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NIHR-funded researchers help influence WHO guidelines for people living with HIV

Published: 01 December 2023

The World Health Organization (WHO) has updated its guidelines for treating cryptococcal meningitis for people living with HIV. This change is based on findings from the AMBITION-cm study, led by NIHR Global Research Professor Joe Jarvis.

The study recommends a new treatment which is simpler, safer, and more cost effective for people living with HIV.

Cryptococcal meningitis is one of the most dangerous diseases for people living with advanced HIV. The disease accounts for 15% of all AIDS related-deaths globally. In 2014, it was estimated that 223,000 cases of cryptococcal meningitis resulted in over 180,000 deaths. 

Updated national guidelines

After the study was published, within just 3 months countries updated their national guidelines. Quickly, patients started to receive the recommended treatment as part of routine care.

WHO released a rapid advice notice one month after the findings of the study.  This prompted countries to update their national guidelines. Then, WHO published new guidelines 4 months later. WHO was able to act fast as a result of the AMBITION-CM study’s design.

The study team ensured key questions were answered as they collaborated with African researchers. They engaged with Ministries of Health, and communities affected by HIV-associated cryptococcal meningitis.

This rapid uptake is very unusual. Normally, it can take up to 17 years from papers becoming available for practice to change

Prof. Jarvis said: “Along with the entire AMBITION Study team, I am extremely happy that our trial has had such an immediate impact on global clinical practice.

“Ultimately, the reason we all do this work is to make a positive difference in people's lives. It is immensely rewarding to see our research findings already resulting in patients benefiting from a much improved treatment for this devastating disease across Africa and around the world.”

Professor Kara Hanson, Programme Director for Global Health, said: “NIHR’s Global Health Research Professorships provide a foundation for research leaders to develop a programme of applied global health research that will translate into health improvements in low and middle income countries.

"The speed with which Professor Jarvis’ research has been adopted in global and national treatment guidelines is exemplary. It highlights the value of the work that takes place alongside the intervention research – on economics, acceptability, and health systems– that help support research uptake.”

International collaboration

NIHR Global Research Professors receive 2 million over a 5-year period. This includes funding for their research and support teams, and leadership development.

The award enabled Professor Jarvis to:

  • develop a meningitis network which determined the cause of cryptococcal meningitis infections in different areas
  • work with local researchers, healthcare professionals and government
  • expand the research team, recruiting 5 PhD students and a post-doc

The AMBITION-cm study took place in

  • Botswana
  • Zimbabwe
  • South Africa
  • Malawi

Joe Jarvis is Professor of Tropical Medicine at the London School of Hygiene and Tropical Medicine.

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