Project: Understanding the determinants of the effectiveness of HIV control strategies targeting HIV-infected pregnant women in Mozambique

Acronym	Preg_multidrug (Reference Number: TMA2017CDF-1927)
Duration	01/02/2019 - 31/01/2022
Project Topic	Current guidelines for HIV management and mother-to-child transmission prevention in Mozambique rely on lifelong administration of antiretroviral therapy (ART) (option B+) from the time of HIV diagnosis during pregnancy; thus, HIV-infected pregnant women need to self-administer an average of five tablets from different medications daily. Available information suggests that adherence to these medications is poor and retention rate is low, while there is little understanding of the factors affecting their adherence. In addition, there are no data on the proportion and clinical presentation of pregnant women with HIV advanced disease, which is needed to implement new management guidelines or individuals with HIV-advanced disease. On the other hand, HIVinfected pregnant women cannot receive intermittent preventive treatment (IPTp) with sulphadoxinepyrimethamine for malaria prevention due to potential drug interactions with cotrimoxazole prophylaxis (CTXp), which is administered to prevent opportunistic infections. This proposal aims to identify the determinants affecting HIV control strategies effectiveness in pregnant women exposed to malaria in rural southern Mozambique, in order to assist policy makers in the implementation of the appropriate interventions in the group of women who is most vulnerable to both infections. Specific objectives are the following: 1. to assess perceptions, acceptability and behavior of HIV-infected pregnant women regarding the administration of the recommended multiple medications 2. to assess the retention rate and its determinants to Option B+ 3. to determine the proportion, characteristics and clinical presentation of pregnant women attending the antenatal care (ANC) clinic with HIV advanced disease. These objectives will be met using three sets of information, namely: i) participants in a randomized placebo-controlled trial to evaluate the safety and efficacy of Dihydroartemisinin-piperaquine for IPTp in HIV-infected pregnant women receiving CTXp, ii) pregnant women attending the same ANC clinic who do not participate in the above mentioned trial, iii) retrospectively collected data from HIV-infected pregnant women attending the ANC clinics. This fellowship will provide a unique opportunity for training a junior African researcher in epidemiology, qualitative research and statistical analysis. Additionally, the proposed fellowship will provide the opportunity to interact with collaborators from other African and European research institutions; all of which will potentiate the candidate’s scientific skills in order to be established as an independent researcher and a team leader. Importantly, the results of the research that is part of this fellowship will help guiding public health policies that might contribute to improving maternal and child health in the most vulnerable populations.
Network	EDCTP2
Call	Career Development Fellowships 2017

Project partner

Number	Name	Role	Country
1	Fundaçao Manhiça	Coordinator	Mozambique