EDCTP portfolio: Neglected infectious diseases
index
The SOLID study is field testing a new point-of-care diagnostic that can detect both adult tapeworm infections and larval cysts in the brain.
Better detection of tapeworm infection and brain cysts
The tapeworm Taenia solium is the leading food-borne cause of death and disability, responsible for the loss of 2.8 million years of healthy life every year. One of the most severe consequences of Taenia infection is the migration of larvae to body tissues including the brain, where they form cysts known as neurocysticerci. In endemic areas, these cysts are responsible for 30% of cases of epilepsy.
Although accurate diagnostics have been developed for cysticercosis, they are expensive, complex and require specialist skills.
The challenge
The US Centers for Disease Control and Prevention (CDC) has developed a more practical dipstick diagnostic able to detect antibodies to both adult tapeworms and cysticerci. It holds great promise as a tool for simultaneously detecting tapeworm infections and cysticercosis using finger-prick blood samples.
However, the CDC test has not been evaluated in field settings. The SOLID study is comparing its performance in primary care and community settings in Tanzania and Zambia, comparing results with gold standard tests and radiographic scanning to detect brain cysts.
The project
The SOLID study will provide key evidence on the field use of the CDC diagnostic. A point-of-care diagnostic for Taenia infections and neurocysticercosis would be a major advance, enabling early identification and treatment of neurocysticercosis cases, as well as treatment of tapeworm infections to reduce the risk of transmission. It would also enable more information to be gathered on the distribution, disease burden and dynamics of transmission of Taenia, supporting control efforts and advocacy.
Impact
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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.
EDCTP portfolio: HIV & HIV-associated infections
The challenge
The tapeworm Taenia solium is the leading food-borne cause of death and disability, responsible for the loss of 2.8 million years of healthy life every year. One of the most severe consequences of Taenia infection is the migration of larvae to body tissues including the brain, where they form cysts known as neurocysticerci. In endemic areas, these cysts are responsible for 30% of cases of epilepsy.
Although accurate diagnostics have been developed for cysticercosis, they are expensive, complex and require specialist skills.
The US Centers for Disease Control and Prevention (CDC) has developed a more practical dipstick diagnostic able to detect antibodies to both adult tapeworms and cysticerci. It holds great promise as a tool for simultaneously detecting tapeworm infections and cysticercosis using finger-prick blood samples.
However, the CDC test has not been evaluated in field settings. The SOLID study is comparing its performance in primary care and community settings in Tanzania and Zambia, comparing results with gold standard tests and radiographic scanning to detect brain cysts.
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 SOLID study will provide key evidence on the field use of the CDC diagnostic. A point-of-care diagnostic for Taenia infections and neurocysticercosis would be a major advance, enabling early identification and treatment of neurocysticercosis cases, as well as treatment of tapeworm infections to reduce the risk of transmission. It would also enable more information to be gathered on the distribution, disease burden and dynamics of transmission of Taenia, supporting control efforts and advocacy.
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
L’homme RF et al. Nevirapine, stavudine and lamivudine pharmacokinetics in African children on paediatric fixed-dose combination tablets. AIDS. 2008;22(5):557–65.
Mulenga V et al. Abacavir, zidovudine, or stavudine as paediatric tablets for African HIVinfected children (CHAPAS-3): an open-label, parallel-group, randomised controlled trial. Lancet Infect Dis. 2016;16(2):169–79.
WHO. Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2010.
WHO. Consolidated guidelines on the use of antiretroviral drugs
for treating and preventing
HIV infection: Recommendations for a public health approach
(second edition). 2016
Projects: Children with HIV in Africa Pharmacokinetics and Adherence of Simple Antiretroviral Regimens (CHAPAS): CHAPAS-1 and -3
Project lead: Professor Chifumbe Chintu, University Teaching Hospital, Zambia (CHAPAS-1); Dr Veronica Mulenga, University Teaching Hospital, Zambia (CHAPAS-3)
Target population(s): Children with HIV
Sample size: 71 (CHAPAS-1); 480 (CHAPAS-3)
Countries involved: Ireland, the Netherlands, the UK, the USA, Zambia (CHAPAS-1); Uganda, Zambia (CHAPAS-3)
Project duration: 2005–2009 (CHAPAS-1); 2010 –2011 (CHAPAS-3)
EDCTP funding: €1.2M (CHAPAS-1); €4.6M (CHAPAS-3)
Total project funding: €1.2M (CHAPAS-1); €5.0M