Meet the CIPHER grantees

Ceri Evans

Year awarded: 2019
Institution: Zvitambo Institute for Maternal and Child Health Research
Research site: Zimbabwe
Primary mentor: Andrew Prendergast, Queen Mary University of London

Ceri Evans is a paediatrician and Wellcome Clinical Research Fellow at Queen Mary University of London in the UK and the Zvitambo Institute for Maternal and Child Health Research in Harare, Zimbabwe.

More information on Ceri | Email

“Despite increasing availability of antiretroviral therapy, there is emerging evidence that children born to HIV-positive mothers do not survive and thrive as well as children born to HIV-negative mothers. This CIPHER Grant will investigate our hypotheses for how to change this.”

Research project: The impact of improved water, sanitation and hygiene (WASH) on cytomegalovirus co-infection in HIV-affected mothers and children in rural Zimbabwe

The issue

Among HIV-exposed uninfected (HEU) children, infant mortality is higher than among HIV-unexposed children, and growth and neurodevelopment are impaired. The drivers of these poor outcomes remain unclear, and further research is needed to identify novel targets for intervention. Dr Evans and his team hypothesise that cytomegalovirus (CMV) has a role in driving immune activation and therefore poor clinical outcomes among HEU children. However, the epidemiology and consequences of CMV among HEU children in settings where prevention of mother-to-child (PMTCT) is now widely adopted are poorly characterized. The team will explore the relationship between active maternal and early-life CMV and survival, growth and neurodevelopment in a rural birth cohort of HEU children.

The CIPHER project

Led by Dr Evans, this study will:

  • Explore the epidemiology of CMV among HIV-affected mother-infant dyads in the SHINE trial in rural Zimbabwe, determining the prevalence of CMV viremia during pregnancy and exploring the association between maternal CMV during pregnancy and timing of infant CMV acquisition.
  • Explore associations between antenatal and early-life CMV infection and clinical outcomes of HIV-exposed children.
  • Evaluate the impact of a household WASH intervention on CMV viraemia in HIV-affected mothers and children.

The impact

As PMTCT coverage improves and mother-to-child HIV transmission declines, the numbers of HEU children are growing, reaching up to 40% of all children born in some southern African settings. Clinical outcomes are poorer than in HIV-unexposed children, including reduced survival, growth and neurodevelopment. Stunting is associated with mortality, poorer school performance and reduced economic productivity in adulthood, and children of stunted parents are themselves more likely to be stunted, creating an intergenerational cycle of poor clinical outcomes and poverty. Interventions are urgently needed to close the gap in outcomes between HIV-exposed and HIV-unexposed children; this has the potential to dramatically improve survival, growth and development of children in rural Africa and improve school attainment and economic productivity. This project will help the researchers develop an understanding of the epidemiology of CMV among HIV-affected mothers and infants in sub-Saharan Africa, and potentially provide a proof-of-principle that CMV transmission can be reduced through household-level public health interventions.

1st International Paediatric HIV Symposium in Africa - Virtual Symposium 17-18 November 2021




Annual international workshop on “Children and Adolescents HIV-Exposed and Uninfected”

CIPHER Grant Programme
Awards up to $150,000 to early-stage investigators to address critical research gaps in paediatric and adolescent HIV in resource-limited settings.

CIPHER Growing the Leaders of Tomorrow Fellowship
Provides support to young investigators in sub-Saharan Africa on priority research topics in paediatric and adolescent HIV clinical science.

CIPHER Global Cohort Collaboration
Brings together the largest collaboration of paediatric and adolescent HIV observational cohort networks to answer key questions of global public health.

Research agendas for paediatric and adolescent HIV