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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

The diversity of malaria parasites is one of the biggest obstacles to malaria vaccine development. Many malaria proteins come in a wide range of forms and antibodies against one form may not recognise other variants of the same protein.

Immunity to malaria seems to arise because, over time, people generate a repertoire of antibodies spanning the diversity of parasites they encounter, but it is still unclear precisely which immune responses are protective.

Professor Faith Osier’s research has focused on understanding the immune response to the malaria parasite, and the elements of it that protect against infection. This understanding is critical to the design of more effective vaccines.

In her EDCTP Senior Fellowship, she has established an international network, SMART, that is sharing samples and epidemiological data on malaria parasites across Africa. The network now spans 12 sites in seven sub-Saharan Africa countries, and has created a dataset of 10,000 samples and data.

Each sample is being systematically analysed to characterise variation in key proteins of interest – creating a unique map of parasite diversity across the continent.

Complementing this focus on the parasite, Professor Osier is also continuing to explore immune responses correlating with protection against malaria (uncomplicated and severe). To this end, she and her colleagues have developed a new ‘protein array’, known as KILchip, which includes more than 100 parasite proteins that are potential targets of antibody responses. This durable and reliable tool, suitable for use in Africa, opens up the prospect of rapid high-throughput screening to quantify antibody responses to multiple key parasite proteins.

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.

This EDCTP Senior Fellowship is supporting the career development of one of Africa’s leading malaria vaccine researchers. In 2014, Dr Osier received the Fifth Merle A Sande Health Leadership Award from the Accordia Global Health Foundation as well as the Royal Society Pfizer Prize. In 2016, she received a Sofja Kovalevskaja Award from the Alexander Humboldt Foundation, enabling her to establish a lab in Heidelberg, Germany, alongside her work at the KEMRI–Wellcome Trust Programme in Kilifi, Kenya.

Her research is helping to identify candidate antigens to include in a malaria vaccine. In addition, her work on the mechanisms of immunity to the malaria parasite is informing how vaccines should be designed and used. She is also committed to developing malaria research capacity in Africa, the SMART collaboration providing a platform for three PhD students, five master’s students and shorter-term training for postdoctoral scientists and postgraduate diploma students.

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