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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

Northern Uganda was the site of the largest Ebola outbreak before the 2014–16 West Africa Ebola epidemic, and remains at risk of further outbreaks.

Healthcare facilities in at-risk areas have a key role to play in the care of people with Ebola or other dangerous infections, but are also important sites for the spread of infections. In addition, health workers are themselves at particular risk of becoming infected.

The ENDORSE project has built health worker capacity in northern Uganda, focusing on epidemic preparedness, biosafety and personal protection from infectious agents in both clinical and laboratory settings.

Following consultations to identify needs, the ENDORSE team developed a package of activities based on the train-the-trainer model. During the first phase of the project, 19 health workers from nine hospitals in northern Uganda received training on infection prevention and control, as well as on methods of adult learning, through theoretical and practical sessions.

In the second phase of the project, the trainers and hospital administrators identified participants who could benefit from training. The training course was delivered to a total of 144 health workers across the nine hospitals, through lectures, group reflection, exercises and practical sessions. The trainers have also begun to cascade training out to other health facilities.

The project concluded with a final conference for participants and other stakeholders, to share experiences and discuss ways to take the initiative forward.

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 project has strengthened the capacity of hospitals and other health facilities in northern Uganda to safely handle cases of Ebola and other serious infections. It will enable the centres to offer safer care and take part in research in an area at particular risk of emerging infections, and thereby better contain and prevent infectious disease emergencies in the region.

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