Safety and efficacy of antimalarial therapy in children with HIV and sickle cell disease:data to aid policy formulation in Ghana
HIV infection (HIV) and sickle cell disease (SCD) are widespread chronic diseases in Africa, and there is major risk of co-infection of these diseases with malaria, particularly in children. Both HIV and SCD may aggravate malaria, and anti-malarial drugs may exhibit sub-optimal efficacy, or increased risk of side effects when administered to children with HIV or SCD receiving concomitant therapy for other associated illness. Despite current international requirements, data on the safety or effectiveness on anti-malarial drugs given to children with HIV or SCD is scarce, effectively limiting access of children with these chronic conditions to antimalarials, and thus increasing inequity to essential medication for an especially vulnerable group of patients. The project aims to compare data on treatment of malaria with artemisinin combination therapies (ACT) – current recommended treatments - in HIV or SCD patients, and in healthy children. Cohorts of children with or without these conditions will be followed up, to compare incidence of malaria. Uncomplicated malaria will be treated with either artemether-lumefantrine or artesunate-amodiaquine. Treated subjects will be followed up according to a standard regime, to monitor for potential drug side effects as well as treatment effectiveness. The data will be analysed in relation to other drugs taken, and the levels of the drug or metabolite(s) in the blood of treated patients. The project will enhance the capacity of participating institutions to conduct locally owned competitive research, and serve as a platform for student training. The results will be of immediate relevance to clinical care for these sub-groups of children with these chronic diseases, and would contribute evidence towards formulating an integrated national policy for treating malaria in HIV or SCD in Ghana.
Project Completion Report:
There is little information on the contribution of malaria to the morbidity experienced by children with HIV infection or sickle cell disease (SCD), two major diseases of public health importance in malaria-endemic areas, such as Ghana. Furthermore, data on the safety and effectiveness of antimalarial drugs is scarce in patients with HIV or SCD, despite a general improvement in access to such medications by the general population.
Antimalarial therapy may also exhibit differential effectiveness and safety in these patients, thus, unavailability of such data is a potential access hindrance to needed efficacious treatment in this sub-group, who stand to benefit most from such treatment. This increases inequity in access to essential medication for malaria, the most common disease these children may encounter.
This post-doctoral project established in Ghana, the contribution of malaria to morbidity experienced by children with HIV or SCD, and provided data on the effectiveness and safety of recornmended malaria treatments. The concentrations of respective anti-malarial drugs were measured to generate data useful for gaining insight on treatment adequacy. The results from the project were disseminated to various stakeholders and end-users in Ghana, and are being written up for publication in relevant peer reviewed scientific journals. Two postgraduate projects were completed, technical staffs were trained, and research infrastracture was improved and sustained.