Prof Anneke Hesseling keeps a painting by Sir Luke Fildes called The Doctor above her desk. The image of the Victorian-era general practitioner observing the “crisis of illness" in a child in those (pre-antibiotic) days is an enduring one – a record of the status of the physician at a particular time in history.
It's an image she grew up looking at often as it used to hang in dad, Peter Hesseling's, study for years. He is a renowned paediatric oncologist based at Stellenbosch University (SU), and Anneke's maternal grandmother, Emma Terblanche, was a psychiatrist who trained at the University of Witwatersrand in the 1920's. “I actually wanted to study music, but medicine is something I kind of fell into. I'm really glad I did!"
Appointed as the Director of the Desmond Tutu Tuberculosis Centre (DTTC) based at SU's Faculty of Medicine and Health Sciences (FMHS) in 2016, Hesseling says she has an “urgent responsibility" to address efforts to prevent tuberculosis (TB) both locally and internationally. After HIV/Aids, this ancient disease is the leading infectious killer on earth. This toll continues despite a known cure existing for nearly a century. Large-scale efforts to ensure the prevention of TB are thus the modern imperative.
Children are her focus
Hesseling is especially concerned with the effects of TB on children, as its rampant spread still affects one in ten South African children. The World Health Organisation (WHO) estimates that at least 1 million children under the age of 15 currently suffer from TB worldwide and the yearly death toll is some 250 000.
“For centuries there were just these ﬁnite ways to treat a disease like TB which, coupled with HIV, causes further complexity. Minors do not get to choose their circumstances or what they are exposed to. They are passive recipients of everything that happens to them and that is why I've decided to make this speciﬁc focus my passion," Hesseling explains.
Her many accolades include being awarded the ﬁrst research chair in paediatric TB in South Africa a few years ago. With nearly twenty years' experience in paediatric TB research in South Africa; she has carved a career path which was virtually unheard of when she completed her medical studies at SU in the 1990s. “At the time, public health wasn't this awe-inspiring thing to look into, but then I worked and studied abroad, ﬁrst in Amsterdam in 2001 and then in the USA in 2003. Spending time and obtaining training in epidemiology and public health in the USA offered me a global (health) perspective of South Africa and its response to TB and HIV/Aids speciﬁcally. That was a transformative experience and it set the course for what would eventually become my career."
Through continued ediﬁcation and leadership of mentors and the people who came before her, she has come to understand the value of a working environment which fosters collaborative learning in an effort to ﬁnd the answers to some of the most pressing questions in the ﬁeld. “The (DTTC) environment has always consisted of this wonderful group of researchers who led from the front and have left us with a rich legacy. I count professors Nulda Beyers (the former and founding DTTC director), Mark Cotton, Simon Schaaf, Peter Donald and Robert Gie as real pioneers in this respect. We also have a wonderfully rich and research-supportive academic department here in Paediatrics and Child Health, with a strong legacy of clinical research."
She has chosen to lead the DTTC, which was established in 2003, in a systematic but consultative way, entrenching paediatric TB alongside operational research and health systems strengthening and HIV prevention as key strategies in a bid to achieve the centre's objectives. “Our current vision and strategy is to be the global leader in paediatric translational TB research, to become a leader in other key research areas within the next ﬁve years, as well as to lead in other domains globally in terms of implementation and health systems strengthening. It is the only way to approach pandemics of this nature.
“We have strong collaborations internally, nationally and internationally to support the design, implementation and analysis of our research programme and we are working very hard at building capacity in our own ranks," Hesseling says. “I have increasingly started to realise what role social behavioural research plays in our work, which is why we prefer to work consultatively. When you are looking for solutions, you have to realise that everything is connected, including social determinants of health. TB and HIV affect families and communities."
Hesseling is a strong proponent of evidence-based strategies and therefore focuses on motivation for good research infrastructure as far as possible. “The DTTC is uniquely positioned in this university in that we're working off a phenomenal research base. This is not necessarily a given everywhere. The DTTC is furthermore geared towards pooling collective knowledge in a consultative and pragmatic way as a means to build capacity for the future and foster the next generation of researchers." These strong collaborative efforts have resulted in what she calls a “breeding ground for great research", which facilitates translational work. “For example, where we've developed an intervention that is relevant for adults, we will ask which strategies (of that intervention) children will like, and what works in the context of families and communities."
Leaders in clinical research
Her work is furthermore concerned with ﬁnding ways to translate the very granular ﬁndings of scientiﬁc research into policy. In mid-2018, Hesseling co-authored a large international systematic review, which was published in the weekly medical journal PLoS Medicine. The review showed that tuberculosis treatment is successful in children with multidrug resistant tuberculosis (MDR-TB) and informed the WHO's guidelines on the treatment of MDR-TB in children in 2017.
According to Hesseling an estimated 32 000 children develop MDR-TB each year. Treatment for MDR-TB is longer and requires more toxic drugs. “These regimens are frequently hard to tolerate, particularly in children. Very little is currently known about the optimal treatment for these children and this review therefore provides vitally important information about potential outcomes and some very good news for the TB ﬁeld.
“We are now leading clinical research on novel drugs like bedaquiline and delamanid in children, and plan on evaluating a six months orally administered regimen for MDR-TB treatment, which will be a major breakthrough for children in South Africa and globally.
“We are also leading work on better ways to treat and prevent TB in children, ending decades of historical neglect in this area," Hesseling concludes.
Photo credit: Damien Schumann