Nyanyiwe Mbeye
University
Malawi-Liverpool-Wellcome Trust Clinical Research Programme.
PhD Title
Malaria Rebound in Cotrimoxazole prophylactic HIV exposed children.
Abstract
Empirical daily cotrimoxazole prophylaxis is recommended and given to HIV exposed breastfed children in Malawi and other developing countries until the child is a year old when breastfeeding stops and the child remains sero-negative. Cotrimoxazole does not only prevent PCP and other bacterial infections but is also an effective anti-malarial despite the wide in-vitro resistance patterns observed. There is concern of this sustained malaria chemoprophylaxis and it is postulated that this daily cotrimoxazole prophylaxis does not allow for malaria specific acquired immunity to develop and results in an increased malaria risk after the prophylaxis is stopped. Additionally, social and cultural issues surrounding adherence to this daily prophylaxis remain unknown. The broad objective is to investigate malaria, other co-morbidities, and practices associated with the use of cotrimoxazole prophylaxis in HIV exposed children. Two cohorts of children, an HIV exposed group on cotrimoxazole prophylaxis for 12 months and a non-HIV exposed group, from the ages 0-2 months will be followed up until 2 years. HIV exposed children will be recruited at the PMTCT clinic, while non-HIV exposed children will be recruited simultaneously from the area of residence of each HIV exposed child. From 12 months of age, after stopping cotrimoxazole prophylaxis which is effectively anti-malarial prophylaxis, the incidence of malaria and all-cause morbidity and mortality will be compared between the two cohorts. Results from this study will be critical in evaluating the advantages and disadvantages of empirical cotrimoxazole prophylaxis in HIV exposed infants. The understanding of the trend of malaria epidemiology of these HIV exposed children will help in the formulation of effective, targeted interventions especially if the rebound malaria phenomenon as postulated is observed.
Background
I have a Bachelor of Science Degree in Nursing, a University certificate in Midwifery and a Masters Degree in Public Health all obtained from the University of Malawi. I worked as a Lead Research Nurse for a large HIV Research institution, the University of North Carolina Project for about 6 years; as Technical Manager for a countrywide non-governmental Reproductive Health Organization for about a year and a National Programme Officer for Reproductive Health for Jhpiego for two years. I am married to Gilder Mbeye, a Mechanical Engineer and we have two sons: Shikunzi and Muwemi.I am so excited to be part of the MCDC team of Students as this gives me an opportunity to realize my long time career goals and I am looking forward to starting the programme.