Overview

The Drug Implementation Research group’s mission is the development and implementation of therapies for poverty-related infectious diseases (PRID) including malaria, HIV/AIDS, filariasis, schistosomiasis and other infections. Our target populations are made of women of childbearing potential, infants, children and adolescents in sub-Saharan Africa. This mission is embedding in BNITM Strategy that is to combat poverty-related and neglected diseases through testing of new drugs directed against tropical diseases in controlled clinical trials and the development of innovative tools to combat diseases.

Highlight in activities and core results

Core Activities:

•Capacity Building of Research Infrastructure (e.g. Satellite site: Four-place, Melen, Mighoma/Tchibanga, Sindara) and Training

•Epidemiology of Infectious and Non-Communicable Diseases including pregnant women, children and adolescent health (SUDESA)

•Clinical Trials

Highlights:

The research group has established a platform for the conduct of clinical trials from early Phase I to Phase III and post-licensure surveillance. 

For malaria, we contribute to international consortia in Africa for the development of diagnostic and therapeutic interventions, these include the West African Network for Clinical trials on Antimalarial drugs (WANECAM), the Central African Network for Clinical Trials on Malaria, TB and HIV/AIDS (CANTAM), the Portfolio Approach to developing the next-generation of Malaria treatments for Africa (PAMAFRICA), the MAMAH consortium (www.mamahproject.net), the ASAAP project (www.asaap-malaria.org), the SINDOFO consortium (www.sindofo.net). Within these consortia, we explore combinations of non-artemisinin next-generation drugs with the ultimate goal of a single encounter radical cure and prophylaxis (SERCAP). The studies drugs and combinations include ganaplacide-lumefantrine, cipargamin, cabamiquine-pyronaridine, sutidiazine-ferroquine, GSK701. We also explore multiple drug combinations such as artemether-lumefantrine plus atovaquone-proguanil.

While awaiting for the next-generation antimalarial drugs, we advocate for making the most of exisiting antimalarial medicines. For that, with the objective of having a single-dose treatment that can tackle the issue of patients' adherence to the standard 3-day malaria treatment, and considering the strategy of multidrug combination therapy used in other infections like TB and HIV, we are developing a single-dose combination of sulfadoxine-pyrimethamine plus artesunate-pyronaridine (SPAP) for the treatment of uncomplicated malaria and also eventually as a chemoprevention used for intermittent preventive treatment (IPT), post-discharge malaria chemoprevention (PDMC), and seasonal malaria chemoprevention (SMC).

We have conducted exploratory studies to assess the effect of ivermectine on malaria parasites (IVERCURE) or praziquantel (CORMA-MAL) in asymptomatic carriers of Plasmodium falciparum.

For schistosomiasis, we assess the potential effects of antimalarials on Schistosoma haematobium. We have tested the effect of mefloquine and SP given to pregnant women as IPTp, we have evaluated artemisinin-based combnation therapies (ACTs) when given for malaria how they can cure a concomitant schistosomiasis (SCHISTO-ACT). More recently, we have evaluated the efficacy of a combination of artesunate-pyronaridine plus praziquantel (CORMA-BIL).

For loiasis, we evaluate new drugs in humans that include moxidectine (LOLOMOX), and oxfendazole (e-WHORM). At the same time we evaluate different regimens of albendazole and ivermectine (LOLOTREAT, LOACARE).

We sporadically investigate other neglected tropical diseases as snakebite and scabies.

To allow a monitoring and evaluation of the public health impact of our research, we have established a network of research satellite sites in Gabon. We are established in urban settings in Lambaréné, Libreville (Melen), and Tchibanga, and in rural settings in Four-place, Mighoma, and Sindara. There, we continuously collect demographic data as well as on pregnancies, birth and deaths and also migration in and out of the area. Baseline data on the prevalence and incidence of infectious and non-communicable diseases are also collected. Then we implement interventions, experimental or established, and track the changes in the epidemiological profiles. We also assess feasibility and acceptability of the different interventions and we promote community engagement.

We ultimately aim to translate our research findings into health policies and practice. We collaborate with different stakeholders including communities and government bodies, but also international stakeholders.