Safety and efficacy of antimalarial therapy in children with HIV and sickle cell disease:data to aid policy formulation in Ghana

project summary

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.