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Each recruited early and mid-career fellow will follow a network-wide training programme and work a specific research project included in a transnational clinical study.
By equipping the fellows with these skills, SUPPORT aims to significantly reduce illness and death rates among children living with HIV.
These are the research projects to be completed by the SUPPORT fellows.
This research aims to enhance the identification of children at a higher risk of post discharge mortality among the study population. Two complementary analyses will be conducted. Firstly, clinical, epidemiological, and laboratory variables will be examined to identify the primary risk factors associated with post discharge mortality. An easy to use calculator will be developed to assist clinicians in identifying patients at a higher risk. Secondly, the performance of a “severity biomarker” will be analysed as a predictor of mortality in this population. This novel biomarker could significantly enhance clinicians’ ability to identify patients at the highest risk, contribute to their prioritization, and will complement the clinical calculator.
Children living with HIV (who have recently been discharged from the hospital face a very high risk of post discharge mortality. The rapid disease progression and heightened mortality risk observed in CLHIV during the post discharge period necessitate differentiated follow up strategies for clinical decision making.
By closely monitoring viral load levels, clinicians can identify children who require intensive management, specialised care, or additional adherence support, thereby reducing the risk of mortality.
This research project aims to evaluate the impact of an improved follow up model on PDM It will involve closer follow up and enhanced adherence interventions based on VL results.
Cytomegalovirus coinfection is a recognized opportunistic infection that significantly contributes to morbidity and mortality in Children Living with HIV, even when on ART Targeting CMV suppression could be a promising approach to reduce Post Discharge Mortality. However, there is insufficient data available to understand the trajectory of CMV viral load, the dynamics of reactivation and re infection in CLHIV, and its impact on morbidity and mortality. This research project will aim at enhancing the understanding of CMV dynamics in CLHIV following admission, thus supporting future treatment proposals.
Prolonged respiratory viral infection occurs in immunocompromised patients People living with HIV seem to shed pathogens in some cases, for longer durations and in larger numbers than presumably non immunosuppressed HIV negative patients. Respiratory Syncytial Virus is the second leading cause of infant mortality with more than 99 of childhood deaths occurring in LMICs. More than 50 of paediatric RSV mortality occurs outside of the hospital in LMICs, with poverty as a substantial risk factor. RSV shedding was prolonged in Children Living with HIV compared with children HIV negative. However, there is no evidence of the potential role on PDM. This research project aims at investigating the impact of prolonged respiratory viral infection on the post discharge mortality of CLHIV.
Patients living with HIV are prone to develop enteropathy and malnutrition. Some studies have linked adenovirus infection and HIV related enteropathy The median norovirus excretion was 28 days in immunosuppressed children compared to 4 days in previously healthy hospitalized patients. In people living with HIV, rotavirus excretion may persist for over 6 weeks. Clinical consequences of viral gut infections in Children Living with HIV may include isolation issues, specific treatment, and supportive care. This research project aims to investigate the impact of ineffective clearance of gastrointestinal pathogens, particularly viruses, in combination with defective immune regulation may have on post discharge mortality. A study focused on histoplasmosis will also be performed.
Among the high proportion of children that died during a post discharge period, a big proportion die at home without consulting. Grunting is a sound related to severe pneumonia that can be present when the children get worse The goal is to develop an application based on a telemedicine platform to automatically record children’s respiratory sounds, with three objectives: first, to make it available to the doctor in real time for direct clinical assessment; second, to train and automatically run an algorithm capable of detecting the pattern of grunting associated to respiratory failure; third, to estimate respiratory rate automatically from the audio. Our final goal is to develop a tool for remote monitoring of signs of respiratory distress associated with pneumonia, and eventually, with post-discharge mortality.
Dose recommendations for paediatric Antiretroviral Therapy (ART) are often based on small pharmacokinetic studies, but paediatric ART dose optimization is becoming increasingly important in drug development. There are, however, still many knowledge gaps concerning ART in children. This research project will use a variety of pharmacokinetic analysis methodologies to support dosing regimens for new fixed dose paediatric ART formulations and to assess drug-drug interactions involving ART in children living with HIV.
While several publications have highlighted a higher prevalence of MDR infection or colonization in the HIV population, there remains a dearth of information regarding Children Living with HIV in resource poor settings and the challenges they face. Children living with HIV, particularly those with advanced HIV disease or experiencing virologic failure and compromised immune status, are highly susceptible to infections and face an increased risk of adverse outcomes. The objective of this research is to enhance the understanding and provide guidance for the treatment of bacterial infections in this vulnerable population. This research project aims at assessing the prevalence of Antibiotic Resistant Bacterial Carriage in CLHIV with virologic failure.
The purpose of this postdoctoral fellowship is to coordinate and support all the laboratory activities of the SUPPORT project: develop Standard Operating Procedures (SOP) for laboratory activities, supervise the collect and storage of samples, and perform the analysis of the samples. The post-doctoral fellow will in addition lead a research project on multidrug resistance, and establish a South-South collaboration on the topic.
The purpose of this postdoctoral fellowship is to develop the scientific coordination skills needed by the SUPPORT network to develop all the scientific projects. This proposed training initiative will prepare the successful candidate for being a research leader and a successful principal investigator in the next future. The SUPPORT scientific coordinator postdoctoral fellow will be responsible for assuring the overall quality of study procedures and deliverables following high-quality standards.
The purpose of this postdoctoral training is to develop computational and quantitative approaches and tools needed by the SUPPORT network to work with biomedical Big Data in the biomedical sciences. The SUPPORT data manager postdoctoral fellow will be responsible for assuring the overall quality of study data and data management deliverables within the scope of the study including overseeing Case Report Forms (CRF) completion, adherence to data standard operating procedures, and creation and management of data management specific timelines.
The purpose of this postdoctoral fellowship is to develop the statistical methods and data resources to strengthen each of the SUPPORT specific studies. The candidate will work on projects related to the network applying a data management plan and statistical analysis plan design, epidemiology, causal inference, semi-parametric models, stochastic processes on networks and graphs, network communication processes, and reports. The Postdoctoral fellow can conduct innovative methodological research in an international environment of one-of-a-kind population-based epidemiologic and microbiology studies and will build methodological and collaborative research programs in concert with their scientific mentors.
Beyond the clinical factors, inadequate health-seeking behaviour and poor access to hospital care were responsible for the high occurrence of post-discharge mortality among children. Barriers to seeking care in SSA are complex and can include financial constraints, distance to health facilities, cultural practices, gender dynamics, limited knowledge or information, and health facility disincentives. All of this can impact post-discharge mortality. Following EMPIRICAL study, several relevant points related to mortality have been raised. The HIV diagnosis is delayed even when the programs for mother-to-child-prevention are in place, adherence is low, missing visits during the follow-up are very frequent and patients have particularly unfavourable social situations. EMPIRICAL external advisors from AFROCAB suggest going in deep into the social factors that are linked to the delay in diagnosis, the limited implementation of useful policies, and mortality causes. In this project, we aim to address this relevant gap.