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REACH: Russian European Alliance for research among women, Children and adolescents impacted by HIV, TB and HCV

Periodic Reporting for period 1 - REACH (REACH: Russian European Alliance for research among women, Children and adolescents impacted by HIV, TB and HCV)

Reporting period: 2019-01-01 to 2019-12-31

Pregnant women, children and adolescents are priority populations in the global public health response to the epidemics of HIV, TB and HCV. The high burden of intersecting epidemics of these 3 infections pose a major public health challenge to Russia and the broader European region. The global health goals of ending AIDS, reducing TB deaths and new HCV cases by 90% by 2030 can only be realized if the unique health needs are considered and targeted research to these priority populations is undertaken to optimize the impact of innovations in diagnostics and treatment. REACH builds on a long-standing, successful collaboration between European clinical research networks with track records of delivering innovative research across the three infections and leading collaborators from clinical centres of excellence in Siberian, North-western and Central districts of the Russian Federation.

The main objective of the project is to contribute to the progress towards an AIDS-free generation through:
1. Conducting joint research towards better understanding of epidemiology, disease progression, treatment and outcomes of among pregnant women, children and adolescents living with HIV, TB and HCV mono- and co-infections, with the long-term goal of reducing morbidity and mortality
2. Exchange of knowledge between Russian and European specialists, capacity building and preparation for future collaborative research on HIV, HCV and TB in children and adolescents.

REACH will promote geographic expansion of the collaborative research in maternal and child health in the WHO European Region and will build capacity for improved coordination and integration between European and Russian research centres beyond 2020. REACH will employ integrated research methods across HIV, HCV and TB and will assess epidemiology, disease progression, comorbidities, and outcomes of pregnant women, children and adolescents living with HIV, HCV and TB in Russia. REACH will fill knowledge gaps in relation to:
- Cascade of HIV care and retention in care
- Late HIV diagnosis and HIV seroconversion during pregnancy
- Safety of antiretroviral therapy in pregnancy
- Safety of long-term Lopinavir/r based antiretroviral therapy in children with HIV
- Effect of delayed switch to the second-line antiretroviral therapy for children with HIV
- Epidemiology of HIV/HCV and HIV/TB coinfections
- Evaluation of transient elastography and the use of direct acting antivirals in children with chronic HCV
- Utilisation of new TB diagnostics and uptake of preventive TB treatment
• The project officially started with the Kick Off meeting in St Petersburg, Russia on 11-12th February 2019
• The Paediatrics and Pregnancy Working groups were established to provide scientific and operational oversight on the planned activities
• Paediatric study protocols addressing HIV, TB and HCV questions, Pregnancy protocol and relevant standard operating procedures (SOPs) were developed
• A number of statistical analyses were conducted. As a result, 5 international conference abstracts were submitted:
i. “Trends in new HIV diagnoses in children and adolescents in Russia, and risk of disengagement from care” by E Milanzi, S Crichton, Y Plotnikova et al. 24th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Sitges, Spain, 26-28th March 2020 (accepted)
ii. “Cascade of care in children and adolescents living with HIV in Russia” by A. Turkova, E Voronin, Y Plotnikova et al. 23rd International AIDS Conference, San Francisco & Oakland, US, 6-10th July 2020 (submitted)
iii. “Characteristics and cascade of HIV care in children with perinatally acquired HIV in three Russian clinics” by L. Okhonskaya, E. Voronin, Y Plotnikova et al. 38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID), Rotterdam, Netherlands, 25-30th May 2020 (submitted)
iv. “Timing of HIV diagnosis in HIV-positive pregnant women giving birth in a high prevalence Russian region” by R. Sconza, Y. Plotnikova, A. Plynsky, V. Rozenberg, C. Thorne. 10th International Workshop on HIV and Women, Boston, US, 6th March 2020 (accepted)
v. “Missed opportunities for the prevention of HIV-1 mother to child transmission: data from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group” by R. Berea de Oliveira, H. Peters, K. Aebi-Popp, H. Bailey, E. Chiappini, A.M. Gamell Fulla, C. Gingaras, T. Goetghebuer, C.R. Kahlert, I. Latysheva, R. Malyuta, Y. Plotnikova, L. Prieto, E. Voronin, C. Thorne. 24th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Sitges, Spain, 26-28th March 2020 (accepted)

• A residential training course took place on 21-23rd October 2019 in Irkutsk, which was attended by 80 delegates from across Russia and 20 faculty members from Russia and Europe, including Russian representatives of youth advisory boards. The course focussed on treatment and management of patients with HIV, TB and HCV and research methodology.
• A Neurocognitive Workshop was organised by the Republican Hospital of Infectious Diseases in St Petersburg on 26-29th November 2019. The REACH experts from Madrid provided training on neurocognitive assessment, functional Brain MRI and approach to treatment.
• An anonymised survey of paediatric HCV care policies and practices was developed. The survey covers screening, diagnosis and management of children with chronic hepatitis C. The survey is due to be launched in Russia and Europe.
• Two youth advisory groups of young people living with HIV in Russia were formed. Each group received training on understanding of research studies and role of community advocacy in research. The groups developed youth-friendly materials explaining cohort study principles to their peers and explored ways of presenting research findings in an engaging and understandable form.
Our priority is to improve maternal and child health through successful research networks.

Our work will help to address important research gaps regarding risk of onward transmission, disease progression, ART toxicity, drug resistance, comorbidities and coinfections, and contribute to capacity building in key areas to advance future research, treatment and prevention of HIV, HCV and TB. Improved evidence base on diagnostics, risk factors and clinical outcomes in pregnant women and children in the context of the ongoing epidemics of HIV, HCV and TB in Russia will help to identify potential interventions to reduce the morbidity and mortality associated with these infections in high incidence countries.

International teams of experts will develop multimodal clinical and research training materials for health care professionals in Russian and English to provide up to date information on diagnosis and treatment for pregnant women and children living with HIV, HCV and TB. The knowledge sharing, training and capacity building work will improve the skill set of Russian and European clinical and research investigators to effectively prevent, diagnose, treat and care for pregnant women and children living with HIV, HCV and TB.

REACH will strengthen the existing Russian-European research collaborations, create new international relationships to advance research opportunities and build foundation for further diagnostic and treatment studies.
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