Current Organisation

Current Job Title

Biography

Project Title

Understanding the determinants of the effectiveness of HIV control strategies targeting HIV-infected pregnant women in Mozambique (Preg_multidrug)

EDCTP Project Call

Career Development Fellowship (CDF)

Host Organisation

Project Objectives

Objectives 3.1 General Objective To improve our understanding of the determinants that may affect the effectiveness of HIV control strategies in HIV infected Mozambican pregnant women to guide public health policies and to target the appropriate interventions. 3.2 Specific objectives 3.2.1 to assess the perceptions, acceptability and behavior of HIV-infected pregnant women regarding the administration of the recommended multiple medications in the context of the ANC clinic 3.2.2 to assess the retention rate and its determinants regarding Option B+ to prevent MTCT-HIV among HIV-infected pregnant women 3.2.3 to determine the proportion, characteristics and clinical presentation of pregnant women attending the ANC clinic with HIV advanced disease.

Study Design

This proposal is nested into the clinical trial entitled: A randomized placebo-controlled trial to evaluate the safety and efficacy of DHA-PPQ as IPTp in HIV-infected pregnant women (MAMAH trial), which is planned to be conducted from mid 2018 to 2020. The study is a randomized placebo-controlled trial to be carried out in Manhiça district. The MAMAH trial aims to evaluate the safety and efficacy of DHA-PPQ as IPTp in Gabon and Mozambique; in the latter it will include 444 HIV-infected pregnant women receiving daily CTXp and ARV drugs. HIV-infected pregnant women will be invited to participate in the trial and sign an informed consent if they meet the following inclusion criteria: HIV seropositive status Gestational age at the first antenatal visit ≤ 28 weeks Permanent resident in the study area Agreement to deliver in the study area’s maternity wards Pregnant women with gestational age ≥ 13 weeks will receive the first administration of a three-day course of IPTp (DHA-PPQ or placebo). The number of DHA-PPQ/placebo tablets administered will be calculated based on the participants’ body weight at the first IPTp administration (two, three, or four tablets a day for bodyweights of 24–35.9 kg, 36–74.9 kg, and 75 kg or more respectively). The first dose of DHA-PQp will be administered under direct observation at the antenatal care (ANC) clinic. Subsequent doses of the intervention in days 2 and 3 will be taken unsupervised at home. Study participants will also receive all other recommended treatments for HIV-positive pregnant women in Mozambique such as, ferrous sulphate and folic acid, mebendazole, isoniazid and a long-lasting insecticide treated net (LLITN) at enrolment, which will coincide with the first ANC contact as part of the study intervention. The nested study will follow a mixed methods design with three components: (i) a qualitative social behavioural study to address objective 1; (ii) the evaluation of the retention to the components of the prevention

Project Summary

Current guidelines for HIV management and mother-to-child transmission prevention in Mozambique rely on lifelong administration of antiretroviral therapy (ART) (option B+) from the time of HIV diagnosis during pregnancy; thus, HIV-infected pregnant women need to self-administer an average of five tablets from different medications daily. Available information suggests that adherence to these medications is poor and retention rate is low, while there is little understanding of the factors affecting their adherence. In addition, there are no data on the proportion and clinical presentation of pregnant women with HIV advanced disease, which is needed to implement new management guidelines or individuals with HIV-advanced disease. On the other hand, HIVinfected pregnant women cannot receive intermittent preventive treatment (IPTp) with sulphadoxinepyrimethamine for malaria prevention due to potential drug interactions with cotrimoxazole prophylaxis (CTXp), which is administered to prevent opportunistic infections. This proposal aims to identify the determinants affecting HIV control strategies effectiveness in pregnant women exposed to malaria in rural southern Mozambique, in order to assist policy makers in the implementation of the appropriate interventions in the group of women who is most vulnerable to both infections. Specific objectives are the following: 1. to assess perceptions, acceptability and behavior of HIV-infected pregnant women regarding the administration of the recommended multiple medications 2. to assess the retention rate and its determinants to Option B+ 3. to determine the proportion, characteristics and clinical presentation of pregnant women attending the antenatal care (ANC) clinic with HIV advanced disease. These objectives will be met using three sets of information, namely: i) participants in a randomized placebo-controlled trial to evaluate the safety and efficacy of Dihydroartemisinin-piperaquine for IPTp in HIV-infected pregnant women receiving CTXp, ii) pregnant women attending the same ANC clinic who do not participate in the above mentioned trial, iii) retrospectively collected data from HIV-infected pregnant women attending the ANC clinics. This fellowship will provide a unique opportunity for training a junior African researcher in epidemiology, qualitative research and statistical analysis. Additionally, the proposed fellowship will provide the opportunity to interact with collaborators from other African and European research institutions; all of which will potentiate the candidate’s scientific skills in order to be established as an independent researcher and a team leader. Importantly, the results of the research that is part of this fellowship will help guiding public health policies that might contribute to improving maternal and child health in the most vulnerable populations.