Collaborative Initiative for Paediatric HIV Education and Research (CIPHER)
The Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) of the International AIDS Society (IAS) is aimed at optimizing clinical management and delivery of services to infants, children and adolescents affected by HIV in resource-limited settings through advocacy and research promotion.
- Promoting and investing in targeted research to address priority knowledge gaps in paediatric HIV
- Convening stakeholders and establishing collaboration mechanisms to strengthen communication, knowledge transfer and exchange among paediatric HIV cohorts
- Advocacy and outreach to support evidence-informed clinical, policy and programmatic decision making (new in 2014).
CIPHER was launched as a two-year research initiative in 2012 with the generous support of an unrestricted grant from ViiV Healthcare's Paediatric Innovation Seed Fund. Over the first two years, a core programme of activities was developed, including a grant programme, a global cohort collaboration and online paediatric HIV cohort database. By the end of 2013, the IAS reaffirmed its commitment to paediatric HIV by making paediatrics a programme priority, with CIPHER as the official branding.
Thanks to renewed support from ViiV Healthcare for 2014 and 2015, CIPHER will continue to build on the activities developed in the initial phase and expand its scope with an advocacy and outreach component.
CIPHER activities are strategically developed in collaboration with a Scientific and Technical Advisory Committee (STAC) of experts in paediatric HIV convened by the IAS. These activities consist of the following:
CIPHER is designed to complement existing global initiatives and create partnerships with other organizations to maximize investment in paediatric HIV research and improve paediatric health outcomes. The first phase of the project consisted of building a solid scientific and programmatic foundation. A comprehensive needs assessment was conducted, including a literature review and key informant interviews with experts, which outlined a set of research priorities that has been used to inform and guide CIPHER.
Too many gaps in paediatric HIV
There has been notable progress in reducing vertical transmission of HIV: 57% of pregnant women with HIV accessed treatment for prevention of mother to child transmission at the end of 2012 compared with 48% in 2010. Despite this progress, 3.4 million children are living with HIV worldwide and 260,000 were newly infected in 2012.
The paediatric population remains significantly disadvantaged with respect to access to treatment in comparison with adults. Only 34% of eligible children received antiretroviral therapy (ART) compared with 65% of adults in 2012. In addition, there is insufficient data on the effect of ART on growth and development of children, as well as not enough data on how to ensure optimal adherence as they reach adolescence. Under the 2013 WHO Consolidated Treatment Guidelines, which recommend that all HIV-infected children under the age of five years should be started on ART regardless of clinical stage, immune status or viral load, an additional 1.4 million children became eligible for ART.
At the same time, access to timely and reliable early infant diagnosis remains a key challenge in resource-limited settings. In 2012, only 39% of HIV-exposed infants received virological testing for HIV in the first two months of life, when peak mortality occurs. Furthermore, there is an increasing population of children living with HIV who are maturing into adolescence; from 2005 to 2012, this particularly vulnerable group has seen a 50% increase in AIDS-related mortality, compared with a decrease of 30% in the global population of people living with HIV.
There is an urgent need to address outstanding research questions to inform the preparation of guidelines and to improve access to more effective diagnosis, prevention, treatment and care interventions for children and adolescents.