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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

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