|Call||Senior Fellowship (SF)|
Development and evaluation of high throughput, cheap and reliable assays for monitoring HIV-1 and HIV-2 viral loads in ARV programmes and clinical trials in developing countries
To develop robust and affordable in-house virus load assays for quantifying HIV-1 and HIV-2 RNA in the blood of an infected individual; with similar sensitivity, specificity, and reproducibility to currently available commercial HIV viral load assays. A secondary objective is to train scientists in the West Africa sub-region to encourage a wider use of the assay
|Medical Research Council (MRC) Laboratories||Gambia|
Laboratory assay development and validation
The project produced a locally validated HIV viral load assay. 10 scientists from West Africa and 9 from Eastern Africa were trained in the course.
Center of Medical Research Lambaréné (CERMEL)
Human Immuno-deficiency Virus (HIV) Tuberculosis (TB)
Background: Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs).
Objectives: To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals.
Methods: A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use.
Results: The majority of patients had skin and soft tissue infections (n=108) followed by surgical site infections (n=72), pneumonia (n=64), urinary tract infection (n=48) and meningitis (n=18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, P<0.0005), dosage (from 15.2% to 36.5%, P<0.0005) and duration (from 13.2% to 31.0%, P<0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P<0.0005).
Conclusions: AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.