Meet the CIPHER grantees

Atupele Kapito-Tembo

Year awarded: 2013
Institution: University of Malawi College of Medicine
Research site: University of Malawi College of Medicine
Primary mentor: Sam John Peter Phiri, Lighthouse Trust Clinic, Malawi

Atupele Kapito-Tembo is a public health specialist and epidemiologist with a research focus on maternal and child health, HIV and malaria. She is co-founder of the Women in Infectious Diseases and Health Research Network in Malawi.

More information on Atupele | Email

“This research has opened opportunities that would otherwise not be possible for me. I intend to build on the results of this project to get more work to improve paediatric HIV care as well as child health care in general.”

Research project: Pharmacovigilance of infants exposed to antiretroviral drugs given to HIV-infected mothers during breastfeeding

The issue

Malawi has implemented the prevention of mother-to-child transmission of HIV option known as B+ that provides lifelong ARVs to pregnant women found to be HIV positive. These mothers are also encouraged to breastfeed their children until they are two years old. However, it is not known whether long-term exposure to efavirenz (EFV), lamivudine and tenofovir disoproxil fumarate (TDF) through breastmilk is safe for infants. HIV-positive children receiving therapeutic doses of these drugs have experienced growth, renal and neurodevelopmental problems.

The CIPHER project

Dr Kapito-Tembo’s research set out to determine EFV and TDF levels in the breastmilk and plasma of HIV-positive breastfeeding mothers receiving ART and from the plasma of their infants. It also proposed reporting neurodevelopmental outcomes, growth and blood measures of bone metabolism and renal function as proxies of EFV and TDF toxicities in breastfeeding infants of mothers who are receiving lifelong ART.

Her project established two implementation research studies as part of the WHO INtegrating and Scaling up PMTCT through Implementation REsearch (INSPIRE) initiative that focuses on improving the retention of HIV-infected mothers and their infants in care. The working hypothesis was that long-term, low-dose exposure of infants to ARVs through breast milk is safe and does not result in serious adverse events, such as growth, bone, renal or neurodevelopmental abnormalities, when compared with infants of HIV-negative mothers.

The impact

Data from the research has filled some critical gaps in HIV paediatric care knowledge. Due to the IAS funding and research, Dr Kapito-Tembo was invited to be a member of the national technical working groups on policy. Other awards that followed her CIPHER grant include:

  • A WHO grant to implement best strategies to improve careers for women scientists involved in infectious diseases of poverty in Africa
  • A UNICEF grant to improve health workers’ capacity to reach every child with child health services in Malawi, and another to build capacity for health workers in management of childhood illnesses in Malawi, including HIV and TB in hard-to-reach areas
  • An HIV implementation science mentored award to pilot models for integrating malaria and HIV services in Malawi
  • UNICEF and Global Affairs Canada grant award to pilot integrating into the national EPI programme various child health programmes such as nutrition, neglected tropical diseases and HIV.