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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

Hypertension, high blood pressure, is the single biggest risk factor for death worldwide. It is more common in sub-Saharan Africa than in any other region – affecting an estimated 30% of adults. 

Owing to the wider use of antiretroviral drugs, more people living with HIV in sub-Saharan Africa are surviving into middle age and beyond, when their risk of hypertension increases significantly. Hypertension is poorly diagnosed and controlled in the region, but HIV treatment clinics may provide a way to deliver integrated care for the two conditions. 

The SEARCH trial recently evaluated an integrated model of care for HIV and hypertension in Uganda and Kenya that led to improved control of both conditions. The model included one-stop care for both conditions, provision of 12-week drug supplies, flexible appointments and phone access to providers. A hypertension toolkit was developed for service providers, including a diagnostic and treatment algorithm, patient register, hypertension job aids and patient information.

The Integrated HIV/HTN project is now aiming to build on this demonstration by supporting and evaluating the introduction of an integrated model into routine care in 26 districts of western Uganda. The care model is being introduced in collaboration with national disease programme directors and middle-level health managers. Training will be provided to health workers at district level and in primary care facilities, while a text messaging system will be introduced to provide real-time feedback on performance at the district and clinic level.

As well as monitoring health outcomes, the project will explore the barriers to and enablers of integrated care through engagement with policymakers, providers and patients. The cost implications of the new model will also be analysed.

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 Integrated HIV/HTN project will accelerate the introduction of a more patient-centred and integrated model of care for people living with HIV. It should also highlight factors that could facilitate the wider rollout of integrated models of care. Ultimately, the project should lead to changes in policy and practice, and to improvements in the health of people living with HIV and hypertension in western Uganda. More generally, the project will enhance national coordination and the capacity to translate research evidence into practice.

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