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

”

Bringing antiretroviral drugs to children

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

The challenge

Seasonal Malaria Chemoprevention (SMC) is a new strategy to reduce the malaria burden in young children in Sahelian countries. SMC consists of the administration of full treatment courses at regular intervals during the malaria high-transmission season. However, it is not clear if there is a cumulative effect of SMC on the acquisition of antibodies to malaria antigens.

Dr Combasssere-Cherif intends to establish the key elements for understanding the potential role of seasonal malaria chemoprevention (SMC) in the buildup of immunity against clinical malaria in Burkina Faso. Specifically, sho proposed to study how SMC during low and high transmission affects parasite presence, density, and diversity (or clones), and host antibodies response. She aims to establish the relationship between asexual parasite densities, multiclonal infections with Plasmodium falciparum and immune responses before and after SMC.

Building on existing collaborations, she and her team will conduct a prospective cohort study following the national health policy of SMC in Burkina Faso. It is a full treatment course of sulfadoxine-pyrimethamine plus amodiaquine (SP+AQ) given to 6-59 months old children at monthly intervals during the malaria high-transmission season from July to October. The project comprises five cross-sectional surveys to establish the relationship between SMC, malaria prevalence, parasite densities, the number of new P. falciparum clones as well as the immune responses across surveys, before and after SMC.

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 approach used in this project could be implemented as part of a surveillance program to explain the impact of SMC in Burkina Faso where malaria is endemic, stable and seasonal. This study will serve as a proof of concept in order to optimise the design of interventions targeting the asymptomatic reservoir of the parasite.

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