“
crucial in

widening African

children’s access

to antiretrovirals

”

Bringing antiretroviral drugs to children

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

The challenge

TB is responsible for around 40% of the deaths of people living with HIV. Hence there is great interest in interventions that address both infections.

Control of HIV is increasingly moving towards ‘test and treat’ strategies, screening as many people as possible and starting antiretroviral therapy in all those found to be infected with HIV.  Potentially, approaches to TB detection and prevention could be integrated into population-based initiatives to identify HIV infections.

The HPTN 071 (PopART) trial, the largest trial ever of combined HIV and TB prevention, involving around one million people, found that targeting entire populations cut the number of new HIV infections by 30%. The TREATS study is using the PopART trial infrastructure to determine whether population screening for active TB, piggybacking universal HIV testing and treatment, leads to a reduction in the community burden of TB.

The trial is taking place in 21 communities in South Africa and Zambia. A trial on the scale of PopART is unlikely ever to be repeated, so it provides a unique opportunity to collect data on population-based approaches for detecting TB.

TREATS will also use a range of methods for detecting TB infections and cases of active TB (most cases of TB are inactive, or latent; people with latent TB infections cannot spread the disease). These studies will provide a wealth of data on the best ways of measuring the number of new cases of TB each year and the prevalence of TB infection and disease.

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 TREATS trial is a unique opportunity to gather information from large numbers of people on the impact of a combined HIV and TB control intervention on the TB disease burden. As countries move to more population-based HIV control strategies, its findings will help policymakers decide whether to combine large-scale TB and HIV screening.

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