Inaugural Lectures
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This collection contains text versions of Inaugural Lectures presented by University of Ghana full professors.
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Item “Of Indomie, Kalyppo and Condoms: An Intimate Conversation About Corporate Social Responsibility in Ghana.”(University of Ghana, 2024-06-27) Ofori, D.Item Child Feeding for Human Health and Development: Bridging the Know-Do Gap(University of Ghana, 2024-07-11) Aryeetey, R.O.N.‘You are what you eat’ is a commonly quoted phrase when people think of diet. A healthy diet promotes optimal health and development. On the other hand, suboptimal diet can hurt you in more ways than you can imagine. Diet simply refers to what you eat and drink regularly as a lifestyle. It also relates to the habits and practices surrounding how you eat. Transitions in lifestyles, fuelled by rapid industrialisation, urbanisation, global trade, information access and other indicators of civilisation is creating a situation where unhealthy diets have become the norm. Indeed, there is a global pandemic of unhealthy diets. The bad news is that, unhealthy diet is one of the leading risk factors driving the main causes of death, diseases and disabilities, including diseases like cardiovascular diseases, diabetes and some cancers. Infants and young children are most vulnerable to unhealthy diets. In our part of the world, they suffer twice from unhealthy diets. During childhood, they experience undernutrition that is occasioned by suboptimal feeding. Across West Africa, about one-third or all children under 5 years are chronically malnourished. The suboptimal feeding in childhood and its resulting malnutrition, then physiologically programmes young children into adults, with a high risk for diet-related chronic diseases. These young children have an even bigger challenge. They depend on their caregivers (mothers, fathers, grandmothers, others), to make the decisions that ensure that their diets are adequate for not only surviving childhood, but also to grow, thrive and to contribute meaningfully to society. This is because when infant feeding goes wrong, it has implications not only for individual children and their families but also for the entire society. A large part of my research and extension over the past two decades has focused on understanding the barriers to optimal infant and young child feeding. My expectation is that this evidence will serve as a basis for advocacy to improve the quality of the public health interventions that target young children. There is robust and consistent evidence that when children are exposed to appropriate ways of breastfeeding and subsequently complementing breast milk with appropriate nutrient-rich foods from the 6th month, in line with national and global recommendations, they, their mothers, their households and society benefit in many ways including reduced risk of disease, death, savings of revenue that will otherwise be spent for health care, improved learning abilities and enhanced productivity. However, despite the weight of the evidence related to these outcomes, as a nation, we have failed to ensure adequate feeding of our children. Our failure is not due to the lack of effort to address this challenge. Indeed, several programmes and projects have been, and continue to be implemented, with much resources expended to address the multi-dimensional and hierarchical drivers of sub-optimal child diets. In this lecture, I utilise global evidence, as well as my own research to demonstrate why we have not been successful in addressing the challenge of child feeding. In outlining the barriers, I point to the irony of having access to all the evidence of what works (efficacy) and yet not being able to translate them into action. I will argue that this is partly a challenge of our institutional arrangements regarding the delivery of services for ensuring optimal infant and young child feeding as well as our individual choices as caregivers of the children we love so much. I also underscore the complexity of delivering interventions in an increasingly urbanising population with diverse needs, and how important it is to enhance coordination across sectors in our governance system to meet the needs. Between 2014 and 2018, I led multiple research projects in Ghana focusing on young child nutrition that provided evidence on how we can improve the diets of infants and young children. I will provide a brief synthesis of findings of these studies as a basis for bridging the know-do gap, to limit the current sub-optimal diets of Ghanaian children. Further, there are emerging challenges that must be recognised as well as novel solutions to infant and young child feeding that Ghana is yet to take advantage of. I will make reference to some of these as a basis for the recommendations that I will advance for improving infant and young child feeding in Ghana.Item Ending HIV/AIDS in Africa: Reflections from the Clinic, Field and Classroom(University of Ghana, 2023-08-10) Torpey, K.The first case of AIDS was first identified in early 1980 in Los Angeles, USA with patients showing evidence of severe immunosuppression. In 1981, the syndrome was described and the virus was subsequently isolated in 1983. There are two types of HIV. HIV-1 is the predominant type found all over the world. In addition, HIV 2 is found in the West Africa region. HIV 2 is less virulent compared to HIV 1. In Ghana HIV 1 accounts for almost 98% whilst HIV 2 alone or in combination with HIV1 account for approximately 2%. The origins of HIV range from several conspiracy theories to divine retribution. Viruses related to HIV-1 have been isolated from the common chimpanzee and several monkey species. There are different clades of HIV -1. Ranging from main group M made up several clades to the outlier O group. Simian immunodeficiency virus of sooty mangabeys (SIVsmm) is recognized as the progenitor of human immunodeficiency virus type 2 (HIV-2). SIV infection in humans has been documented. A paper by Marcia Kallish on Emerging Infectious Disease in 2005 among Central African hunters, showed a prevalence of 17.1% in the most exposed, that is those who hunted and butchered or kept non-human primates. There are about 39million people living with HIV. 20.8 million of them are in East and Southern Africa, 4.8million in West and Central Africa. UNAIDS update in 2023 estimates that a life is lost every minute due to HIV. This is equivalent to 650,000 HIV related deaths. In addition, there are 4,000 new infections daily. Every week, 4,000 adolescent girls and young women get infected, while 84,000 children died of HIV last year. Subsaharan Africa accounts for 51% of all new infections. 76% of people living with HIV are on treatment. Unfortunately for children, only 57% are on treatment. Key populations account for less than 5% of the world population but 70% of new infections occur among them and their sexual partners, underlying their vulnerability and a call to action. In 2002, the HIV treatment project called START was birthed through a collaboration of Family Health International and the Ministry of Health. The funding was to start the first 100 patients in St. Martin’s Hospital in Agomanya and Atua Government Hospital in Atua in the Manya Krobo District, on antiretroviral therapy. Following the overwhelming success in the pilot project, the then UK Department for International Development moved to support the programme. Subsequently the national treatment programme secured funding from USAID, Global Fund and the World Bank. The success was attributable to the commitment of health care workers, facilities, and use of evidence based approach. The experiences in treating persons living with HIV from the pilot project allowed the development of practice guidelines on the management of side effects like anaemia, peripheral neuropathy, hepatoxicity among others. Antiretroviral therapy made a huge difference in the life of individuals. There was a reduction in morbidity and mortality. It was clear that patient level strategies at the clinic was effective, however many persons living with HIV did not have access to treatment. This required radical change in mindset to transfer the benefits observed at the clinic to the population level, particularly in countries with high HIV prevalence or population. This influenced our intervention strategies particularly in Eastern, Southern Africa and Nigeria and marked an important transition in my career by moving the advantages observed in the clinic to the population level. In Zambia, we implemented the adherence support worker strategy to address the human resource challenges. Adherence Support (Models of Hope in Ghana) are persons living with HIV who are trained to offer adherence counseling and follow up. We showed that the adherence counselling provided by these lay providers was comparable to that provided by nurses. We were also able to demonstrate that HIV testing using lay providers was comparable to testing service by nurses. This important evidence provided a strong basis for task shifting efforts to expand access to HIV services across sub-Saharan African countries. HIV in children is a blot on the conscience of humanity. This is because we have the knowledge and the strategies to eliminate pediatric HIV Elimination of Mother to Child Transmission in Africa. Mother to child transmission of HIV can take place during pregnancy, labour and delivery and during the breastfeeding period. In an observation study of over 28,320 HIV positive mother baby pairs from 317 facilities and 40 districts in Zambia, we observed that HIV transmission was lowest among those where baby and mother received prophylaxis and highest among those who did not attend antenatal clinic. In addition, mothers who received the drugs were less likely to transmit HIV to their babies. Women who practiced mixed feeding were likely to transmit HIV to the babies. Other early infant diagnosis studies that we conducted in Kenya and Malawi affirmed this fact. Majority of pregnant women screened at the antenatal clinic would test negative. Unfortunately, several of them would seroconvert during the pregnancy because of repeated sexual exposure. In our published work in JIAPAC, we were able to show that pregnant women who seroconverted during pregnancy were four times more likely to transmit the infection to the baby. HIV re-testing among seronegative mothers is essential in eliminating HIV. Key populations are defined groups who, due to specific higher risk behaviors, are at increased risk of HIV, irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviors that increase their vulnerability to HIV. The key populations are important to the dynamics of HIV transmission. UNAIDS describes five main groups as key population. They include the following; sex workers, men who have sex with men, transgender people, persons who inject drugs and prisoners as well as other incarcerated people. Key populations account for less than 5% of the world’s population but about 70% of new infections in 2021. In sub-Saharan Africa, 49% of new infections are among the general population, 41% are among sex workers, clients of sex workers and sexual partners of other key populations and 6% among men who have sex with men. In terms of relative risk, for persons who inject drugs the risk is 7X higher, 4X higher among sex workers, 11X among men who have sex with men and 14X among transgender people. A strong HIV programme can only do well in a strong health system.Globally, official development assistance for HIV from bilateral partners apart from the US Government has declined. The World Bank projects that 52 countries, home to 43% of people living with HIV, will experience a significant drop in their public spending capacity through 2026. The role of domestic financing of HIV programmes will become very crucial. Ghana must make urgent steps to increase its domestic contribution to HIV not only to provide services to its people but also demonstrate its commitment to the national response. The approval and operationalization of the National HIV/AIDS fund will be a step in the right direction. As a teacher, building capacity of the next generation of implementers and scientists in HIV programming, is an area of great importance. Currently our training grants and scholarships, programme related research and evaluations seek to give hands on experience in programme implementation to our beneficiaries. The use of long-acting agents in HIV treatment is another interesting area. Evidence from LATTE 1&2, FLAIR and ATLAS studies has shown that long acting Carbotegravir and Rilpivirine administered monthly or bimonthly are effective compared to the standard of care for treatment. Carbotegravir and Rilpivirine also known as Carbenuva, was approved by the US FDA in January 2021 for two monthly dosing. Lenacapavir is an exciting new drug that was approved in the European Union and UK, recently, in August 2022 for drug resistant HIV. It belongs to capsid inhibitors group. It can be given 6 monthly. Can we end AIDS in Africa? To get into the right trajectory to end AIDS in Africa, we need to attain the state of epidemic control. Epidemic control of HIV is when the number of new HIV infections in less than the number of HIV deaths. This will lead to a gradual decline of persons infected with HIV. In 2022, West and Central Africa had 160,000 new HIV infections with 120,000 HIV deaths. In Eastern and Southern Africa there were 500,000 new infections and 260,000 deaths. Back home in Ghana, there were 17,000 new infections and 9,900 deaths in 2021. Eswatini, Botswana, Rwanda, Tanzania and Zimbabwe have achieved the 95-95-95 whilst eight others are on track to reach the target. Achieving epidemic control requires systematic reduction of new infections in the Africa region.Item Beyond The Limit: Engineering Sustainable Solutions for Basic Human Needs(University of Ghana, 2024-06-13) Prof. David Dodoo-ArhinItem Pharyngoesophagoplasty for Patients with Benign Intractable Pharyngoesophageal Stricture: The Daunting Task of Restoring Deglutition(University of Ghana, 2024-05-09) Prof. Mark TetteyABSTRACT Swallowing or deglutition is one of the complex functions of the body. This is often taken for granted until there is a challenge that makes this function difficult or impossible. The swallowing mechanism can be disrupted functionally or by pathological conditions of the structures that are involved in ensuring coordinated swallowing without aspiration. The anatomy of the pathway through which food masticated is delivered to the stomach is quite complex especially at the pharyngeal level. The pharynx (throat) is a muscular tunnel that connects the mouth and nose to the oesophagus and the larynx. At this level the food is no longer under voluntary control and any pathological process that disrupts the smooth and fine coordination of muscles is complicated by aspiration. One of the pathological conditions which severely disrupts the swallowing mechanism and at the same time threatens the airway is benign pharyngoesophageal strictures. This commonly occurs because of caustic ingestion and rarely, from radiation injury during treatment of head and neck tumours. Caustic injuries to the aerodigestive tract occur when individuals accidentally or intentionally (suicidal intent) ingest strong acid or alkali. In our environment, accidental ingestion of caustic soda is common and a serious public health issue. Caustic soda is a strong alkali and has devastating consequences when it encounters tissues; the chemical reaction that ensues leave behind chemical burns with necrosis that can penetrate very deep into tissues and organs. Victims who accidentally swallow this substance are mostly children of mothers or relative of these mothers who engage in local soap making. The caustic soda which is the main ingredient of local soap is often stored in familiar containers (cups or water bottles) by these mothers. The unsuspecting child, when thirsty, reaches out for this and drink before realizing he/she has swallowed a poison. Patients who swallow caustic substances destroy structures in the oral cavity, pharynx, larynx, and the oesophagus. The long-term complications of fibrosis and stricture formation destroy the normal anatomy – structural distortion, lumen obliteration from stricture and loss of coordination of these structures. The outcome of these complications is dysphagia which may be absolute for life and sometimes with obliteration of the normal airway. Most patients suffer these complications downstream in the oesophagus, but a few about 0.6% to 24% of these patients have complications at the level of the pharynx. Restoring gastrointestinal continuity in patients with caustic and radiation injury at the level of the pharynx (pharyngoesophageal strictures) is a dauting task all over the world. The challenge is at the pharyngeal phase where the anatomy is shared by the airway and the path for food. This is well coordinated to regulate the safety of the airway during swallowing. Repair of a stricture at this level to restore gastrointestinal continuity and preserve normal functioning of the airway is the struggle for most surgeons all over the world. Repair is complicated by aspiration whenever the patient attempts to eat and often takes weeks to overcome with physiotherapy. An unsuccessful correction may commit these patients to feeding through a gastrostomy tube with or without tracheostomy for life. Currently, no standard procedure is prescribed for strictures involving the pharynx. The National Cardiothoracic Center since 2006 started research into the management of these complex pharyngoesophageal injuries resulting from caustic ingestion. The demonstration lecture I delivered on the 20th of May 2011 as part of the procedure for my appointment as a lecturer in the University of Ghana Medical School, was my initial research work in patients with complex pharyngoesophageal strictures. The first article of work done in this regard was published by the Interactive Cardiovascular and Thoracic Surgery titled ‘Colopharyngoplasty for intractable caustic pharyngoesophageal stricture in an indigenous African community – adverse impact of concomitant tracheostomy outcome’ The conclusion was ‘In this African community (Ghana), colopharyngoplasty provided an effective means of restoration of upper digestive tract continuity in patients with severe caustic pharyngoesophageal strictures. Tracheostomy in this setting portends a significant long term mortality risk.’ Some of the patients operated who needed tracheostomy to protect the air way or presented with permanent tracheostomy suffered complications from the tracheostomy that resulted in their death. Tracheostomy care in the country has some challenges, especially in the poor. We were motivated to work on a procedure that will eliminate the use of tracheostomy in patients with severe pharyngoesophageal stricture with destroyed supraglottic apparatus. The search for a solution gave birth to the procedure I termed Colon- Flap Augmentation Pharyngoesophagoplasty (CFAP). More than 20 patients have benefited from this procedure with excellent outcomes. In this lecture, Professor Mark Tettey will provide in-depth knowledge of the aetiopathogenesis of caustic destruction of tissues, the different presentations of the devastating effect of complications of caustic ingestion and different procedures currently used in the management of these complications. The innovative procedure developed at the National Cardiothoracic Center and a classification of pharyngoesophageal strictures yet to be published will be presented. The classification is meant to help identify the different presentations and the surgical options available for optimal treatment.Item The Autobiographical Self as an Object for Sociological Enquiry(University of Ghana, 2024-07-25) Rev. Fr. Prof. Michael Perry Kweku Okyerefo(Auto)biographies are not accidental products; instead, they are shaped by the social world which gives birth to them. Societies inherently impact an individual’s life by means of their very social structures, which are themselves created through the interaction of social actors within and across a society’s history. In other words, the constant symbiotic interaction between social structures and social actors is an ongoing dynamic that can be observed and explained within historical and contemporary events. Consequently, the different social worlds in which an individual grows up and lives impact that individual’s life course. In this inaugural lecture, I examine this concept of the interaction between the individual’s life course and the social world further, drawing on my experiences of teaching and researching in different societies. I examine an example of autobiography intertwined with social structure which shapes academic life and discipline, through socially constructed networks. I argue that social worlds shape the social actor regardless of society, lending credence to the necessity for biographical and oral history, or “narrative” approaches to sociological discourse across societies. I rely on different facets of my life to reflect on my many years of engagement in teaching and researching sociological material and of my inner longing to unravel the eternal interconnectedness between the personal and the social. My goal is to achieve at least three things in this Inaugural Lecture: First, to convince you that autobiographies or biographies and social structures intertwine, as my own life illustrates. This makes the biographical method in sociology a useful platform, where structural and individual circumstances coincide to nurture social actors. Second, and flowing from the first, the biographical method can make Sociology a discipline tenable in all societies and cultures. Third, to inspire you, especially young people aspiring to read Sociology, that the discipline arouses one’s curiosity to understand oneself in relation to society. The individual develops an appreciation for the constant symbiotic interaction between social structures and social actors in an ongoing dynamic, that can be observed and explained within historical and contemporary events. In short, I aim to engender an awakening of your ‘social imaginations’ about the sociological endeavour that is true of our society, and any society for that matter. I draw on my life course and research corpus to depict how stories/narratives/biographies are central to critical and ‘decolonial’ research methods. Rather than deploying the time-worn approach of ‘decolonizing’ knowledge, which continues to define and denigrate a peoples knowledge production with reference to a single historical event and process that subjugate them, their thought process can be understood by interrogating their biography as impacted by their space, place and time. More explicitly in this context, biography serves as a mirror to envision African Social Thought to nurture a critical ‘African emancipatory sociological imagination’. The centrality of creativity and relationality in African and Indigenous Social Thought gives prominence to an African emancipatory imagination. The lecture underscores the interplay between autobiography and social structure. It argues that the social world, created by social actors, shapes the social actor, thereby making the (auto)biographical approach to sociological discourse an important global sociological enquiry. Drawing on the autobiographical self, this conceptual lecture reflects on how the personal life course is shaped by the social world, thereby impacting later years of teaching and researching sociological materials inspired by what nurtures the autobiographical development. The (auto)biographical approach, thus, emanates from a creative sociological imagination that situates the individual’s personal history within society’s public issues, thereby blurring a binary that is central to the very sociological endeavour. The fact that the biographical and the structural are inherently connected in a continuously and eternally dynamic symbiosis is thus laid bare.Item The Pursuit of Health amidst Scarcity: Economics, Health and the Romance in-between.(University Of Ghana, 2023-07-27) Nonvignon, J.ABSTRACT Economic scarcity and health Scarcity is a foundational concept in economics and is often referred to as the basic economic problem. Scarcity implies that while resources are essential to human existence, they are only available in limited quantities compared with the unlimited wants they seek to satisfy. This concept, therefore, requires that decisions about how these limited resources are used are made in the most optimal ways. For every resource, there are potential alternative uses, implying that the decision to tie a resource to a particular use denies one the benefits that would have been derived from an alternative use – a concept Economists refer to as opportunity cost. This implies that optimal resource use also requires setting priorities in a way that derives the best possible outcome for society (and minimizes the opportunity cost associated with the resource). In resource poor settings like Ghana and most of Africa, optimal use of recourses is particularly relevant given the wide range of competing needs for the limited resources. Society values health – good health – and often craves to “sacrifice” anything and everything to achieve good health. Indeed, as demonstrated by the COVID-19 pandemic, health is a public good that requires public resource allocation for sufficient benefits. The World Health Organization (WHO) recognizes health as a human right and this places obligations on states to ensure “access to timely, accessible and affordable health care”. The Sustainable (and Millennium) Development Goals emphasize the need for improved population health. However, the health sector also competes with other sectors for the available limited resources. The in-between: The economics-health romance The discussion so far points to a special relationship between health and economics. The popular saying that “Health is Wealth” underscores this relationship. Several theoretical propositions in the history of economics have pointed to a healthy population (labour force) as important determinant of economic growth. From Adam Smith’s (1776) “Wealth of Nations” to Gary Becker’s (1975) Human Capital theory and their extensions, economic theory proves that investing in health creates human capital and other resources necessary to grow economies. Specifically, Grossman (1972) argues that investment in good health allows for healthy time to participate in market and non-market activities, thereby boosting growth and wealth. These theoretical propositions together suggest a strong bi-directional relationship between health and economics, something that several empirical findings have confirmed over the years – the strongest to date being the COVID-19 pandemic. However, while investing in health is crucial, the concept of scarcity suggests that we cannot pursue health at all costs because resources have competing needs. Indeed, many countries in Africa seem to prioritize other things but health investments. For instance, despite the many commitments to ramp up funding for health (in the Abuja Declaration in 2001 African countries committed to allocate a minimum of 15% of their annual budgets to health) many countries continue to spend less than 10% of their annual budgets on health. In fact, each year, only between one and three countries have reached the Abuja target since 2001 (Ghana has never attained that target).1 In essence, society must decide on what amount of health we can pursue at the expense of other equally important objectives. That decision is not an easy one to make given the obvious implication of prioritizing one over the other, and often requires a comparative analysis of costs (inputs) and consequences (outcomes) of alternative interventions or courses of action – a health economics technique known as economic evaluation, which analyzes the efficiency of alternative courses of action. What this lecture offers In this lecture, I will argue that the future of health and the economy could not be said to be complete without the crucial role that health economics has to offer. I will further argue that, given the importance of health for the economy, decisionmakers, particularly in resource-constrained settings such as Africa, will need to prioritize health investments (more money for health) based on the potential to boost economic outputs, rather than for purely social reasons.. That said, I will also contend that health resources will need to be expended efficiently to achieve more health for the money. A combination of both will optimize population health with the limited resources. Re-prioritizing health investments in national economic policies – more money for health 1 Computations from the WHO World Expenditure Database Historically, health spending in many low and middle-income countries (LMICs), particularly in Africa, have been heavily donor dependent. Despite efforts at weaning such countries off donor dependence, through improved domestic resource mobilization, national budgets often rely heavily on development assistance for health (DAH), with basic services and commodities that could have been funded through domestic sources offloaded onto donors. Some argue that these countries, especially low-income countries, cannot afford to allocate more of their scarce resources for health. In this lecture, I will argue otherwise, that policymakers in Africa can – and should – re-prioritize their spending to allocate more for health, with DAH serving as a catalyst for domestic spending. I will also highlight how health economics tools can support the case for investing in health amidst scarcity. Priority setting for evidence-informed policymaking in Africa: more health for the money. While investing more in the health system is important, efficient allocation of the available resources is equally important. This part of the lecture will focus on how health decision makers can allocate and use the scarce resources to optimize outcomes. Health economics tools such as health technology assessment (HTA – a comparative assessment of costs and benefits, alongside ethics, equity and other frameworks, of health technologies, medicines and other interventions to inform decision-making and improve overall health service delivery and outcomes) provides the needed platform for evidence-informed priority setting (EIPS – a systematic approach to decision-making that uses health, economic and other evidence for decision-making). Many African countries are making efforts to institutionalize EIPS albeit with challenges. I will argue that the sustainability of Africa’s approach to institutionalizing EIPS lies in her ability to drive conceptualization and implementation, developing country capacity in a context-relevant manner and closing the evidence-policy gap through regular interactions between academic/research and policy communities. These arguments will be supported with specific examples from my research and evidence-policy initiatives, which have been the focus of my work over the past five years, helping countries in Africa implement a framework for systematically incorporating EIPS into health decision making.Item Ending HIV/AIDS in Africa: Reflections from the Clinic, Field and Classroom(University Of Ghana, 2023-08-10) Torpey, K.Abstract: Ending HIV/AIDS in Africa: reflections from the clinic, field and classroom The first case of AIDS was first identified in early 1980 in Los Angeles, USA with patients showing evidence of severe immunosuppression. In 1981, the syndrome was described and the virus was subsequently isolated in 1983. There are two types of HIV. HIV-1 is the predominant type found all over the world. In addition, HIV 2 is found in the West Africa region. HIV 2 is less virulent compared to HIV 1. In Ghana HIV 1 accounts for almost 98% whilst HIV 2 alone or in combination with HIV1 account for approximately 2%. The origins of HIV range from several conspiracy theories to divine retribution. Viruses related to HIV-1 have been isolated from the common chimpanzee and several monkey species. There are different clades of HIV -1. Ranging from main group M made up several clades to the outlier O group. Simian immunodeficiency virus of sooty mangabeys (SIVsmm) is recognized as the progenitor of human immunodeficiency virus type 2 (HIV-2). SIV infection in humans has been documented. In a paper by Marcia Kallish in Emerging Infectious Disease in 2005 among Central African hunters that showed a prevalence of 17.1% in the most exposed that is those who hunted and butchered or kept non-human primates. There are about 39million people living with HIV. 20.8 million of them are in East and Southern Africa, 4.8million in West and Central Africa. UNAIDS update in 2023 estimates that a life is lost every minute due to HIV. This is equivalent to 650,000 HIV related deaths. In addition, there are 4,000 new infections daily. Every week, 4,000 adolescent girls amd young women get infected, 84,000 children died of HIV last year. Subsaharan Africa accounts for 51% of all new infections. 76% of people living with HIV are on treatment. Unfortunately for children only 57% are on treatment. Key populations account for less than 5% of the world population but 70% of new infections occur among them and their sexual partners underlying their vulnerability and a call to action. In 2002, the HIV treatment project called START was birthed through a collaboration of Family Health International and the Ministry of Health. The funding was to start the first 100 patients in St Martin’s Hospital in Agomanya and Atua Government Hospital in Atua in the Manya Krobo District on antiretroviral therapy. Following the overwhelming success in the pilot project, the then UK Department for International Development moved to support the program. Subsequently the national treatment program secured funding from USAID, Global Fund and the World Bank. The success was attributable to the commitment of health care workers, facilities, and use of evidence based approach. The experiences in treating persons living with HIV from the pilot project allowed the development of practice guidelines on the management of side effects like anaemia, peripheral neuropathy, hepatoxicity among others. Antiretroviral therapy made a huge difference in the life of individuals. There was a reduction in morbidity and mortality. It was clear that patient level strategies at the clinic was effective however many persons living with HIV did not have access to treatment. This required radical change in mindset to transfer the benefits observed at the clinic to the population level particularly in countries with high HIV prevalence or population. This influenced our interventions strategies particularly in Eastern, Southern Africa and Nigeria and marked an important transition in my career by moving the advantages observed in the clinic to the population level. In Zambia, we implemented the adherence support worker strategy to address the human resource challenges. Adherence Support (models of Hope in Ghana) are persons living with HIV who trained to offer adherence counseling and follow up. We showed that the adherence counselling provided by these lay providers was comparable to that provided by nurses. We were also able to demonstrate that HIV testing using lay providers was comparable to testing service by nurses. This important evidence provided a strong basis for task shifting efforts to expand access to HIV services across sub-Saharan African countries. HIV in children is a blot on conscience of humanity. This is because we have the knowledge and the strategies to eliminate pediatric HIV Elimination of Mother to Child Transmission in Africa. Mother to child transmission of HIV can take place during pregnancy, labour and delivery and during the breastfeeding period. In an observation study of over 28,320 HIV positive mother baby pairs from 317 facilities and 40 districts in Zambia, we observed that HIV transmission who lowest among those where baby and mother received prophylaxis and highest among those who did not attend antenatal clinic. In addition, mothers who received three drugs were less likely to transmit HIV to their babies. Women practiced mixed feeding were likely to transmit HIV to the babies. Other early infant diagnosis studies that we conducted in Kenya and Malawi affirmed this fact. Majority of pregnant women screened at the antenatal clinic would test negative. Unfortunately, several of them would seroconvert during the pregnancy because of repeated sexual exposure. In our published work in JIAPAC, we were able to show that pregnant women who seroconverted during pregnancy were four times more likely to transmit the infection to the baby. HIV re-testing among seronegative mothers is essential in eliminating HIV. Key populations are defined groups who, due to specific higher-risk behaviors, are at increased risk of HIV, irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviors that increase their vulnerability to HIV. The key populations are important to the dynamics of HIV transmission. UNAIDS describes five main groups as key population; they include the following; sex workers, men who have sex with men, transgender people, person who inject drugs and prisoners and other incarcerated people. Key populations account for less than 5% of the world’s population but about 70% of new infections in 2021. In sub-Saharan Africa, 49% of new infections are among the general population, 41% are among sex workers, clients of sex workers and sexual partners of other key populations and 6% among men who have sex with men. In terms of relative risk, for persons who inject drugs the risk is 7X higher, 4X higher among sex workers, 11X among men who have sex with men and 14X among transgender people. A strong HIV program can only do well in a strong health system Globally, official development assistance for HIV from bilateral partners apart from the US Government has declined. The World Bank projects that 52 countries, home to 43% of people living with HIV, will experience a significant drop in their public spending capacity through 2026. The role of domestic financing of HIV program will become very crucial. Ghana must make urgent steps to increase its domestic contribution to HIV not only to provide services to its people but also demonstrate its commitment to the national response. The approval and operationalization of the National HIV/AIDS fund will be a step in the right direction. As a teacher, building capacity of next generation implementers and scientists in HIV programming is an area of great importance. Currently our training grants and scholarships, program related research and evaluations seek to give hands on experience in program implementation to our beneficiaries. The use of long-acting agents in HIV treatment is another interesting area. Evidence from LATTE 1&2, FLAIR and ATLAS studies has shown that long acting carbotegravir and rilpivirine administered monthly or bimonthly is effective compared to the standard of care for treatment. Carbotegravir and rilpivirine also known as Carbenuva. Carbenuva was approved by the US FDA in January 2021 for two monthly dosing. Lenacapavir is an exciting new drug that was approved in the European Union and UK, recently, in August 2022 for drug resistant HIV. It belongs to capsid inhibitors group. It can be given 6 monthly. Can we end AIDS in Africa? To get into the right trajectory to end AIDS in Africa, we need to attain the state of epidemic control. Epidemic control of HIV is when the number of new HIV infections in less than the number of HIV deaths. This will lead to a gradual decline of persons infected with HIV. In 2022, West and Central Africa had 160,000 new HIV infections with 120,000 HIV deaths. In Eastern and Southern Africa there were 500,000 new infections and 260,000 deaths. Back home in Ghana, there were 17,000 new infections and 9,900 deaths in 2021. Eswatini, Botswana, Rwanda, Tanzania and Zimbabwe have achieved the 95-95-95 whilst eight others are on track to reach the target. Achieving epidemic control requires systematic reduction of new infections in the Africa region.Item Inaugural Memorial Lecture to Commemorate Okyenehene Ba Dr. Jones Akwasi Amoako Atta Ofori-Atta(University of Ghana, 2022-07-06) Oquaye, A.M.Item How our Immune System Acquires Tolerance to Malaria and Helped us Survive COVID-19.(University of Ghana, 2023-06-08) Awandare, G.A.Malaria and COVID-19 are two of the most devastating infectious diseases that have impacted public health globally. While they are caused by two entirely different pathogens, their clinical manifestations overlap significantly, and these similarities mirror the immunological mechanisms that determine disease outcomes. In this lecture, the biology of the two pathogens, as well as the human immune responses to infections by these pathogens will be discussed. In addition, the lecture will discuss science capacity building in Africa, and the impact of the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in developing science leadership on the continent. One of the most remarkable phenomena observed during the COVID-19 pandemic was the relatively low mortality in sub-Saharan Africa, despite various ominous predictions of devastation of the continent. Data will be presented to demonstrate how frequent exposure to malaria trained the human immune system to tolerate further infections. Furthermore, the data will show that the malaria-induced reprogramming of the immune system was beneficial to people living in malaria endemic areas during the COVID-19 pandemic by protecting them from severe disease and death. Malaria is caused by a parasite known as Plasmodium, and the specific type that causes the most disease and death in humans is called Plasmodium falciparum. This parasite is transmitted from one human to another through the bite of an infected Anopheles mosquito. Although the parasites go to the liver first, they eventually enter the blood where they repeatedly invade, grow and burst out of red blood cells. During each cycle, when the parasites burst out, large quantities of parasite products are released into the blood, which stimulate the immune system, and cause symptoms such as fever. The immediate reaction of the immune system is an inflammatory response, characterized by the release of mediators including cytokines such as interleukin-12 (IL-12), Tumor necrosis factor alpha (TNF-alpha) and reactive nitrogen and oxygen species, which help kill the parasites. However, excessive production of these pro-inflammatory mediators can be deleterious to human tissues and organs, and therefore needs to be carefully regulated to prevent exacerbation of disease pathogenesis. In individuals living in malaria-endemic countries such as Ghana and the rest of sub-Saharan Africa, exposure to malaria begins early in childhood, with immunity (resistance) being acquired after repeated infections by Plasmodium. This acquired resistance to malaria appears to be two-fold: anti-parasite immunity and anti-disease immunity. While anti-parasite immunity is mediated by the development of specific antibodies targeting P. falciparum, which act to suppress parasite multiplication, our data demonstrate that anti-disease immunity is mediated by controlling excessive inflammation and thereby minimizing clinical symptoms without necessarily clearing the parasites. In that sense, anti-disease immunity is essentially clinical immunity, which can be achieved by ‘tolerating’ the parasites. Recent research indicates that the blunting of inflammatory responses that confers tolerance to malaria parasites is mediated by epigenetic (on-top-of genetics) mechanisms, which involve reprograming of immune cells to prevent them from responding to inflammatory stimuli. Therefore, the anti-disease effects of malaria-induced tolerance appears to extend beyond Plasmodium stimulation to other inflammatory stimuli, including other pro-inflammatory pathogens such as certain bacteria and viruses. COVID-19 is caused by the Novel Coronavirus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which is highly contagious and transmitted through the oral and nasopharyngeal routes. Although SARS-CoV-2 is a much smaller and less complex pathogen than Plasmodium, COVID-19 shares several symptoms with malaria, including fever/ chills, headaches, malaise, vomiting etc. As observed in malaria, COVID-19 pathogenesis is characterized by the increased release of pro-inflammatory cytokines, the so-called ‘cytokine storm’, which if unchecked could cause multi-organ damage in the patients. Furthermore, the majority of SARS-CoV-2 infections are asymptomatic (without clinical symptoms), which mirrors the situation in malaria-endemic areas, where the majority of Plasmodium-infected individuals show no symptoms of disease. Given these curious similarities between COVID-19 and Malaria, and the general trend of less COVID-19 severity in sub-Saharan Africa, it was of interest to investigate the possible interactions between the two diseases. Therefore, we investigated the production of cytokines in SARS-CoV-2-infected individuals in Ghana who were either asymptomatic or had mild to severe symptoms of COVID-19. Our data show clearly that asymptomatic infections were associated with a distinct lack of inflammatory responses while individuals showing symptoms had significantly increased levels of pro-inflammatory cytokines in their blood. Of significant interest, we also observed that evidence of high previous exposure to malaria was associated with a blunted inflammatory response and protection from clinical disease following a SARS-CoV-2 infection, indicating the impact of malaria-induced tolerance to inflammatory stimuli. Taken together, the evidence from our research establishes that our immune system learnt how to tolerate malaria parasites after repeated infections by inhibiting our cells from responding to further stimulation. Further, our work extended to COVID-19 and showed that the immune cell reprogramming that was acquired from living in a malaria-endemic area protected us against development of severe disease during infections by SARS-CoV-2. These findings contribute to a better understanding of the global dynamics of COVID-19 infections and mortality.