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test the safety and efficacy of this new formulation in young children

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Bringing antiretroviral drugs to children

The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.

The challenge

Rabies contracted following bites by infected dogs still kills 60,000 people a year. This is despite the existence of a highly effective treatment, post-exposure prophylaxis, in which a rabies vaccine is administered soon after a bite from an infected animal. 

The cost of post-exposure prophylaxis is a major barrier to its use in low-income settings. To overcome this barrier, Gavi, the Vaccine Alliance, is willing to make funds available to support procurement of rabies vaccine by Gavi-eligible countries. However, effective systems are required in countries to ensure post-exposure prophylaxis can be introduced effectively. 

Major obstacles to the use of post-exposure prophylaxis include inadequate supply chains and poor communication between public and animal health bodies. The BlockRabies project aims to overcome these barriers using innovative blockchain technology, which enables information to be captured electronically and stored securely and shared among collaborating groups.

The project is engaging with European stakeholders to develop blockchain-based approaches to ensure adequate supplies of rabies vaccine in Mali and Cote d’Ivoire. Blockchain requires only simple tools to use, such as mobile phones, but provides a powerful way to coordinate and manage supply chains so that stocks are always available where they are needed. Blockchain approaches are also being used to promote the sharing of information and alerts between health providers and health and veterinary authorities.

The project will also drive forward use of a streamlined protocol for intradermal post-exposure prophylactic vaccine use for all rabies-suspected bite victims, which has been recommended by WHO but has not been widely adopted in sub-Saharan Africa.

Other activities include promoting wider implementation of rabies diagnostic testing in animals. Adherence to treatment and clinical outcomes will be monitored through use of mobile technologies and health centre visits. The project will also undertake an economic analysis to determine the financial implications of the new approach.

The project

The later CHAPAS-3 trial compared the efficacy and safety of three fixed-dose combinations including two without stavudine (found to have some long-term side effects in adults, leading to a recommendation that its use be discontinued in children). The trial the first of its kind in Africa studied nearly 500 children at four sites in two African countries.

The BlockRabies project will establish a model for treatment of suspected rabies with the potential to be scaled nationally and adapted by other countries. It will provide a mechanism to deliver the Gavi rabies strategy, and contribute to global goals to reduce human deaths from rabies to zero by 2030.

ratios forfixed-dose combinations and on appropriatedosage according to weight. 

The CHAPAS-3 trial confirmed the effectiveness of fixed-dose combinations, providing further impetus to the rollout of antiretrovirals to children. Its evidence on abacavir informed the WHO recommendation of abacavir-containing combinations for first-line therapy in children. Trial data have also been used to support applications for regulatory approval for new scored efavirenz tablets.

Impact