Current Research Activities
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is a recognized global leader in the fight to prevent pediatric HIV infection, eliminate pediatric AIDS, and create a generation free of HIV through research, advocacy, health systems strengthening, and the delivery of comprehensive HIV services.
In the last 25 years, EGPAF has contributed to the most significant breakthroughs related to HIV in children, including discoveries that have helped to dramatically reduce the rate of mother-to-child transmission of HIV around the world. EGPAF has expanded the research knowledge base around pediatric HIV, contributing to major advances regarding how HIV enters cells and the effects of early combination therapy in children. Active support for underfunded areas of innovative basic science research relevant to prevention, treatment, and cure of HIV in children remains a hallmark of EGPAF research priorities.
Today, EGPAF plays a critical role in both defining the pediatric AIDS research agenda and supporting and conducting research to improve the lives of women, children, and families affected by HIV. EGPAF leads studies in clinical, laboratory, and implementation science research with a focus on optimizing health service delivery, building an evidence base for new and innovative interventions, and effectively scaling up promising HIV and maternal, newborn, and child health interventions. In addition to an extensive network of field sites in Africa, EGPAF has a Global Research Unit with clinical, community, regulatory, immunological, statistical, and qualitative and quantitative research expertise that facilitates, initiates, and supports on-the-ground research and evaluation across EGPAF-supported countries.
EGPAF has long prioritized raising external funding to support leading scientists and clinicians dedicated to pediatric HIV/AIDS research. Through its Elizabeth Glaser Scientist Award (EGSA) program (1996–2006), EGPAF has awarded grants to support groundbreaking research. In 2005, through her EGSA, Dr. Deborah Persaud conducted the first studies in young children on how HIV hides in the body to avoid detection and elimination. More recently, Dr. Persaud and Dr. Katherine Luzuriaga, another EGSA awardee, were part of the team that documented the “Mississippi baby,”the first case of a functional HIV cure in an infant.
Areas of Expertise
EGPAF researches and evaluates new and improved methods of service delivery so successful prevention of mother-to-child transmission of HIV (PMTCT) and HIV care and treatment programs can be replicated to assist in HIV prevention and treatment efforts worldwide. EGPAF provides support to more than 6,800 PMTCT and care and treatment sites in 14 countries. Through its model of partnering with national HIV programs and working through existing national systems, EGPAF is uniquely placed to carry out implementation research within the context of existing service delivery. EGPAF understands the critical problems facing health systems as well as what additional data and research may have the greatest impact in solving them. For instance, with the growing trend toward service integration, EGPAF has led several recent studies focused on areas such as integration of family planning into HIV care and treatment services, and integration of services for other sexually-transmitted infections into PMTCT programs.
Mobile Phone Technology
In Kenya, EGPAF is implementing a study to determine the effect of targeted SMS messaging on completion of key PMTCT milestones from antenatal care to six weeks postpartum.
By working closely with ministries of health at national, district, and site levels, EGPAF also understands national priorities and where research may be needed to inform national policies and strategies. For instance, EGPAF recently led a study in Kenya that compared models for providing services and care for HIV-exposed infants. The study concluded that integrating HIV services in a maternal, newborn, and child health (MNCH) clinic provided better follow-up to HIV-exposed children than in the stand-alone HIV comprehensive care clinic, leading the Kenyan Ministry of Health to incorporate integration of HIV services in MNCH into its 2012 national PMTCT guidelines. Additional recent implementation research studies have concentrated on evaluating the effectiveness of clinic- and/or community-based interventions; ways to improve treatment adherence and retention in HIV care programs; effectiveness of new technologies, such as mHealth; and comparative assessments across countries implementing Options A, B, or B+ of the World Health Organization’s PMTCT guidelines.
EGPAF’s Project ACCLAIM is testing the effect of community-based interventions on demand, uptake, and retention of MNCH and PMTCT services in Swaziland, Uganda, and Zimbabwe.
In Malawi, the first country to implement PMTCT Option B+, EGPAF is leading a pilot study on the acceptability of lifelong ART among HIV-positive pregnant and postpartum women to gain a better understanding of the barriers and facilitators that encourage women to accept or reject lifelong therapy.
Laboratory and Basic Science Research
To further its goal of eliminating pediatric AIDS, EGPAF conducts laboratory-based research, builds the capacity of laboratory clinicians and technicians, strengthens laboratory systems, and assesses new diagnostic tests and technologies. EGPAF collaborates with leading laboratory scientists and point-of-care product developers to test products in field settings. EGPAF has also led several recent studies to evaluate the effectiveness, acceptability, and/or feasibility of implementing point-of-care diagnostic technologies such as rapid syphilis and CD4 cell count testing in MNCH and PMTCT settings, and to evaluate their impact on health outcomes.
Basic science research remains a key component of HIV research. Despite the progress made in understanding HIV, critical gaps exist in our knowledge of the immune response to HIV, correlates of protection, pathogenesis, and transmission mechanisms, particularly in infants and children. Such knowledge is necessary for the development of potential vaccines and cures for HIV. EGPAF has been a leader in advocating for the inclusion of infants and children in the HIV vaccine research agenda and raising resources to support studies to contribute to the development of a pediatric HIV vaccine. Recent studies have focused on understanding HIV transmission through breast milk; understanding pediatric immune responses to HIV; and identifying solutions to the obstacles to conducting clinical trials in infants.
Early Infant Diagnosis
In Lesotho, EGPAF recently undertook an analysis of early infant diagnosis turnaround times. By documenting where delays occur along each step of the pathway from specimen collection to receipt of results, interventions and products can be developed to shorten the testing interval, allowing for faster initiation of infants on lifesaving treatment.
Pediatric Cure Consortium
In 2013, EGPAF established the Pediatric Cure Consortium to focus the research agenda on children and to drive progress to find a cure. The Consortium, led by EGPAF staff and an International Pediatric Cure Consortium Advisory Board of scientists, seeks to enhance scientific collaboration to determine research priorities and to garner resources for the cure of HIV infection in children. Through this forum, EGPAF will provide seed funding for the most promising ideas, support think tanks, and ensure the sharing of key data and research results.
The collaborative nature of EGPAF’s research program emphasizes linkages between researchers in developing and developed countries, who share findings and insights into the practical implications of their work. EGPAF is dedicated to strengthening the research capacities of both field-based staff and local institutions in all countries where it works. Globally, EGPAF has developed and implemented an operations research training curriculum to build research capacity among its country teams and governmental and non-governmental partners.
The Kabeho Study
EGPAF has partnered with the Ministry of Health (MOH) and National University of Rwanda, School of Public Health (NURSPH) to evaluate the outcomes of the PMTCT program in Rwanda under the Kabeho Study. This study assesses 18-month HIV-free survival and growth outcomes in a cohort of children born to HIV-positive pregnant women receiving lifelong ART and comprehensive infant counseling and support. EGPAF will enhance the capacity of MOH and NURSPH investigators and students in design, implementation, analysis, and dissemination of research.
Since EGPAF was founded, raising funds to support scientists and clinicians with research relevant to the prevention, treatment, and cure of HIV in children has been a priority. EGPAF has built a strong and highly-regarded network of scientists who continue to collaborate on projects that have produced some of the most important results related to the treatment and prevention of HIV/AIDS.
Through the generous support of private foundations, corporations, and private donors, EGPAF offers financial support and technical oversight and support for two grant programs:
International Leadership Awards
International Leadership Awards (ILAs) are three-year grants given to individuals in resource-limited settings to develop and manage programs to assist in the elimination of pediatric AIDS in the countries where they live. Recent award winners have focused on issues such as improving the effectiveness of PMTCT services; strengthening maternal and infant diagnosis of HIV; supporting the development of national policies and strategies to combat pediatric HIV and AIDS; and examining the impact of ART on children.
ILA Grantee: Dr. Landon Myer
Recent ILA grantee Dr. Landon Myer of the University of Cape Town has developed a project that integrates ART services into antenatal care (ANC) to reduce the time to initiation of ART for HIV-infected pregnant women. Positive research results have led provincial health authorities to make integration of ART services into ANC a core program goal for local PMTCT services.
Susie Zeegen Fund Postdoctoral Awards
Susie Zeegen Postdoctoral Awards are two-year grants that support postdoctoral fellows to conduct basic immunologic or virologic research in one of the following priority areas:
- Neonatal/infant immunology, particularly studies that are directly relevant to development of immunologic approaches to HIV prevention or cure
- Immunologic approaches to infant HIV preventive or therapeutic vaccination (active or passive)
- Novel approaches toward a cure in HIV-infected infants in parallel with current research in this area in adults, which contributes to greater understanding of infant immunology and HIV pathogenesis
Research Brief: Current EGPAF Research Activities (2014), Download PDF
Technical Bulletin: Haba-na-Haba: The Role of Research in Achieving Virtual Elimination of HIV Infection in Children: An EGPAF Perspective (2012), Download PDF