index
EDCTP portfolio: Clinical Research & Development Fellowships
CANTAM3: Central African Network on Tuberculosis, HIV/AIDS and Malaria
The CANTAM network is drawing on South–South and North–South collaborations to strengthen clinical trial capacity in less-developed centres in Central Africa.
The challenge
Countries in Central Africa are badly affected by poverty-related infectious diseases. Furthermore, many of these countries have limited capacity to carry out international standard clinical trials and other clinical studies on these infections.
Nevertheless, centres of research excellence do exist in Central Africa and have the potential to disseminate knowledge and good practice through networking, taking advantage of their links to academic institutions in Europe.
The project
CANTAM was established in 2009 with EDCTP funding. It initially encompassed seven institutions in three countries – Cameroon, Republic of Congo and Gabon – and had the specific aim of developing the capacity of institutions in Cameroon and the Republic of Congo, drawing on an established research centre in Gabon.
Initial funding enabled the institutions to establish the CANTAM network and to connect to other regional and international networks. It provided a platform for training of multiple master’s and PhD students in collaboration with European partners, as well as extensive short-term training. The network also carried out epidemiological studies characterising the prevalence, genotypes, and drug resistance profiles of HIV, malaria and TB pathogens in Cameroon and the Republic of Congo to provide a baseline for future intervention studies.
In follow-up CANTAM2 funding, the network expanded to include additional African and European partners, including the Democratic Republic of the Congo (DRC), France, Switzerland and the UK, with Zambia as a collaborator. The scope of research expanded to include co-infections, including neglected infectious diseases, and co-morbidities.
Harmonisation of procedures across sites enabled CANTAM2 to support a multicentre phase IV trial of a fixed-dose artemisinin combination therapy for malaria, which enrolled more than 8,500 patients across five sites. New clinical trial monitors have been trained in Cameroon, Republic of Congo, Gabon and the DRC, and a network-wide data-sharing plan has been developed.
Across CANTAM1 and CANTAM2, 19 master’s and 21 PhD students have received training, while four career development fellowships have been awarded to female researchers. Notably, the network has nurtured the development of Dr Laure Stella Ghoma Linguissi (Republic of Congo), who has progressed from PhD student in CANTAM1 to team leader in CANTAM2, was awarded an EDCTP Career Development Fellowship, and is now head of department at her host institute and helping to train the next generation of Congolese researchers.
CANTAM2 has also worked closely with the EDCTP-funded PANDORA-ID-NET epidemic preparedness network, aligning research and capacity development activities, and coordinating responses to the COVID-19 pandemic. Shared infrastructure has been utilised for COVID-19, TB, HIV and malaria surveillance, while the networks have liaised with the Africa Centres for Disease Control and Prevention (Africa CDC) to enhance preparedness and hosted a COVID-19 preparedness workshop.
Laboratory strengthening at different sites has created a shared platform to support training of PhD students. The TB laboratory in Gabon has been upgraded and is now acting as the national reference laboratory for TB diagnostics.
CANTAM3 is building on this foundation to strengthen the capacity for clinical research in Central Africa. It will continue to provide an infrastructure for training of young researchers. It will also prepare sites for phase I–IV clinical studies, particularly by continuing to strengthen pharmacovigilance capacity and mechanisms of regulatory and ethical oversight, working in partnership with bodies such as the African Vaccine Regulatory Forum (AVAREF), the Pan-African Bioethics Initiative (PABIN) and the African Medicines Regulatory Harmonisation (AMRH) initiative.
CANTAM3 will also carry out baseline epidemiological studies for HIV, TB, malaria, neglected tropical diseases and COVID-19 to provide a basis for future clinical trials. It will have a particular interest in developing a platform for rigorous clinical studies of traditional African medicines.
In 2021, CANTAM3 won a grant from UK DHSC to fund a dynamic female fellowship program known as WISE. The fellowship program aims to strengthen gender capacity in clinical research within Central Africa and will support up to 8 female PhD students who will mentor master’s students as part of their projects. The overall goal of the program is to contribute to the generation of a critical mass of skilled female clinical researchers based within the Central African region.
Impact
CANTAM is extending the number of institutions and number of health research staff able to take part in multicentre clinical trials in Central Africa. Baseline data on key pathogens will provide an important resource ahead of intervention studies. In partnership with the PANDORA-ID-NET Consortium, CANTAM has also played an important role in the response to the COVID-19 pandemic in the region, and more generally developed preparedness for outbreaks of emerging and re-emerging infectious diseases.
EDCTP portfolio: HIV & HIV-associated infections
The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.
Bringing antiretroviral drugs to children
“
test the safety and efficacy of this new formulation in young children
”
Countries in Central Africa are badly affected by poverty-related infectious diseases. Furthermore, many of these countries have limited capacity to carry out international standard clinical trials and other clinical studies on these infections.
Nevertheless, centres of research excellence do exist in Central Africa and have the potential to disseminate knowledge and good practice through networking, taking advantage of their links to academic institutions in Europe.
The challenge
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 project
CANTAM was established in 2009 with EDCTP funding. It initially encompassed seven institutions in three countries – Cameroon, Republic of Congo and Gabon – and had the specific aim of developing the capacity of institutions in Cameroon and the Republic of Congo, drawing on an established research centre in Gabon.
Initial funding enabled the institutions to establish the CANTAM network and to connect to other regional and international networks. It provided a platform for training of multiple master’s and PhD students in collaboration with European partners, as well as extensive short-term training. The network also carried out epidemiological studies characterising the prevalence, genotypes, and drug resistance profiles of HIV, malaria and TB pathogens in Cameroon and the Republic of Congo to provide a baseline for future intervention studies.
In follow-up CANTAM2 funding, the network expanded to include additional African and European partners, including the Democratic Republic of the Congo (DRC), France, Switzerland and the UK, with Zambia as a collaborator. The scope of research expanded to include co-infections, including neglected infectious diseases, and co-morbidities.
Harmonisation of procedures across sites enabled CANTAM2 to support a multicentre phase IV trial of a fixed-dose artemisinin combination therapy for malaria, which enrolled more than 8,500 patients across five sites. New clinical trial monitors have been trained in Cameroon, Republic of Congo, Gabon and the DRC, and a network-wide data-sharing plan has been developed.
Across CANTAM1 and CANTAM2, 19 master’s and 21 PhD students have received training, while four career development fellowships have been awarded to female researchers. Notably, the network has nurtured the development of Dr Laure Stella Ghoma Linguissi (Republic of Congo), who has progressed from PhD student in CANTAM1 to team leader in CANTAM2, was awarded an EDCTP Career Development Fellowship, and is now head of department at her host institute and helping to train the next generation of Congolese researchers.
CANTAM2 has also worked closely with the EDCTP-funded PANDORA-ID-NET epidemic preparedness network, aligning research and capacity development activities, and coordinating responses to the COVID-19 pandemic. Shared infrastructure has been utilised for COVID-19, TB, HIV and malaria surveillance, while the networks have liaised with the Africa Centres for Disease Control and Prevention (Africa CDC) to enhance preparedness and hosted a COVID-19 preparedness workshop.
Laboratory strengthening at different sites has created a shared platform to support training of PhD students. The TB laboratory in Gabon has been upgraded and is now acting as the national reference laboratory for TB diagnostics.
CANTAM3 is building on this foundation to strengthen the capacity for clinical research in Central Africa. It will continue to provide an infrastructure for training of young researchers. It will also prepare sites for phase I–IV clinical studies, particularly by continuing to strengthen pharmacovigilance capacity and mechanisms of regulatory and ethical oversight, working in partnership with bodies such as the African Vaccine Regulatory Forum (AVAREF), the Pan-African Bioethics Initiative (PABIN) and the African Medicines Regulatory Harmonisation (AMRH) initiative.
CANTAM3 will also carry out baseline epidemiological studies for HIV, TB, malaria, neglected tropical diseases and COVID-19 to provide a basis for future clinical trials. It will have a particular interest in developing a platform for rigorous clinical studies of traditional African medicines.
In 2021, CANTAM3 won a grant from UK DHSC to fund a dynamic female fellowship program known as WISE. The fellowship program aims to strengthen gender capacity in clinical research within Central Africa and will support up to 8 female PhD students who will mentor master’s students as part of their projects. The overall goal of the program is to contribute to the generation of a critical mass of skilled female clinical researchers based within the Central African region.
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
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
Impact
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.
CANTAM is extending the number of institutions and number of health research staff able to take part in multicentre clinical trials in Central Africa. Baseline data on key pathogens will provide an important resource ahead of intervention studies. In partnership with the PANDORA-ID-NET Consortium, CANTAM has also played an important role in the response to the COVID-19 pandemic in the region, and more generally developed preparedness for outbreaks of emerging and re-emerging infectious diseases.