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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

Under-developed health systems in affected countries, including Sierra Leone, were poorly prepared to manage the 2014–16 West Africa Ebola outbreak. The outbreak itself also had a significant damaging impact on health systems in affected countries, adding further to the health consequences of the outbreak.

Development and rebuilding of health systems after shocks such as the Ebola outbreak should be informed by evidence-based policies. However, countries such as Sierra Leone had limited capacity after the outbreak to systematically identify needs and to adopt evidence-informed policy and practice.

The RECAP-SL project aimed to strengthen health research capacity in Sierra Leone, to facilitate the development and implementation of evidence-based policy and practice. It focused on the College of Medicine and Allied Health Services (COMAHS), Sierra Leone’s only school of medicine and pharmacy.

The project established a health systems research centre at COMAHS, facilitating the development of a four-year research strategy and an action plan to support the development of institutional research capacity. The strategy has been widely used in COMAHS’s discussions with potential research partners.

The project also supported the training of four research fellows in multidisciplinary health systems research, supported by mentors from the Liverpool School of Tropical Medicine, UK, and Sierra Leone. The fellows have received research training, taken part in COMAHS research projects and supported other researchers at COMAHS. Two of the fellows went on to secure PhD scholarships and one was accepted onto the highly competitive three-week intensive Health Systems Global ‘Emerging Voices’ networking and professional development programme.

In addition, research methodology training was provided to all final-year medical students, and a programme of engagement was undertaken for students at all stages of their studies to raise awareness of research and to encourage interest in research-related activities.

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 established a health research centre within Sierra Leone’s national medical school, providing a platform for further institutional research capacity strengthening. It has developed staff research capacities and created international connections to support further capacity strengthening. The project has therefore laid the ground for further progress towards the long-term goal of a sustainable fit-for-purpose health system in Sierra Leone.

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