MAGFA

The challenge

Great strides have been made in HIV testing in sub-Saharan Africa, and most people living with HIV are now aware of their HIV status. The same is not true of many other chronic infections, particularly where symptoms may not be obvious but long-term harms can occur. In pregnant women, if undetected, there is a risk that these infections are passed on to their babies during pregnancy.

For example, only about half of women are screened for syphilis infections during pregnancy, and less than 1% are tested for the hepatitis B virus (HepB). This leads to around 216,000 cases of congenital syphilis each year, as well as 360,000 new HepB infections. Although HepB vaccination at birth can protect newborns, in most countries in sub-Saharan Africa, HepB vaccine is given too late to prevent mother-to-child transmission.

Several point-of-care tests have been developed for HIV and other infections. However, they are separate tests with different procedures and run times, making it difficult to use them in many types of health facilities. Furthermore, testing for active HepB replication, which is associated with an increased risk of transmission, requires specialist facilities and is costly, limiting its use in sub-Saharan African settings.

The project

The MAGFA project is addressing these challenges by adapting an existing point-of-care testing platform to detect HIV, syphilis and HepB infections simultaneously, and to provide a quantitative assessment of HepB virus levels to identify women in need of treatment.

Its MagIA platform detects antibodies to infections, using a cartridge-based system that can simultaneously analyse 10 samples (two cartridges, each with five samples). Its MagIA Analyzer device carries out automatic sample analysis and delivers simple-to-understand results to users.

The company behind the MagIA platform has already developed a cartridge for the co-detection of HIV, HepB and hepatitis C virus. In the MAGFA project, it will incorporate syphilis detection rather than the hepatitis C virus. The new test will be validated in the laboratory before being field-tested at 22 antenatal care sites in Côte d’Ivoire, the Democratic Republic of the Congo (DRC), and Kenya.

A second strand of work will focus on HepB. A cartridge will be developed based on antibodies against HepB antigens, with quantification of antibody levels to indicate viral replication. Women showing high levels of HepB replication will be eligible for prophylactic antiviral treatment. 

The project will determine the impacts on the prevention of mother-to-child transmission of the different infections, and also track women who test positive to assess their retention in care. Cost-effectiveness analyses will also be carried out.

Impact

The MAGFA project could have a major impact on the identification, treatment and prevention of important infections affecting women and children. It will:

• Create a new tool for rapidly detecting HIV, syphilis and hepatitis B infections in pregnant women.
• Help to identify those women who could benefit most from antiviral treatment for HepB infections.
• Show whether the platform is a cost-effective way to prevent mother-to-child transmission of these infections.
• Generate economic returns for device distributors in sub-Saharan Africa.

With an estimated 46 million pregnancies occurring a year, and 6% of women likely to have HepB infections, widespread use of the platform could have a significant impact on the transmission of HepB and other infections to children in sub-Saharan Africa.