives and community birthassistants and provides higher qualityneonatal care.IMPACT Summer 2012 9

PUBLIC HEALTHPEOPLE WHO INJECT DRUGS ARE ATMUCH HIGHER RISK OF INFECTION WITHHEPATITIS VIRUSES THAN THE REST OFTHE AUSTRALIAN POPULATION.HEPATITIS BNational surveillance data indicate that 50 per cent of allnew hepatitis B infections occur in people who inject drugs.Without appropriate treatment, 25 per cent of peoplewith chronic hepatitis B will die from liver cancer orliver failure.HEPATITIS CChronic hepatitis C is most often acquired throughinjecting drug use, and the disease is now the mostcommon indication for a liver transplant.Hepatitis C infection can be treated, but treatment isdebilitating and not always successful. No preventativevaccine exists but Burnet’s Associate Professor HeidiDrummer and others are making great strides towardsthis goal.REACHING OUT:WORKING WITHMELBOURNE’S MOSTVULNERABLESUPPORT BURNET’S MOBILE OUTREACHBurnet’s vans are essential to our outreach work;they enable us to cover large distances acrossmetropolitan Melbourne, and are great platforms forresearch and delivering services. Our second van isnearing the end of its useful life, and we need fundsfor a replacement. For information on how to help usobtain this vital piece of equipment, please contactProfessor Paul Dietze on (03) 9282 2111.Research participants are interviewed about sensitivebehaviours such as sex and drug use.10 IMPACT Summer 2012Outreach – meaningengaging people in theirown environments, ontheir own terms, to helpthem improve their healthand well-being – hasbeen a major feature ofthe Burnet Institute’sepidemiological researchprogram for more thantwo decades.HIGHLY VULNERABLEAUSTRALIANSPeople who inject drugs areamong the most vulnerableand marginalised Australians.Compared with the rest of thepopulation, they experiencehigher rates of incarceration,poverty, homelessness, ill-health,educational disadvantage,unemployment, violenceand sexual abuse, socialdisconnectedness, and familybreakup. Head of Burnet’s Centrefor Population Health, ProfessorMargaret Hellard points out thatusing illicit drugs such as heroinor methamphetamines can be asmuch a response to these social,health and economic problems asa cause of them.“The poor health statusof people who injectdrugs is one of Burnet’skey research priorities,especially their riskof drug overdose andexposure to infectiousdiseases such ashepatitis B and C,”Professor Hellard said.OUTREACH ANDRESEARCHThe Burnet’s Centre for PopulationHealth works with vulnerablepeople in Melbourne andelsewhere in Victoria throughseveral field-based researchprojects. The largest of theseprojects is the Melbourne InjectingDrug Users Cohort Study (MIX).

Researchers travel acrossMelbourne to locationswhere people who injectdrugs congregate.MIX involves six fieldresearchers who travel acrossMelbourne to locations wherepeople who inject drugscongregate. The brainchild ofBurnet’s Professor Paul Dietze,MIX’s chief investigator, thestudy aims to radically improveour understanding of the lifetrajectories of people who injectdrugs, with particular emphasison their use of health servicesand patterns of hepatitis B andC infection.“With over 700 participants,MIX is the largest cohort study(following the same group ofpeople over time) of people whoinject drugs ever conducted inAustralia, giving it a unique abilityto make accurate measurementsand draw valid conclusions,”he said.MIX began in 2008 and buildson previous long-running studies,so Burnet’s researchers are wellknown on Melbourne’s streets.Professor Dietze noted, “Thisrecognition factor, the servicesoffered by our researchers,and the knowledge that weapply the highest standardsof ethical practice, give usaccess to disadvantagedpopulations that are simplyimpossible with traditionalepidemiological approaches.”MOBILE OUTREACHMIX operates two vans speciallyfitted out for outreach researchpurposes; they allow researchersto engage people on the streetbut in privacy. The vans carryall the equipment necessaryto collect blood sampleshygienically and confidentially,and are useful spaces forinterviewing research participantsabout sensitive behaviours suchas sex and drug use.“In late 2012 we began offeringfree hepatitis B vaccinations (theB-VAX project) from the vans in aneffort to increase immunisationrates among people who injectdrugs in Melbourne. An effectivehepatitis B vaccine has beenavailable for 30 years, butmany people who inject drugsmiss out on vaccination dueto homelessness, absencefrom school, and other factorsassociated with disadvantage,”Professor Dietze said.Burnet researchers aim tovaccinate 150 people in 2013,while assessing the relativeeffectiveness of an opportunisticaccelerated schedule (3 dosesover 3+ weeks) and the standardschedule of vaccination (3 dosesin 6 months). As research nurseDanielle Collins notes, “B-VAX isa great opportunity to improveparticipants’ health; the fact thatwe’re evaluating the acceptabilityand effectiveness of an assertivemethod of vaccine delivery is anadded bonus.”ETHICAL PRACTICEConducting research andoutreach with disadvantagedand marginalised people bringsunique ethical challenges. ‘Do noharm’ is the standard injunction,Burnet fieldworker collectsa blood sample hygienicallyand confidentially.but the best ethical practiceinvolves making a positivedifference. According to ProfessorHellard, hepatitis B vaccinationsare one way Burnet’s outreachwork directly benefits researchparticipants. But Burnet staffalso offer invaluable support toalso help smooth participants’access to legal advice andrepresentation, housing andincome support, and primaryhealth care and drug treatment.IMPACT Summer 2012 11

iCRLTAKING HIVTRAININGWHERE IT ISNEEDED MOSTBurnet’s International Clinical ResearchLaboratory (iCRL) is focused on HIV laboratoryand clinician training, sharing knowledge andexpertise with local medical communities indeveloping countries.Created by Co-head of Burnet’sCentre for Virology ProfessorSuzanne Crowe AM, in answer toAustralia’s need for HIV testing,the Clinical Research Laboratorywas the first lab to bring HIV viralload and CD4 testing to Victoria.It measured the viral load ofall HIV patients at The Alfred(as well as from some otherhospitals and clinics in Victoria,NSW and Tasmania) from 1996to 2012 and is accredited bythe National Association ofTesting Authorities.In February this year, Burnethanded over HIV viral load testingto The Alfred hospital allowingthe CRL to focus on the growingdemand of strengtheninglaboratories in other countries inthe Asia and Pacific regions.Supervising scientist, AdeleLee-Wriede says the teamapproaches its work with ahumanitarian view, providingits expertise to help Australia’sneighbours improve theirown laboratories and take onaffordable tests for monitoringHIV infection.“So the iCRL was born – the ‘i’standing for international. We arein a prime position to collaborateand assist these countries in ourregion in developing their ownlaboratories and strengtheningtheir HIV monitoring,”Ms Lee-Wriede explained.LAB STRENGTHENINGThe iCRL has also beenappointed the World HealthOrganization (WHO) RegionalReference Laboratory for HIV DrugResistance testing in the Asia-Pacific region.In this role the iCRL developsnew, simpler tests to determinewhether HIV strains aresusceptible to anti-HIV drugsand performs surveillance in theregion as well as research intodrug resistance.Ms Lee-Wriede spent a weekat the University of Indonesia inearly 2012 training staff in HIVdrug resistance and performingan audit of their laboratory aspart of the laboratory’s work withthe WHO.“It was such a greatopportunity; I initiallydemonstrated the assay to thescientists explaining each ofthe steps and then I supervisedthem as they performed the test,auditing their procedures andfacility,” she said.While Professor Croweand her team have beenworking in these neighbouringcountries for more than adecade, the new iCRL structurewill allow them to accept moreopportunities to train techniciansand assess laboratories in thedeveloping world.Further work planned includestraining of scientists from thePhilippines in a low-cost HIVviral load assay and assistingscientists from Papua NewGuinea to develop further skillsin quality control and drugresistance testing.“In the scientificcommunity we arealways striving to dobetter by the patientsand trying to developthe best possible, andmost affordable, testwithout forgettingthat the major burdenof disease is indeveloping countries,”Ms Lee-Wriede said.“It’s impossible to transfersophisticated tests to countriesthat are lacking the basicrequirements – running water,constant electricity, fridges andfreezers for storing samples;even logistically getting a bloodsample from the patient in aremote clinic to the laboratory isextremely difficult.12 IMPACT Summer 2012

“In order to develop andimplement national testingstrategies these countriesneed laboratories with trainedtechnicians and appropriateinfrastructure to support that.So, we are bridging a gapbetween the laboratories indeveloped countries and theresource-poor ones.”The work of the iCRL includesexpanding clinical HIV trainingprograms for doctors, nursesand laboratory technicians inresource-limited countries.An internationally recognisedHIV scientist, Professor Croweis also a highly respected HIVclinician, starting the firstHIV clinic at Fairfield Hospitalwith her colleague AssociateProfessor Anne Mijch OAMin the early 1980s and hasremained at the forefront of HIVclinical management.Professor Crowe hasorganised and conductedmore than 60 HIV clinicaltraining programs in the Asiaand Pacific regions where sheand a teamof Australian HIV clinicianstrain local doctors in HIVclinical management.“We cover everything fromstigma to discrimination, to thetoxicities of HIV drugs.“On our recent trip toMyanmar (Burma) we tailoredour program to complement thenational guidelines, workingwith the local Burnet officeand the Myanmar MedicalAssociation so what we teachcan be sustained.“HIV can present in somany different ways, wehave doctors attending ourcourses with a special interestnot just in HIV medicine, butalso obstetrics, paediatrics,neurology, psychiatry orrespiratory medicine.“When many of thesedoctors went to medicalschool there was no HIVeducation because theinfection didn’t exist intheir country,”Professor Crowe said.iCRL Supervising scientist Adele Lee-Wriede and Quality ManagerEman Aleksic provide their expertise to resource-limited countriesin the Asia and Pacific regions.Professor Crowe explainedthat doctors are now needingto learn about HIV clinicalmanagement at the sametime as taking care of largenumbers of patients who areoften presenting very lateand very sick.“The management of thesepatients is very complicatedand trying to diagnose theirillness is often very difficult.These doctors can’t afford togo to conferences in the USA,Europe or Australia, so it’s upto us to go there and providethem with training,” she said.Conducted more than60 PROGRAMSin resource-limited countries –India, Indonesia, Fiji, Macedonia,Myanmar and Lao PDR.Over2000medical personnelhave trained inthese programs.Lectures have beentranslated into Hindi,Bahasa and Lao.NURSES, PHARMACISTS and LABORATORY TECHNICIAN TRAINING in HIV500 200nurses and allied healthlaboratoryprofessionals and...staff in India havebenefitted from this course.IMPACT Summer 2012 13

BURNET AT AIDS 2012Professor Sharon Lewin withProfessor Françoise Barré-Sinoussi at the Towards an HIVCure Symposium at AIDS 2012.on the Asia and Pacific regions,”she said.Among the 13 Burnet staffwho attended the conferencewas promising young scientist,Ms Nitasha Kumar.AIDS 2012It’s the biggestHIV conference inthe world, Bill andHillary Clinton, BillGates and EltonJohn were theremixing with leadingresearchers andscientists, includingthe woman behindthe discovery of thevirus, Nobel LaureateProfessor FrançoiseBarré-Sinoussi.At AIDS 2012 – the InternationalAIDS Society’s Conference inWashington – a large team fromBurnet shared the same stagewith many illustrious names.Professor Sharon Lewin, alsoCo-chair of AIDS 2014 to be heldin Melbourne, who followeda rousing speech by formerUS President Bill Clinton, tolddelegates that Washingtonwould be a hard act to follow,“…up there with speaking afterBill Clinton I think…” she joked.“…but together with mywonderful Co-chair FrançoiseBarré-Sinoussi, we are readyand up for the challenge.AIDS 2014 will be a regionalconference with a strong focusMs Kumar was awarded theprestigious International AIDSSociety (IAS)/Agence NationalRecherche de SIDA (ANRS)Young Investigator prize atthe conference.Her research on how dendriticcells assist the establishmentof latency, achieved the highestscoring abstract in ‘cureresearch’ in the basic sciencetrack, securing a cash prizeof $2000.“It was really humbling, I’vealways been interested in thehumanitarian side of thingswhich is why I decided to focuson HIV research,” Ms Kumar said.Dr Lachlan Gray presenting at AIDS 2012.Dr Lachlan Gray fromBurnet’s Centre forVirology was invitedto present his mostrecent work, a discoveryabout how HIV hidesin the brain, at AIDS2012 supported by anumber of scholarships,most notably fromthe InternationalAIDS Society.“The pre-conference Towards anHIV Cure wrapped up completinga two-day event that culminatedin the release of the NatureReviews Immunology paperTowards an HIV Cure: a globalscientific strategy, which wasprepared by the IAS ScientificWorking Group on HIV Cure.My colleagues, ProfessorSharon Lewin and AssociateProfessor Melissa Churchill areboth members of the workinggroup and it’s a great testamentto them and their pioneeringwork that they were selectedto join this very importantand instrumental group.Together the group undertooka comprehensive review of theresearch related to HIV cure andidentified seven major themesgoing forward that will aid in thedevelopment of HIV cure anderadication strategies.My presentation at the meetingwas well received and generateda lot of discussion.I really enjoyed presenting atAIDS 2012, covering half of theposter session as a rapporteur atthe pre-conference symposiumand chairing another sessionwith Nicholas Chomont.(Dr Nicolas Chomont is aprincipal investigator at theVaccine & Gene TherapyInstitute of Florida, USA andan internationally recognisedscientist who specialises in HIVand AIDS research.)We heard inspiring talks fromTony Fauci (Director NIAID), PhilWilson (Black AIDS Institute),Hillary Clinton and Elton John.My second presentation andchairing session went well andI met with a journalist fromNature and my co-chair NicholasChomont to discuss cure, latencyand the Berlin patient.”(Timothy Ray Brown is known asthe “Berlin patient”, becausethat’s where he received a bonemarrow stem cell transplant in2007 and has since claimed he iscured of HIV.)14 IMPACT Summer 2012

Historic moment in signing MOUin Papua New GuineaBurnet has been actively involved in health programsin PNG for more than a decade.The successful long-standing partnership between the BurnetInstitute and the University of Papua New Guinea was formalised withthe signing of a Memorandum of Understanding (MOU) in September.Institute Director and CEO, Professor Brendan Crabb signed theMOU with the University of Papua New Guinea’s Dean of the Schoolof Medicine and Health Sciences, Professor Sir Isi Kevau.The MOU outlined locating the Institute’s Port Moresby office tothe University’s campus, supporting the Public Health Program ofthe School of Medicine, and developing joint research activities.“This MOU reflects our commitment to work closely with key localpartners in PNG to help address some of the country’s most criticalhealth issues,” Professor Crabb said.Burnet Director and CEO electedAAMRI PresidentProfessor Brendan Crabb has taken on the role of Presidentof the Association of Australian Medical Research Institutes(AAMRI), the peak body that represents Australia’sindependent medical research institutes.Professor Crabb said he was honoured to beelected President.“I see this appointment as an opportunity to ensure thatgovernment, business and the public are kept aware of thetremendous contributions that medical research makes toimproving human health and to the economy, particularlythrough the activities of medical research institutes,” he said.AAMRI represents 41 medical research institutes acrossAustralia and has among its key goals the effectiverepresentation of medical research interests to government,industry and the public.Professor Brendan Crabb, the new President of AAMRI.IMPACT Summer 2012 15

Your bequest will help transform lives.At Burnet, we’re passionate in our commitment to a healthier world.Whether it’s researching and developing newapproaches to the prevention and treatment ofinfectious diseases such as HIV, hepatitis,malaria or tuberculosis, understanding thefactors underlying cancer, or building capacityand strengthening health services in thedeveloping world, everything we do is focusedhealth in Australia and overseas.your Will, please call our Planned Giving ManagerMerrilyn JulianPlanned Giving ManagerTel: (03) 8506 2338Email: mjulian@burnet.edu.auburnet.edu.auAUSTRALIAHead Office85 Commercial Road, Melbourne, Victoria 3004Tel: +61 3 9282 2111Fax: +61 3 9282 2100Email: info@burnet.edu.auwww.burnet.edu.auA.B.N. 49 007 349 984Overseas OfficesThe Institute has offices in South East Asia, the Pacific region and China (Tibet). For moreinformation about our work overseas or to contact our international offices, please emailinfo@burnet.edu.au or call us on + 61 3 9282 2111MYANMAR (BURMA)No 226, 4th Floor, 226 Wizaya Plaza U,Wisara Road, Bahan Township,Yangon, MyanmarPAPUA NEW GUINEAPort Moresby3 Mile, School of Medicine,Medical Sciences Building, University of PNGCHINA (TIBET)Baofa Hotel, No 6 Hong Qi Road,Lhasa 850000, TAR ChinaKokopoPO Box 1458, Kokopo Post Office,East New BritainLAO PDRSCC Co Ltd, Building No. 006, Ban Sihom,Room 4B/01a, Vientiane, Lao PDR