A randomised trial of monitoring practice and pulse antiretroviral therapy in African children with HIV infection
Lead Research Organisation:
MRC Clinical Trials Unit
Abstract
In industrialised countries, triple-drug Anti-Retroviral Therapy (ART) has transformed AIDS from a fatal to a chronic disease where the main issues are the effects of long-term side-effects to these drugs. ART is becoming increasingly available in resource-poor countries, following dramatic price reductions and donor commitments to provide drugs, such as the global fund for Malaria, TB and AIDS. However, ART remains out of reach for many patients in the African countries worst affected by AIDS. This is also because of the additional need for infrastructure to do blood tests for monitoring immunity levels and side-effects of drugs. These test are routinely done in industrialised countries but are expensive, require special machines and trained personnel and may not always be necessary. The DART trial is finding out whether ART can be given safely and effectively to adults with HIV by health agencies with limited ability to do monitoring. DART is also investigating whether intermittent therapy (in regular on-off cycles), which might reduce long-term side-effects as well as drug costs, is as safe and effective as continuous ART at fighting HIV/AIDS. The results are expected in 2008. So far 2000 of the 3000 adults needed for the trial have been enrolled during 2003. In an anonymous survey, we found out that around 40% DART trial participants are caring for a sick child with symptoms suggestive of HIV in the same household. Therefore for ethical as well as scientific and practical reasons (to avoid pill-sharing), we are planning a similar trial to DART for children. Junior DART will enrol 1200 children and adolescents of DART families and address similar questions as adult DART. Growth could be an important additional way to monitor how well children are responding to ART, making clinical monitoring even more viable than in adults. In addition, children have more active immune systems, which may recover better and more quickly when ART is restarted after a period off therapy. Therefore it is quite possible that the results from the adult DART trial cannot just be assumed to be the same for children DART and Junior DART will be done in the same centres in Uganda and Zimbabwe and will form the basis of developing family-based care for HIV infection in Africa.
Technical Summary
Junior DART is a randomised open-label trial enrolling 1200 African HIV-infected children, aged 6 months to 18 years, with an adult carer in the DART (Development of AntiRetroviral Therapy) trial which has enrolled 2000 of 3000 adults in Uganda (2 sites) and Zimbabwe (1 site). Junior DART will take place in the same sites and the 2 trial teams will work closely together. Junior DART will have two major randomisations: to clinical monitoring only (CMO) versus laboratory and clinical monitoring (LCM); and to intermittent (planned treatment interruptions, PTI) versus continuous ART. In a further randomised substudy, 3 regimen strategies for initiating ART will be compared in terms of HIV RNA viral load response.
Eligible children should have paediatric WHO Stage 2 or 3 disease, and CD4 percent 20% for children 2 years, 15% for children 2-11 years, or CD4 count 200 cells/mm3 for those aged 12-18 years. It is expected that at least 750 children randomised to CMO versus LCM will be 2 years and have achieved a sufficient increase in CD4 (CD4 ?20% for 2-11 years and CD4 250 cells/mm3 for 12-18 years) by 48 or 72 weeks to be eligible for the second randomisation to PTI versus continuous ART. This will only open after a non-randomised pilot study of PTIs in 100 children satisfying these threshold criteria has been completed (with all children having monthly CD4 measurements) and the DSMC and Trial Steering Committee have assessed the safety of the proposed PTI strategy.
Recruitment into the trial will take place over one year with minimum follow-up of 4 years. First and second-line ART will be available for all children (for up to five years). The decision to change to second-line ART will be based on clinical criteria alone for the CMO arm and on clinical plus laboratory criteria for the LCM arm. Issues of after-trial ART are being negotiated with governments in the same way as for adult DART.
The primary efficacy endpoint will be progression to a new paediatric WHO stage 3 (AIDS) event or death in children under 13 years, or adult WHO stage 4 disease for those 13 years and older. The primary outcome for the randomised substudy will be change in HIV RNA from baseline to 48 weeks, performed retrospectively on stored plasma samples.
Eligible children should have paediatric WHO Stage 2 or 3 disease, and CD4 percent 20% for children 2 years, 15% for children 2-11 years, or CD4 count 200 cells/mm3 for those aged 12-18 years. It is expected that at least 750 children randomised to CMO versus LCM will be 2 years and have achieved a sufficient increase in CD4 (CD4 ?20% for 2-11 years and CD4 250 cells/mm3 for 12-18 years) by 48 or 72 weeks to be eligible for the second randomisation to PTI versus continuous ART. This will only open after a non-randomised pilot study of PTIs in 100 children satisfying these threshold criteria has been completed (with all children having monthly CD4 measurements) and the DSMC and Trial Steering Committee have assessed the safety of the proposed PTI strategy.
Recruitment into the trial will take place over one year with minimum follow-up of 4 years. First and second-line ART will be available for all children (for up to five years). The decision to change to second-line ART will be based on clinical criteria alone for the CMO arm and on clinical plus laboratory criteria for the LCM arm. Issues of after-trial ART are being negotiated with governments in the same way as for adult DART.
The primary efficacy endpoint will be progression to a new paediatric WHO stage 3 (AIDS) event or death in children under 13 years, or adult WHO stage 4 disease for those 13 years and older. The primary outcome for the randomised substudy will be change in HIV RNA from baseline to 48 weeks, performed retrospectively on stored plasma samples.
Organisations
- MRC Clinical Trials Unit (Lead Research Organisation)
- University College London, United Kingdom (Collaboration)
- Joint Clinical Research Center, Kampala (Collaboration)
- Government of the UK (Collaboration)
- University of Zambia, Zambia (Collaboration)
- University Medical Centre Nijmegen (Collaboration)
- University of Zimbabwe, Zimbabwe (Collaboration)
- GlaxoSmithKline (GSK) (Collaboration)
- London Sch of Hygiene and Trop Medicine, United Kingdom (Collaboration)
- The Sainsbury Family Charitable Trusts (Collaboration)
People |
ORCID iD |
Diana Gibb (Principal Investigator) |
Publications

Mabugu T
(2013)
The Methodological Challenges for the Estimation of Quality of Life in Children for Use in Economic Evaluation in Low-Income Countries.
in Value in health regional issues

ARROW Trial Team
(2013)
Routine versus clinically driven laboratory monitoring and first-line antiretroviral therapy strategies in African children with HIV (ARROW): a 5-year open-label randomised factorial trial.
in Lancet (London, England)


Jaganath D
(2014)
HIV-associated anemia after 96 weeks on therapy: determinants across age ranges in Uganda and Zimbabwe.
in AIDS research and human retroviruses

Fillekes Q
(2014)
Pharmacokinetics of zidovudine dosed twice daily according to World Health Organization weight bands in Ugandan HIV-infected children.
in The Pediatric infectious disease journal

Bwakura-Dangarembizi M
(2014)
A randomized trial of prolonged co-trimoxazole in HIV-infected children in Africa.
in The New England journal of medicine

Revill PA
(2015)
Opportunities for improving the efficiency of paediatric HIV treatment programmes.
in AIDS (London, England)

Musoke P
(2015)
Single-dose nevirapine exposure does not affect response to antiretroviral therapy in HIV-infected African children aged below 3 years.
in AIDS (London, England)

Szubert AJ
(2015)
Pubertal development in HIV-infected African children on first-line antiretroviral therapy.
in AIDS (London, England)

Bwakura-Dangarembizi M
(2015)
Prevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy.
in The Pediatric infectious disease journal
Guideline Title | GUIDELINE ON WHEN TO START ANTIRETROVIRAL THERAPY AND ON PRE-EXPOSURE PROPHYLAXIS FOR HIV |
Description | ARROW influence on WHO Guidelines on When to Start ART (2015) |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Citation in clinical guidelines |
Impact | The new WHO guidelines cite the ARROW results, saying "Expanding ART services for children will require strategies to improve retention in care and to support adherence. Careful clinical monitoring remains essential to assess the risk of treatment failure, but lack of laboratory monitoring should not be a barrier to initiating ART." ARROW showed that children on ART had excellent outcomes with clinical monitoring, and that routine laboratory monitoring was not cost-effective in most circumstances. It is important that this is acknowledged in the WHO guidelines, as there is a move towards requiring routine viral load monitoring, which could act as a barrier to access for children in rural areas in low-income countries. |
URL | http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1 |
Description | Antiretroviral Therapy of HIV Infection in infants and Children in Resource-Limited Setttings: Towards Universal Access. Recommendations for a public health approach |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Participation in advisory committee |
Guideline Title | WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach |
Description | Influence on WHO ART guidelines 2013 |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Citation in clinical guidelines |
Description | Member of WHO Maternal and Child Health Guideline Development Group |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Membership of a guidance committee |
Description | Post marketing data for EMA for scored adult tablets for children (antiretroviral therapy) |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Citation in other policy documents |
Impact | The data provided from ARROW was submitted to EMA for scored adult tablets for children, along with evidence of acceptability, required post-licensing. THese products now widely used for children worldwide. (antiretroviral therapy) |
Description | WHO advisory group on formulations of antiretroviral medicines for HIV infected children |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Participation in advisory committee |
Impact | Data from ARROW has provided evidence on pharmacokinetics and acceptability of weightband tables for scored tablet formulations in HIV-infected children. |
Description | ARROW: A randomised trial of monitoring practice in the management of antiretroviral therapy in children with HIV infection in Africa/Medical Research Council (MRC) and Department for International Development (DFID) |
Amount | £1,651,128 (GBP) |
Organisation | Medical Research Council (MRC) |
Sector | Academic/University |
Country | United Kingdom |
Start | 06/2006 |
End | 06/2012 |
Description | ARROW: A randomised trial of monitoring practice in the management of antiretroviral therapy in children with HIV infection in Africa/Medical Research Council (MRC) and Department for International Development (DFID) |
Amount | £1,651,128 (GBP) |
Organisation | Government of the UK |
Department | Department for International Development (DfID) |
Sector | Public |
Country | United Kingdom |
Start | 06/2006 |
End | 06/2012 |
Description | The Causes and Consequences of Residual Immune Activation in HIV-Infected Children on ART in Resource-Limited Settings |
Amount | £654,391 (GBP) |
Funding ID | G1001190 |
Organisation | Medical Research Council (MRC) |
Sector | Academic/University |
Country | United Kingdom |
Start | 05/2011 |
End | 04/2016 |
Description | Young Lives: the Social Contexts of Paediatric Anti-Retroviral Therapy. A DFID Social Science programme in Uganda and Zimbabwe |
Amount | £788,800 (GBP) |
Organisation | Government of the UK |
Department | Department for International Development (DfID) |
Sector | Public |
Country | United Kingdom |
Start | 01/2011 |
End | 01/2015 |
Title | ARROW Pharmacy Database |
Description | Prior to ARROW the sites in Uganda and Zimbabwe had used paper based methods for recording for all drug processes in the pharmacy. ARROW has created an ACCESS pharmacy database which allows for ease of tracking and accountability of drugs in the trial. |
Type Of Material | Database/Collection of Data/Biological Samples |
Provided To Others? | No |
Impact | The creation of the ARROW Pharmacy database resulted in capacity development for local staff from Uganda, who were instrumental in the development of the database along with members of the ARROW team at MRC. This has also resulted the person being involved in on-going database maintenance work and other data services work with the MRC. |
Description | DFID (Department for International Development) |
Organisation | Government of the UK |
Department | Department for International Development (DfID) |
Country | United Kingdom |
Sector | Public |
PI Contribution | The research team at the MRC co-ordinates the ARROW trial and the Lablite Project. The Young Lives project team (LSHTM) work across ARROW and PENTA 16 trials in Uganda. |
Collaborator Contribution | DFID fund Lablite and co-funded ARROW and the Young Lives. They attend all Trial Steering Committees and we have an ongoing active communication and collaboration. |
Impact | DFID co-funds ARROW and provides funding for the Young lives social science study. Without the co-funding from DFID ARROW would not be possible |
Start Year | 2006 |
Description | GlaxoSmithKline |
Organisation | GlaxoSmithKline (GSK) |
Country | Global |
Sector | Private |
PI Contribution | The research team at the MRC co-ordinates the overall ARROW trial and reports regularly to GSK on drug consumption and any reported events that may be related to GSK drugs. Protocols for GSK funded sub-studies were written and implemented through the MRC and results are shared with GSK before being publicly disseminated. |
Collaborator Contribution | GSK provide first line ART drugs for the trial.GSK will compensate ARROW up to a total amount of $212,700.00 (not £) for the work on Virology. |
Impact | GSK donates ARROW first-line drugs and provides funding for sub-studies (Pharmacokinetic of syrups and tablets; Acceptability/Adherence of these formulations; virology) Data from part of the Virology sub-study has been submitted to FDA for once daily dosing of Abacavir+lamivudine for children; in 2014 these data contributed to approval also of once daily dosing of fixed dose combination tablet from a generic company |
Start Year | 2006 |
Description | GlaxoSmithKline |
Organisation | GlaxoSmithKline (GSK) |
Country | Global |
Sector | Private |
PI Contribution | The research team at the MRC co-ordinates the overall ARROW trial and reports regularly to GSK on drug consumption and any reported events that may be related to GSK drugs. Protocols for GSK funded sub-studies were written and implemented through the MRC and results are shared with GSK before being publicly disseminated. |
Collaborator Contribution | GSK provide first line ART drugs for the trial.GSK will compensate ARROW up to a total amount of $212,700.00 (not £) for the work on Virology. |
Impact | GSK donates ARROW first-line drugs and provides funding for sub-studies (Pharmacokinetic of syrups and tablets; Acceptability/Adherence of these formulations; virology) Data from part of the Virology sub-study has been submitted to FDA for once daily dosing of Abacavir+lamivudine for children; in 2014 these data contributed to approval also of once daily dosing of fixed dose combination tablet from a generic company |
Start Year | 2006 |
Description | Institute of Child Health |
Organisation | University College London |
Department | Institute of Child Health |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Collaborators on an MRC Immunology substudy within ARROW, delegating activities as described under an agreement with ICH, and we take responsibility for the project in accordance with the provisions of the Funder; application for NIHR funding for PENTA 16 immunology substudy |
Collaborator Contribution | Training, laboratory capacity building, teaching on PENTA Courses in East and West Europe and across Africa; sharing supervision of PhD Wellcome Trust studentships (Prof. Nigel Klein). Working together on EuroCoord, EPPICC, PENTA and Hepatitis C activities (Dr Claire Thorne). Collaborators and grant holders on NIHR PENTA 16 main study and biomarker substudy |
Impact | MRC grant secured in 2010. Work ongoing with baseline data presented at international conferences. Involves collaboration, training and capacity building between clinical, laboratory and trial management personnel at Ugandan and Zimbabwean sites and MRC CTU and Institute of Child Health. Site laboratory trained in four colour Immunophenotyping, nucleic acid extraction protocols and quantitative and real time PCRs (on HIV, CMV and EBV), and ELISA assays. Further training will be done on other techniques, in year 2 of the study. Training was done by personnel from both CTU and ICH. |
Start Year | 2010 |
Description | Joint Clinical Research Centre, Kampala, Uganda |
Organisation | Joint Clinical Research Center, Kampala |
Country | Uganda |
Sector | Academic/University |
PI Contribution | Multicentre clinical trial collaboration on DART, ARROW, CHAPAS 3, PENTA 16 (BREATHER) and REALITY Trials and substudies Partner on the Lablite Project and on PENTA 17 (SMILE) and PENTA 20 (ODYSSEY) trials |
Collaborator Contribution | Clinical trials site and coordination of satelite sites. Laboratory substudies e.g HIV virology and immunology |
Impact | Trial results and substudies DART, ARROW, CHAPAS 2, CHAPAS 3, BREATHER and REALITY trials including virology, social science and economic substudies DART trial Fim Young lives project from ARROW trial Outputs from the Lablite Project |
Start Year | 2006 |
Description | Monument Trust |
Organisation | The Sainsbury Family Charitable Trusts |
Department | Monument Trust |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | MRC CTU co-ordinates the CHAPAS-2 trial and the AALPHI study |
Collaborator Contribution | funding. The Monument Trust also contribute to I-Base publications which CTU staff have input in to. |
Impact | The Monument Trust funds the pharmacokinetic teams at 2 of the Ugandan trial centres for ARROW and CHAPAS trials. Some second-line children from ARROW are co-enroled in CHAPAS-2. AALPHI study started recruiting in Q3 2012. |
Start Year | 2010 |
Description | Radboud University Nijmegen Medical Centre, the Netherlands |
Organisation | Radboud University Nijmegen Medical Center |
Country | Netherlands |
Sector | Academic/University |
PI Contribution | The research team at the MRC co-ordinates the ARROW, CHAPAS-1,2,3 and PENTA trials and provides scientific input and analysis of EDCTP funded VITA 1 and 2 trials. |
Collaborator Contribution | Long standing nesting of key pharmacokinetic studies within larger trial programmes. Contributed to several PhD studentships (all Dutch), PK data resulted in licensing of new appropriate antiretroviral formulations for children in resource limited settings. |
Impact | Radbound University has been involved in the analysis and writing up of the pharmacokinetics data from ARROW, PENTA 18 and the CHAPAS trials which has resulted in presentations at international conferences, peer review publications, FDA and EMA approval of drugs and Clinton Foundation and UNITAID dissemination in Africa. |
Start Year | 2007 |
Description | The London School of Hygiene and Tropical Medicine |
Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
Department | Faculty of Public Health and Policy |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | coordination and facilitation of the Young Lives substudy in the ARROW trial, qualatative substudy of PENTA 16 (UK, Uganda and US) and input in to AALPHI. |
Collaborator Contribution | intensive training in areas of social science adding to collaborations in the African centres (ARROW and PENTA 16). provision of a forum for young people in the ARROW trial to contribute to knowledge about living with HIV infection in Africa |
Impact | 3 Social Scientists trained in Africa; publications and presentations at major conferences on qualitative work in ARROW and BREATHER (PENTA 11) |
Start Year | 2011 |
Description | University of Zambia |
Organisation | University of Zambia |
Country | Zambia |
Sector | Academic/University |
PI Contribution | Contribution to CHAP, CHAPAS 1 & 3 trials |
Collaborator Contribution | enrolled patients into CHAP, CHAPAS 1 & 3 trials Project lead of EDCTP project Contribution to all aspects of reserach including outputs and implementation (CHAP Trial of cotimroxazole prophylaxis) |
Impact | Trial results and substudies and implementation and impact of CHAP & CHAPAS 1 and 3 trials, including economic analyses CHAPAS 3 trial just completed and papers ongoing |
Start Year | 2006 |
Description | University of Zimbabwe |
Organisation | University of Zimbabwe |
Country | Zimbabwe |
Sector | Academic/University |
PI Contribution | DART, ARROW, REALITY Trials funding and coordination by MRC CTU LAblite Project on enabling rollout of antiretroviral therapy. |
Collaborator Contribution | Clinical sites for DART, ARROW, REALITY, PENTA 20(ODYSSEY) Trials Staff are partners in all aspects of reserach from design through to enrolling patients and writing results papers |
Impact | DART and ARROW trials and substudy outcomes and implementation impact; ARROW young lives study and economic substudies REALITY trial ongoing LAblite Project outputs |
Start Year | 2006 |
Title | ARROW Trial |
Description | 4 randomisations, 1) monitoring for efficacy and toxicity of ART in children. 2) induction maintenance ART strategies versus standard of care. 3) stoping cotrimoxazole prophylaxis 4) once versus twice daily lamivudine plus abacavir. |
Type | Management of Diseases and Conditions |
Current Stage Of Development | Late clinical evaluation |
Year Development Stage Completed | 2012 |
Development Status | Closed |
Clinical Trial? | Yes |
Impact | influenced WHO ART 2013 Guidelines (monitoring management, ART for TB co-infection, cotrimoxazole prophylaxis |
URL | http://www.controlled-trials.com/ISRCTN24791884 |
Title | ARROW Trial scored formulations of lamivudine, abacavir, combivir made by GlaxoSmithKline |
Description | GSK provided funding for the PK and acceptability substudies which were undertaken in ARROW clinical sites |
Type | Therapeutic Intervention - Drug |
Current Stage Of Development | Early clinical assessment |
Year Development Stage Completed | 2011 |
Development Status | Closed |
Clinical Trial? | Yes |
Impact | greater choice of appropriate drug formulations for children worldwide |
URL | http://www.arrowtrial.org/ |
Description | ARROW Cotrimoxazole film |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Film about the ARROW cotrimoxazole results released on YouTube. 161 views so far from the YouTube website. Unsure how many views from the MRC CTU website. |
Year(s) Of Engagement Activity | 2014 |
URL | https://www.youtube.com/watch?v=D1n_We7x8Do |
Description | ARROW Cotrimoxazole policy brief |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | The policybrief was distributed to policymakers in the Ministry of Health in Uganda and Zimbabwe (where the trial took place). It has also been more widely distributed at meetings, and is available on the MRC CTU website. Feedback from policymakers at the Ministry of Health was very positive about the policy brief. |
Year(s) Of Engagement Activity | 2014 |
URL | http://www.ctu.mrc.ac.uk/12602/13009/children_on_art_in_africa_need_to_continue_cotrimoxazole_prophy... |
Description | ARROW Induction-maintenance policy brief (2013) |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Type Of Presentation | Paper Presentation |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | The policy brief was circulated to policymakers at the Ministry of Health in Zimbabwe and Uganda. It was also distributed at the CROI conference in 2013 when the results of ARROW were presented. It has been distributed to members of staff at the UK Department for International Development. It has also been distributed via the MRC CTU, Lablite and ARROW websites. The 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection included a recommendation that a triple NRTI regimen could be used for children while on TB treatment. (See Influence on Policy section). |
Year(s) Of Engagement Activity | 2013 |
URL | http://www.ctu.mrc.ac.uk/PDF/ARROWInductionMaintenancepolicybrief.pdf |
Description | ARROW case studies |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | Yes |
Primary Audience | Public/other audiences |
Results and Impact | Three policy briefs on different aspects within ARROW (Tablets are more acceptable and give fewer problems than syrups among young HIV-infected children in resource-limited settings in the ARROW trial; improving children's access to research participation in poorly resourced communities; Use of scored tablets of first line antiretroviral drugs in HIV-infected children in resource limited settings: Experiences from the ARROW Clinical trial The case studies were well received in both Uganda and Zimbabwe with copies of the documents being handed out at the National Ugandan Paediatric conference and at the MRC stand for BHIVA. |
Year(s) Of Engagement Activity | 2010 |
Description | ARROW immune reconstitution press release (2013) |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Media (as a channel to the public) |
Results and Impact | A press release based on the ARROW immune reconsistution paper was issued. This story was covered by Medical Xpress. |
Year(s) Of Engagement Activity | 2013 |
URL | http://www.mrc.ac.uk/Newspublications/News/MRC009540 |
Description | ARROW monitoring film |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Type Of Presentation | Keynote/Invited Speaker |
Geographic Reach | International |
Primary Audience | Health professionals |
Results and Impact | We made a short film about the monitoring results of the ARROW trial. It has been made available on the Lancet website, as well as YouTube, the MRC CTU website, ARROW website and Lablite website. It has also been screened at the BHIVA conference. It has had 121 views on YouTube, but we do not have statistics on views via the other websites. The results regarding toxicity monitoring have fed into the WHO Consolidated Guidelines (see Influence on Policy Section). |
Year(s) Of Engagement Activity | 2013 |
URL | http://www.youtube.com/watch?v=vhCBXmxE7DQ&feature=c4-overview&list=UUxUK9Zn4Es5SxMbAYeTSO2g |
Description | ARROW monitoring policy brief (2013) |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Type Of Presentation | Paper Presentation |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | The policy brief was circulated to policymakers at the Ministry of Health in Zimbabwe and Uganda. It was also distributed at the CROI conference in 2013 when the results of ARROW were presented. It has been distributed to members of staff at the UK Department for International Development. It has also been distributed via the MRC CTU, Lablite and ARROW websites. The results regarding toxicity monitoring providing no benefit discussed in this policy brief have influenced WHO guidelines (see entry in Influence on Policy, Practice, Patients & the Public section). |
Year(s) Of Engagement Activity | 2013 |
URL | http://www.ctu.mrc.ac.uk/PDF/ARROWmonitoringstrategypolicybrief.pdf |
Description | ARROW monitoring press release |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | A press release was issued to tie-in with the publication of the ARROW monitoring and induction-maintenance results. A press conference was also held at CROI. The story was covered by HIVandHepatits.com and AIDSMap in their conference reporting. |
Year(s) Of Engagement Activity | 2013 |
URL | http://www.mrc.ac.uk/Newspublications/News/MRC009041 |
Description | Graphic novels on growing up with HIV (based on ARROW Young Lives research) |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Study participants or study members |
Results and Impact | We produced a series of 3 graphic novels to communicate the findings of the ARROW Young Lives social science sub-study. These novels explore what it is like to grow up with HIV in Uganda. The novels are available in English and Luganda. The novels were distributed to study participants at a results meeting, and to clinic waiting rooms. They are also available online, and are being translated into different languages for use in other countries. |
Year(s) Of Engagement Activity | 2015 |
URL | http://www.ctu.mrc.ac.uk/resources/multimedia/arrow_graphic_novels/ |
Description | Series of training videos for managing children on antiretroviral therapy |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | We have produced a set of interactive training videos to teach paediatric HIV care. The videos were filmed mostly in a district hospital in Malawi and follow the management of children with HIV over time. They are designed to force students to make the kinds of clinical decisions they will face in their work. Topics include early infant diagnosis, ART initiation, common opportunistic infections, drug reactions and assessing possible treatment failure. The videos have frequent stop points with questions which can be used to generate discussion. They are accompanied by detailed notes for teachers and trainers which can easily be adapted to different settings and guidelines. At present the videos are being used in PENTA (Paediatric European Network for the Treatment of AIDS) courses which are held around the world. The films are available to watch and download for free on our Vimeo Channel, where the notes and scripts can also be downloaded. They vary in length from 3 minutes to 16 in length. At present 12 videos are complete. There will be an additional 8 videos uploaded in coming months. |
Year(s) Of Engagement Activity | 2014,2015,2016 |
URL | http://www.ctu.mrc.ac.uk/resources/multimedia/arrow_videos_and_teaching_scripts/ |