Important work in the field of pediatric HIV

Dr. Alfeu Passanduca is faculty in the Department of Microbiology at the University Eduardo Mondlane (UEM) School of Medicine in Maputo, Mozambique. As a clinician, Dr. Passanduca currently focuses on inpatient and outpatient pediatric HIV care. He is also leading a study called PCP-PED, which is nested within the EMPIRICAL trial — a larger trial that aims to improve treatment of severe pneumonia among infants with HIV throughout Mozambique and other sub-Saharan African countries. In the PCP-PED study, Dr. Passanduca is investigating novel methods of diagnosing Pneumocystis jiroveci pneumonia (PCP) in children with HIV. Dr. Passanduca was recently selected as a GloCal Fellow (UCLA mentors Dr. Chris Buck and Dr. Karin Nielsen from Pediatrics), and received a European and Developing Countries Clinical Trials Partnership (EDCTP) Career Development award to support the study. GHP spoke with Dr. Passanduca to understand the importance of improving PCP diagnostics for children in Mozambique.

Dr. Passanduca, congratulations on being awarded a GloCal Fellowship and an EDCTP award! Can you share with us the details of the research being funded by these two awards?

Dr. Passanduca: Thank you, we are very excited! In Mozambique, the prevalence of adults aged 15-49 living with HIV is 11.5% and the country currently ranks second in the world in terms of new annual pediatric HIV infections. It is well-established that people living with HIV are more likely to develop opportunistic infections, such as PCP. To diagnose PCP, physicians in high-income countries typically obtain a deep respiratory specimen via bronchoalveolar lavage. However, this is an invasive procedure, particularly for a child with a compromised immune system. And the specialized resources needed to collect and analyze such specimens are scarce in countries like Mozambique. As a result, we currently treat infants with suspected PCP empirically, without laboratory confirmation.

So, we asked ourselves, can we perform diagnostic tests in infants with HIV-positive who are hospitalized with severe pneumonia that are affordable, minimally invasive, and that match the medical capacity across Mozambique? Our project proposes to test the accuracy of immunofluorescent microscopy and real-time PCR performed on nasopharyngeal aspirates and to examine blood biomarkers to decipher whether blood samples can be used to diagnose PCP in children.

This research will be supported by GloCal for one year and then will transition to EDCTP support, with a goal to recruit approximately 200 children by early 2024. Both awards have a strong focus on professional development and I plan to use this study for my doctoral (PhD) studies.

In light of World AIDS Day, we’re curious to hear your perspective on strides related to HIV prevention and care in Mozambique, and what you think might be the next biggest challenge?

Dr. Passanduca: HIV incidence rates have declined by nearly half over the last decade (from 6.92% in 2010 to 3.5% in 2020) and the coverage of anti-retroviral therapy (ART) has increased significantly. In Mozambique, we recently implemented a new standard first-line antiretroviral treatment for adults that is stronger and combines three medications into one pill. This, I hope, will help increase adherence to life-saving medication.

I think the greatest challenge is related to behavior change, and the greatest opportunity is in education. It is critical that we invest in education, particularly to emphasize the importance of adhering to medication, increase community sensitization to help destigmatize the disease, and empower women as household decision-makers.

As many of our colleagues know, GloCal Fellowships are unique in that they are mentored research opportunities. Can you share a bit about the significance of the mentorship you’ve received?

Dr. Passanduca: I feel very lucky to have such great mentors. They have really helped me articulate my research proposal and have provided invaluable career development. For example, under their mentorship, I’ve learned how to search for, find, and analyze relevant published research articles, and how to write a proposal and develop a budget (among many other skills). This mentorship has helped me think in a way that allows me to reach my goals. Thank you to Drs. Chris Buck and Karin Nielsen at UCLA, and Dr. Jahit Sacarlal at UEM!

Thank you to Drs. Chris Buck and Karin Nielsen at UCLA, and Dr. Jahit Sacarlal at UEM!