A new grant from the Bill & Melinda Gates Foundation will allow the Child Health and Mortality Prevention Surveillance (CHAMPS) network to leverage its laboratory capacity and partnerships in Africa to identify and document causes of death among adults who were living with HIV.


Source: NIAID

Transmission electron micrograph of HIV-1 virus particles (purple) from infected H9 cells, produced in cell culture.

CHAMPS collects, analyzes and shares evidence to prevent child mortality in regions where it is highest in the world. The CHAMPS program office at Emory Global Health Institute coordinates a network of 19 catchments across nine countries.

Despite significant progress in scaling access to antiretroviral therapy for people living with HIV, HIV-related deaths remain unacceptably high in low-resource communities across the CHAMPS network.

Advanced HIV disease

Approximately 40% of the WHO-estimated seven million AIDS-related deaths over the next decade could be prevented by addressing advanced HIV disease (AHD). While it is well-established that tuberculosis is a leading cause of death in AHD, the contribution of other underlying causes for most adults who were living with HIV (PLHIV) remain unknown across the African region.

“CHAMPS network data can be used to close critical gaps in understanding the causes of deaths among persons living with HIV, including deaths related to advanced HIV disease,” says Victor Akelo, CHAMPS senior director for science, site strategy and implementation, who will direct the study for the network and lead the Kenya site.

In 2022, an estimated 21,000 people died from AIDS-related illnesses in Kenya. Thus, “knowing the definitive causes of death can help transform HIV programs and inform targeted investments to reduce HIV transmission, prevent progression to AHD and save lives in these communities,” Akelo says.

Building capacity

Since 2015, CHAMPS has worked with communities and built local capacity to determine definitive causes of stillbirths and child deaths across its network in Africa and South Asia, two regions that account for 82% of under-five child mortality worldwide. The work funded by this new grant will support network partners in CHAMPS sites in Kenya, Sierra Leone, Mozambique and South Africa to enroll and investigate deaths in adults aged 18-64 years with HIV. The study will use CHAMPS procedures and methods with additional tests to investigate markers of AHD.

CHAMPS identifies and analyzes specific causes of death using minimally invasive tissue sampling, histopathology, molecular and microbiologic diagnostics, clinical data abstraction and verbal autopsies. Over the three-year study period, timely, open access to data and expert analysis will be available to local and global health programs, policymakers and practioners to evaluate and guide existing HIV programs, while informing service delivery to underserved communities.