Dr Grace McHugh

Zimbabwe

EDCTP portfolio: Career Development Fellowships

Dr Grace McHugh investigates new strategies to reach adolescents and young people to improve the uptake of HIV self-testing.

HIV self-testing in adolescents and young people

HIV testing and counselling (HTC) is the critical entry point for access to HIV treatment, and also a means of accessing prevention for those who test HIV-negative. UNAIDS has set an ambitious target of 90% of individuals living with HIV to be identified by 2020. Adolescents and young people have the highest incidence of HIV in sub-Saharan Africa of any age-group, with particularly high rates among women. Adolescents and young people face both supply and demand barriers to HTC. Generally, this age group is comprised of infrequent users of health care. Moreover, healthcare provider attitudes towards young people seeking HTC can be stigmatising and discriminatory. They often perceive the risk of HIV acquisition as low. Therefore, access to age-appropriate information about HIV for adolescents and young people, resulting in HIV testing and counselling, is considered neither necessary nor important.

The challenge

Dr McHugh aims to investigate innovative age-appropriate strategies, youth-friendly approaches to explore the feasibility and acceptability of HIV self-testing. The study will conduct a study to investigate the effectiveness of two different community-based strategies for delivering HIV self-testing to adolescents and young people at educational institutions and within communities in areas frequented by adolescents and young people, using peer distribution. A mixed-methods process evaluation will be used to assess the intervention.

The project

It is expected that this study will be useful to inform and facilitate the scale-up of HIV self-testing services for adolescents and young people in Zimbabwe and inform on how to make the connection with HIV health care and prevention through the HIV self-testing process.

Impact


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

HIV testing and counselling (HTC) is the critical entry point for access to HIV treatment, and also a means of accessing prevention for those who test HIV-negative. UNAIDS has set an ambitious target of 90% of individuals living with HIV to be identified by 2020. Adolescents and young people have the highest incidence of HIV in sub-Saharan Africa of any age-group, with particularly high rates among women. Adolescents and young people face both supply and demand barriers to HTC. Generally, this age group is comprised of infrequent users of health care. Moreover, healthcare provider attitudes towards young people seeking HTC can be stigmatising and discriminatory. They often perceive the risk of HIV acquisition as low. Therefore, access to age-appropriate information about HIV for adolescents and young people, resulting in HIV testing and counselling, is considered neither necessary nor important.

Dr McHugh aims to investigate innovative age-appropriate strategies, youth-friendly approaches to explore the feasibility and acceptability of HIV self-testing. The study will conduct a study to investigate the effectiveness of two different community-based strategies for delivering HIV self-testing to adolescents and young people at educational institutions and within communities in areas frequented by adolescents and young people, using peer distribution. A mixed-methods process evaluation will be used to assess the intervention.

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.

It is expected that this study will be useful to inform and facilitate the scale-up of HIV self-testing services for adolescents and young people in Zimbabwe and inform on how to make the connection with HIV health care and prevention through the HIV self-testing process.

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

About us

The European & Developing Countries Clinical Trials Partnership (EDCTP) is a public–public partnership between 14 European and 16 African countries, supported by the European Union. EDCTP’s vision is to reduce the individual, social and economic burden of poverty-related infectious diseases by affecting sub-Saharan Africa. EDCTP’s mission is to accelerate the development of new or improved medicinal products for the identification, treatment and prevention of infectious diseases, including emerging and re-emerging diseases, through pre- and postregistration clinical studies, with emphasis on phase II and III clinical trials. Our approach integrates conduct of research with development of African clinical research capacity and networking. The second EDCTP programme is implemented by the EDCTP Association supported under Horizon 2020, the European Union’s Framework Programme for Research and Innovation.

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