Project: Integrating the diagnosis and management of HIV-associated central nervous system (CNS) infections into routine healt services in low and middle income countries (LMICs)

Acronym	DREAMM (Reference Number: DRIA2014-314)
Duration	01/04/2016 - 31/03/2020
Project Topic	The DREAMM project at the 3rd year reporting stage is showing important signs of success: 1) Significant reductions in mortality are being achieved in routine care setttings in African low- and middle-income countries (LMICs) in the 3 DREAMM sites in Malawi and Tanzania that have reached the implementation phase of the project; 2) Established patient and laboratory pathways appear to be not only effective but sustainable in the 3 DREAMM sites; and 3) The DREAMM model of care is being put forward as a unique model for the management of advanced HIV disease (AHD) by large implementers including the Clinton Health Access Initiative (CHAI) and Elizabeth Glazer Paediatric Foundation (EGPAF) and global funders such as Unitaid.  Slower than expected recruitment is a remaining significant challenge that is being addressed by 1) The opening of a new DREAMM site in Mwanayamala in autumn 2018,  2) The request to EDCTP to add a new beneficiary in Lighthouse Trust to open a new DREAMM site at Zomba Hospital following the closure of the Kamuzu Central Hospital which is now recruiting patients into the Ambition trial, 3) The progression of the DREAMM site in Cameroon to the implementation phase in June 2019 and 4) A request to EDCTP for a no cost extension for the DREAMM project till April 2021, with patient recruitment and follow up at all 5 DREAMM sites including in Cameroon and at Zomba Hospital due to end in December 2020.  An important factor in explaining the slower than expected recruitment into DREAMM is that a significant number of people living with HIV (PLHIV) (approximately 1 in 5) presenting with symptoms and signs of meningo-encephalitis, after investigation within the implementation phase of DREAMM, do not in fact have HIV-related meningo-encephalitis and have another HIV-related diagnosis. Thus the DREAMM project is not only optimising the care of HIV-related meningo-encephalitis patients but also having a positive knock on effect on the overall management of advanced HIV disease in secondary and tertiary level hospitals. The DREAMM project is already having very significant impact on local, routine healthcare workers (HCWs) working in African LMICs and AHD patient outcomes, both in terms of the DREAMM training program and unique model of care DREAMM provides for some of the sickest hospitalised patients with AHD. To date, the main training module of the DREAMM training program on cryptococcal meningitis, launched on World AIDS day in 2018, has garnered over 1300 views across the globe and been downloaded over 415 times (https://www.sgul.ac.uk/centre-for-global-health/meningitis/dreamm-project).  In addition, members of the DREAMM consortium are playing key roles not only in the shaping but also in the delivery of the Unitaid/CHAI grant on AHD (https://unitaid.org/advanced-hiv-disease/#en,  https://www.sgul.ac.uk/news/news-archive/researchers-played-key-role-in-unitaid-us-20-million-initiative).  DREAMM is proving to be a unique model of care for up to a third of PLHIV with AHD presenting to hospital and Unitaid/CHAI are interested to build on this model of care within their AHD project to slash HIV-related deaths. Here is the link to the DREAMM project website: https://www.sgul.ac.uk/centre-for-global-health/meningitis/dreamm-project
Website	visit project website
Network	EDCTP2
Call	Research & Innovation Action: Diagnostic tools for poverty-related diseases

Project partner

Number	Name	Role	Country
1	St George’s Hospital Medical School	Coordinator	United Kingdom
3	Institut Pasteur	Partner	France
4	Lilongwe Medical Relief Trust Fund	Partner	Malawi
5	Liverpool School of Tropical Medicine	Partner	United Kingdom
6	National Institute for Medical Research - Tanzania	Partner	Tanzania
7	The Central Hospital of Yaounde, Cameroon	Partner	Cameroon