Dates: April 2016 – ongoing
Chief Investigator: Dr Angela Loyse
Principal Investigators: Dr Cecilia Kanyama, Prof Sayoki Mfinanga, Dr Charles Kouanfack
Locations: Malawi, Tanzania, Cameroon
Funding: EDCTP and ANRS
DREAMM aims to reduce mortality linked to HIV-related meningitis in resource-limited settings in Tanzania, Cameroon, and Malawi. Meningitis is a leading cause of HIV-related death in routine care settings across African low-and middle-income countries (LMICs).
Sister Bupe from Amana Hospital, DREAMM clinical training, Safe Amphotericin B deoxycholate administration workshop, Dar es Salaam, Tanzania, September 2017. Photo courtesy of EDCTP.
DREAMM is an implementation project that uses a mixture of traditional clinical trial methodology combined with local health system strengthening, social science, education and health economics.
A starting premise for the DREAMM project is independent African research leadership linking with hospital directors working in routine care services and their Ministry of Health counterparts. DREAMM has three project phases: 1) Observation, 2) Training and 3) Implementation. DREAMM study sites will work as test sites within country and region with collated health system process and epidemiological data informing local and regional public health policy.
DREAMM collaborators and study sites
DREAMM is currently ongoing at these sites in southern, eastern and central Africa:
Amana and Mwananyamala hospitals, Dar Es Salaam, Tanzania
Kamuzu Central Hospital (KCH), Lilongwe, Malawi
Hôpital Central Yaoundé (HCY), Yaoundé, Cameroon.
The DREAMM project is in collaboration with the following partners:
National Institute for Medical Research, Tanzania
University of North Carolina Project-Malawi (UNC Project)
Yaoundé Central Hospital
Why is DREAMM needed?
Mortality due to HIV-related meningitis remains unacceptably high in resource limited settings in African LMICs. This is due to a number of factors including:
late presentation to care
lack of specific training for frontline healthcare workers (HCWs) on the diagnosis and management of HIV-related meningitis
lack of access to appropriate diagnostic tests and essential medicines for meningitis such as amphotericin B and flucytosine
breakdown of routine laboratory pathways
poor communication between laboratory technicians and clinicians.
DREAMM addresses many of the factors underlying high HIV-related mortality through:
Provision of diagnostic tests and medicines
All patients are tested using rapid diagnostic tests (RDTs) (the cryptococcal antigen lateral flow assay (CrAg LFA) and urinary lipoarabinomannan (LAM)) by the bedside, alongside routine basic microbiological techniques in the laboratory.
A new semi-quantitative CrAg LFA test developed between industry and Biosynex is being evaluated. The DREAMM project implements the results of the ACTA trial, with patients diagnosed with cryptococcal meningitis receiving one week of amphotericin B and flucytosine or two weeks of fluconazole and flucytosine, in line with 2018 WHO guidance.
Dr Djamila from Amana Hospital, clinical training workshop on bedside use of the urinary lipoarabinomannan (LAM) rapid diagnostic test, Dar es Salaam, Tanzania, September 2017. Photo courtesy of EDCTP.
DREAMM education programme
The DREAMM education programme aims to increase the knowledge of frontline HCWs to effectively diagnose and treat HIV-related meningitis. The programme includes posters, workshops and background theoretical modules. The workshops have been designed to focus on simple and practical interventions that can reduce mortality (e.g. safe antifungal drug administration). All of the materials have been created in conjunction with African researchers, hospital directors and frontline HCWs.
There are 6 training modules on:
DREAMM Project advocacy
The DREAMM project includes advocacy work to improve access and procurement mechanisms in African LMICs for RDTs and essential medicines including flucytosine. Some of this work is encompassed by the work of the cryptcoccal meningitis action group (cryptoMAG) chaired by Dr Angela Loyse. You can learn more about cryptoMAG on the Working Internationally page.
This project is part of the EDCTP2 programme supported by the European Union.