Collaborative Initiative for Paediatric HIV Education and Research (CIPHER)

MISSION: Optimize clinical management and delivery of services to infants, children and adolescents affected by HIV in resource-limited settings.

Despite notable progress in reducing vertical transmission of HIV, the paediatric population remains significantly disadvantaged regarding access to treatment, with only 43% of children in need receiving treatment in 2016. As the HIV epidemic matures, there is a growing population of adolescents living with HIV; in recent years, this particularly vulnerable group has seen a 50% increase in AIDS-related mortality compared with a decrease of 30% globally. These populations face unique challenges, which the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) is committed to placing firmly on the global public health agenda. CIPHER works through a capacity-building approach, supporting the development of young investigators and building the evidence base in low-and-middle-income countries.

CIPHER has three primary objectives:

  • Promote and invest in targeted research to address priority knowledge gaps in paediatric HIV
  • Convene stakeholders and facilitate collaboration to strengthen communication, knowledge transfer and exchange among paediatric HIV cohorts
  • Undertake advocacy to support evidence-informed clinical, policy and programmatic decision making.

CIPHER is guided by a world-class Scientific Technical and Advisory Committee (STAC) of experts in paediatric HIV. It is designed to complement existing global initiatives and create partnerships to maximize investment in paediatric HIV research and improve paediatric health outcomes.

Learn more about CIPHER's committees and working groups


POLICY

Setting a global policy research agenda for paediatric and adolescent HIV

Achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets by 2020 will remain an aspirational goal unless efforts to fill vital gaps in the HIV response for children and adolescents are intensified. Through identifying research priorities and funding key research, publications and advocacy, CIPHER works to build the evidence-base needed to inform policy and programmatic decision making for a more efficient and impactful response.

Featured work:

Special Issue in JAIDS
Mind the Gap: Filling Knowledge Gaps in Paediatric and Adolescent HIV for an AIDS Free Generation

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CIPHER grantee co-author of 2017 South African National Adolescent & Youth Health Policy
Rebecca Hodes is one of the first early-stage investigators to receive a CIPHER grant in 2013. Rebecca and the study, Mzantsi Wakho (‘Your South Africa’), has now informed the 2017 South African National Adolescent & Youth Health Policy, which takes a holistic approach to adolescent health.

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Rebecca Hodes is now Director of the AIDS and Society Research Unit, University of Cape Town. She is a medical historian, and co-principal investigator of the Mzantsi Wakho group. Mzantsi Wakho conducts quantitative and qualitative research for evidence-informed social policy and interventions to best care for and support young people and families living in AIDS-affected communities in South Africa. This innovative study focuses on youth health, including medicines-taking and sexual and reproductive health, using multiple methods and data sources to identify and investigate risk and resilience-promoting factors. Rebecca’s original CIPHER study looked at “Promoting adolescent antiretroviral adherence and sexual and reproductive health uptake in South Africa: How can health and social protection services collaborate programmatically with HIV-positive adolescents?”. The study was planned in collaboration with HIV-positive adolescents, UNICEF, the South African government, NGOs and CBOs, and offered an unprecedented opportunity to bring the experiences of youth into the policy arena.


RESEARCH

Filling key research gaps through individual capacity building and collaborative approaches

Building the next generation of researchers

CIPHER provides seed funding to early-stage investigators from low-and middle-income countries to answer key research gaps while building research capacity where it is needed most. The intention is to attract new talent – from inside and outside the field of HIV research – to address critical research questions, while providing a unique opportunity for professional development.

The CIPHER Grant Programme awards early-stage investigators worldwide up to $75,000 for up to two years to addresses critical research gaps in paediatric and adolescent HIV in resource-limited settings; 80% of funds awarded each year are reserved for researchers from low- and middle-income countries.

The CIPHER Growing the Leaders of Tomorrow Fellowship provides support for two years for young investigators from sub-Saharan Africa to work with a senior investigator on priority research topics in paediatric HIV clinical science in the region.

Global Cohort Collaboration

The CIPHER Global Cohort Collaboration brings together the largest collaboration of paediatric and adolescent HIV observational cohort networks to date, to answer key questions of global public health impact that cannot be answered by one network alone. Young-investigators opportunities are also provided to work with the Collaboration, to help build data analysis capacity directly in low-and middle-income countries.

Featured work:

Global Cohort Collaboration
New publication: The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. The Collaboration has published the largest multiregional epidemiological analysis of adolescents living with perinatally acquired HIV (APH). The study describes for the first time the global epidemiology of APHs, looking at trends over time, mortality, transfer, and loss to follow-up across geographic regions, country income groups, and birth cohorts.

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New Publication: Inequality in outcomes for adolescents living with perinatally acquired HIV in sub-Saharan Africa: a Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Cohort Collaboration analysis.

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Special Issue in JIAS
Paediatric and Adolescent HIV and the Sustainable Development Goals: the road ahead to 2030. Guest Editors: Douglas Webb, Chewe Luo, Lucie Cluver.

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STRUCTURAL BARRIERS

Advocating for paediatric HIV drug optimization

Compared with adults, treatment coverage among children remains low, and currently available therapeutic options are limited and often inadequate. Aspects of and inefficiencies in research, development and regulatory approval processes present key barriers to optimizing paediatric treatment. CIPHER is working on a number of fronts to address these barriers in order to increase treatment access for children and adolescents.

Featured work:

New Publication: Forum on the Risks of Preconception Dolutegravir Exposure: FAQs for Dolutegravir & Women of Childbearing Potential: Interim Considerations.

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New Publication: Shortening the decade-long gap between adult and paediatric drug formulations: a new framework based on the HIV experience in low- and middle-income countries.

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