R&D Helping the Most Vulnerable Women

[This article has been published in Spanish in El País-Planeta Futuro]

Exploring new ways to prevent malaria in HIV-infected women living in sub-Saharan Africa

HIV-seropositive pregnant women (...) have no access to malaria preventive therapies

Malaria and HIV/AIDS—two major obstacles to socio-economic development in Africa—are among the principal causes of morbidity and mortality in pregnant women and their children in Africa. It is estimated that at least 1 million pregnancies every year in Africa occur in women coinfected with malaria and HIV. This combination is particularly damaging during pregnancy, when both the risk of malaria and the viral load of HIV are higher than usual. The interaction can increase the frequency of HIV transmission from mother to child. The great paradox is that HIV-seropositive pregnant women, one of the most vulnerable population groups because of their gender and status, have no access to malaria preventive therapies.

Inequality is a major issue that was not adequately addressed by the Millennium Development Goals (MDG, 2000-2015). The primary focus of that agenda was to improve development indicators at global and national levels. In practice, this led to the prioritisation of interventions that particularly targeted population groups in which progress could be achieved most quickly. This strategy worked against more vulnerable groups and those with scant political voice to defend their interests, including pregnant women and newborn infants in the poorest quintiles, especially in sub-Saharan Africa. Meeting the needs of these vulnerable population groups requires greater investment or solutions that have not yet been developed.

Initiatives, innovation and research focused on the most marginalised populations are sorely needed

The health-related targets in the new Sustainable Development Goals (SDG, 2015-2030) include the reduction of the global maternal mortality ratio to less than 70 per 100,000 live births and ending preventable deaths of newborns and children under five years of age and the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases. These targets cannot be achieved without addressing the problems and prioritising the needs of much broader population groups, including those currently neglected or excluded. Initiatives, innovation and research focused on the most marginalised populations are sorely needed. One of the ways of reducing inequality that has been recommended is the implementation of policies and strategies that specifically address the needs of these groups, one of which is universal health coverage. However, it is still too early to determine to what degree this approach will prevail in this new phase (2016-2030).

The  MAMAH consortium's main objective is to generate evidence needed to improve the health of pregnant HIV-positive women exposed to malaria

The MAMAH consortium, funded by the European & Developing Countries Clinical Trials Partnership (EDCTP) and coordinated by the Barcelona Institute for Global Health (ISGlobal) in collaboration with five other organisations*, is fully aligned with that vision. The Consortium’s main objective is to generate evidence needed to improve the health of pregnant HIV-positive women exposed to malaria, a population group that is particularly vulnerable due to gender inequality and status. Its goals are, on the one hand, to find a safe and effective treatment for the prevention of malaria in pregnant women infected with HIV and, on the other, to generate greater knowledge about the pharmacological interactions between antimalarial and antiretroviral drugs. Another important aspect of its work is to strengthen links and foster collaboration between European and African research centres.

Although a highly effective and cost-effective intermittent preventive treatment for pregnant women exists in the form of sulphadoxine-pyrimethamine (SP), this regimen is contraindicated in HIV-infected women receiving cotrimoxazole prophylaxis (CTXp) due to possible adverse effects. This contraindication has given rise to the paradox cited at the beginning of this article: there is no preventive treatment available for the  most vulnerable group of pregnant women.

The leadership, in this context, of the European Union (EU) should be highlighted. As part of its second EDCTP programme (EDCTP2), the EU is funding a research project focused on generating knowledge and providing preventive options against malaria for women infected with HIV.

The mission of the EDCTP is to accelerate the clinical development of new or improved interventions to prevent and treat poverty-related diseases prevalent in sub-Saharan Africa by promoting and funding collaborative research executed through partnerships between European and African institutions. The organisation recently defined coinfections and comorbid diseases as a strategic priority. This decision highlights an important public health problem responsible for increased morbidity and mortality in developing regions, and recognises the need for a concerted effort to advance research and the development of clinical products for the prevention and treatment of these diseases.

Investment in projects undertaken to improve maternal, neonatal and reproductive health not only saves lives, but also brings social and economic benefits

Furthermore, owing to the importance of women’s contribution to the domestic and national economies, interventions targeting these population groups have enormous potential for generating changes and having a positive impact on society, not only on the lives of the women but also on those of their families and communities. Investment in projects undertaken to improve maternal, neonatal and reproductive health not only saves lives, but also brings social and economic benefits to the societies and countries where these projects are implemented.

For all these reasons, the start-up of MAMAH*, a Euro-African research consortium, is another positive step in the field of research aimed at reducing health and gender inequalities, perhaps one of the best ways to celebrate March, a month dedicated especially to women everywhere.

This project is part of the EDCTP2 programme supported by the European Union.

*The MAMAH Consortium comprises six European and African research institutions: the Barcelona Institute for Global Health (ISGlobal), the Centre de Recherches Médicales de Lambaréné (CERMEL, Gabon), the Manhiça Health Research Centre/Fundaçao Manhiça (CISM, Mozambique), the Medical University of Vienna (MedUni Wien, Austria), the Bernhard Nocht Institut für Tropenmedizin (BNITM, Germany), and the Eberhard Karls Universitaet in Tuebingen (EKUT, Germany). The 5-year project has received a grant of €3 million to fund the project.