Research and Capacity Building Related to Medicines for Major Health Problems in Tanzania (malaria, TB, and HIV)

project summary

Effective drugs remain essential for the control of diseases like malaria and HIV where effective vaccines are not (yet) available; or when preventive measures alone may not be available, acceptable or practicable. New antiretroviral drugs (ARV) become available continuously; this is not the case for malaria and other diseases primarily affecting poor countries, with few exceptions (like artemisinin-based combination therapies, ACT for malaria). There is a great need to research into securing the drugs we have, by proper manufacturing, usage and distribution of and adherence to these, along with searching for new drugs. For any drug, new or old, and combinations of drugs, effects as well as side-effects should be monitored; unexpected effects may be revealed only post marketing and/or when used by vulnerable individuals; drug-uptake or -metabolism may differ from those persons originally tested with the drugs (often healthy young Caucasian men). Patients in rich countries are increasingly supplied with drugs tailored to fit individual pharmaco-genomics, and side-effects are monitored post-marketing. Poorer populations are left with standard drugs, sometimes sub-standard, often not adopted to nutritional condition, co-morbidity, age, sex or genetic constitution. Many actors on the relief and development scene advocate for scaling up supplies of eg. ARV for HIV and ACT for malaria, fewer prioritize developing and integration of health-services, delivery, surveillance and quality assurance. Only few actors and researchers focus on how drugs for different diseases are actually being (mis)used, how they may interact, or how they may not act because of being sub-standard, or even counter-feit produced. The key questions for this applications are: Is the lack of control of malaria (and HIV) in Africa (using NE Tanzania as an example), besides of the well-known role of poverty, related to lack of targeting, and lack of proper uptake, use and adherence, rather than due to lack of drugs? How can combinations of drugs and of interventions be optimised? How can development of drug-resistance be prevented? Diseases may - just like drugs - interact synergistic, additive or antagonistic: HIV (re-)activating TB, malaria worsening HIV and vice versa. Other key questions are whether the new combinations of antimalarials, ACT, may interact with ARV like the anti-TB drug, rifampicin does, and whether controlling one disease (malaria), may delay progression of another (HIV). Finally, whether introduction of new diagnostic tools may help targeting treatment and avoid over- as well-as under-use of medicines against malaria, and HIV, and prevent resistance, and in the end reduce burden of disease(s).