About Us
DREAMM is a humanitarian project that aimed to develop, implement, and evaluate pragmatic implementation strategies to reduce mortality from HIV-related meningitis in public hospitals in Cameroon, Malawi, and Tanzania within routine care. The project was divided into three phases:
- Observation
- Training
- Implementation
It drew on clinical trials, mixed methodology, and health system engineering. Working alongside African health workers and local leaders, the DREAMM project developed a new approach for resource-limited settings to save lives from HIV-linked meningitis.
Our Work
Despite antiretroviral therapy there are 650,000 HIV-related deaths globally each year. Around one in three are caused by central nervous system infections including meningitis.
The DREAMM project researched how to strengthen clinical and laboratory care in public hospitals in three African countries and has halved the number of deaths from HIV-linked meningitis.
Barriers to Treatment & Diagnosis
- In many low- and middle-income countries, people living with HIV are not diagnosed with meningitis or are not treated with effective medicines for conditions which attack the central nervous system.
- Lack of access to essential tests and medicines remains a significant barrier within routine care settings.
- The results of clinical trials are often not translated into routine care practices and procedures.
- Weak health systems particularly in public hospitals
Approach
Iterative, three-phased, co-designed with local health leaders and hospital staff
Aim
To implement rapid diagnostic testing and ensure WHO meningitis treatment guidelines were followed
Location
Five public hospitals in Tanzania, Malawi, and Cameroon; tested two implementation strategies in each hospital
Timescale
New, co-designed procedures were put into practice at each site for around 10 months, between January 2018 and March 2021
Our Key Findings
Deaths within two weeks of presenting to hospital among adults living with HIV who were admitted with a suspected first episode of CNS infection:
Before new DREAMM procedures | 49% |
With new DREAMM procedures | 24% |
During the DREAMM observation phase essential tests and medicines were mostly lacking and prescribed treatments largely empirical leading to poor outcomes.
Under local leadership, using available tests and medicines in the hands of front-line healthcare workers and laboratory technicians, the DREAMM approach substantially reduced deaths from HIV-linked meningitis.
The project also found that the cause of HIV-linked meningitis appeared to vary geographically.
Our Recommendations
1 Obtain additional qualitative and mortality data on the DREAMM approach in ten public hospitals in African low- and middle-income countries to inform scaling-up the DREAMM model of care.
3 Use DREAMM epidemiological data (and advocate foractive surveillance including mortality data) to inform HIV programmes, Ministries of Health, implementing partners and global funders about packages of tests and medicines for HIV-related CNS infection so treatments can be targeted to save lives.
2 Continue advocating for essential tests and medicines for central nervous system infections linked to HIV through the cryptococcal meningitis action group (CryptoMAG), Fight AIDS Coalition and End AIDS Action Group.
Help us DREAMM
$10m Changes AIDS Forever
Help Fund DREAMM 2
To ensure we can build on DREAMM and save thousands of lives, we are now raising 10m euros to scale up DREAMM in at least five countries and over ten public hospitals. We will also work to codesign new interventions and strategies for ambulatory care to further reduce mortality. Lastly, we wish to build new networks and structures to explore the unique DREAMM biobank in Africa by African scientists.
DREAMM is all about strengthening health systems and sharing valuable knowledge, creates a one-to-many-to-many training approach that will enable DREAMM to scale up well past the immediate impact of our Phase 2 funding.
This program will strengthen health systems across the continent by and for Africans. The time is now for humanitarian reasons and to help meet The Sustainable Development Goals.
If you would like to support DREAMM, ensure it is widely available globally and help save thousands of lives over the next decade alone, then please contact us.
Phase 1 - Complete
Phase 1 of DREAMM has been an amazing success. Our Train the Trainer DREAMM program and new implementation methodology have shown how much positive impact well used funding can make. We are grateful to all our partners and sponsors who have helped make DREAMM a life changing project for people living with HIV suffering needlessly from meningitis.
Phase 2 - More to Do
We achieved a lot with our initial 2m Euros of funding. Our new, codesigned DREAMM approach is effective and appears to be generalisable. Our work is published in high impact peer-reviewed papers including The Lancet HIV and The Lancet Global Health and our approach can help put an end to preventable and unacceptable suffering from meningitis due to AIDS.
DREAMM Phase 2 aims to rollout and expand the work of DREAMM strengthening public hospitals and creating networks of skilled healthcare workers and empowered leaders across Africa thus leading to lasting and sustainable impact.
Help us DREAMM
$10m Changes AIDS Forever
Phase 1 Complete
Phase 1 of DREAMM has been an amazing success. Our Train the Trainer DREAMM program and new implementation methodology have shown how much positive impact well used funding can make. We are grateful to all our partners and sponsors who have helped make DREAMM a life changing project for people living with HIV suffering needlessly from meningitis.
Phase 2 - More to Do
We achieved a lot with our initial 2m Euros of funding. Our new, codesigned DREAMM approach is effective and appears to be generalisable. Our work is published in high impact peer-reviewed papers including The Lancet HIV and The Lancet Global Health and our approach can help put an end to preventable and unacceptable suffering from meningitis due to AIDS.
DREAMM Phase 2 aims to rollout and expand the work of DREAMM strengthening public hospitals and creating networks of skilled healthcare workers and empowered leaders across Africa thus leading to lasting and sustainable impact.
Help Fund DREAMM 2
To ensure we can build on DREAMM and save thousands of lives, we are now raising 10m euros to scale up DREAMM in at least five countries and over ten public hospitals. We will also work to codesign new interventions and strategies for ambulatory care to further reduce mortality. Lastly, we wish to build new networks and structures to explore the unique DREAMM biobank in Africa by African scientists.
DREAMM is all about strengthening health systems and sharing valuable knowledge, creates a one-to-many-to-many training approach that will enable DREAMM to scale up well past the immediate impact of our Phase 2 funding. This program really is a potential generational legacy to strengthen health systems across the continent by and for Africans. The time is now for humanitarian reasons and to help meet The Sustainable Development Goals.
If you would like to support DREAMM, ensure it is widely available globally and help save thousands of lives over the next decade alone, then please contact us.
DREAMM
Driving Reduced AIDS-associated Meningo-encephalitis Mortality.
The project strengthened clinical and laboratory care in public hospitals.
DREAMM and act to prevent over 200,000 deaths every year
Our DREAMM Team
Our team is multi-organisational
Dr Cecilia Kanyama, PI
Dr Cecilia Kanyama is an internal medicine physician and infectious diseases researcher with the University of North Carolina at Chapel Hill School of Medicine’s...
UNC Project, Lilongwe, Malawi
Prof Sayoki Mfinanga, PI
Prof Sayoki Mfinanga is a global health and clinical research expert. He is a Director and Chief Research Scientist for the National Institute of...
National Institute for Medical Research, Tanzania
Prof Charles Kouanfack, PI
Professor Kouanfack Charles is an internal medicine physician and epidemiologist, an associate Professor at Faculty of Medicine and Pharmaceutical Sciences of Dschang University. He...
University of Dschang, Cameroon
Dr Saulos Nyirenda, PI
Dr Saulos Kondwani Nyirenda is an internal medicine specialist and Head of the department of Medicine at Zomba Central Hospital in Malawi. He has...
Zomba Hospital, Malawi
Prof Sam Phiri
Prof Sam Phiri is a Clinician and Clinical Epidemiologist. He is a Programs Director at Partners in Hope (PIH) Malawi, providing Strategic Leadership to...
Lighthouse Trust / Zomba Hospital
Dr. Sokoine Kivuyo
Dr. Sokoine Kivuyo is a senior researcher and physician working at the National Institute of Medical Research (NIMR) in Tanzania, trained in medicine and...
National Institute for Medical Research, Tanzania
Dr Lauriane Fomete
Lauriane Fomete Nomene is a researcher in implementation science and clinical trials. She has worked as the country project coordinator for various research studies...
Yaoundé Central Hospital, Cameroon
Mr Chimwemwe Chawinga
Mr Chimwemwe Chawinga is a Clinician by profession with a Diploma in Clinical Medicine and Bachelors of Arts in Healthy Systems management, and is...
UNC Project, Lilongwe, Malawi
Dr Angela Loyse, Chief Investigator
Dr Angela Loyse trained in infectious diseases and works on AIDS-related clinical trials, implementation science projects, and advocacy initiatives, mainly in low- and middle-income...
St. George’s University of London, UK
Prof Olivier Lortholary
Olivier Lortholary is Deputy Director of the French National Reference Center for Invasive Mycoses and Antifungals, co-director of the Medical Mycology course, Professor of...
Institut Pasteur, France
Dr Timothee Boyer-Chammard
Timothée Boyer Chammard is an Infectious Diseases and Tropical Medicine clinical specialist, from Paris. He has been working in the Molecular Mycology unit at...
Institut Pasteur, France
Mme Aude Sturny-Leclère
Aude Sturny-Leclère is a Research Engineer at Institut Pasteur involved in multiple research projects, on Cryptococcus neoformans and Histoplasma spp.. She is particularly involved...
Institut Pasteur, France
Prof Tom Harrison
Tom Harrison is Professor of Infectious Diseases and Medicine at St Georges University of London, and Professor of Medical Mycology at the MRC Centre...
St. George’s University of London, UK
Prof Shabbar Jaffar
Shabbar Jaffar is Prof of Epidemiology and Director of the UCL Institute for Global Health. He is involved in research, mostly intervention studies and...
University College London, UK
Dr Elizabeth Shayo
Dr Elizabeth H Shayo is a Principal Research Scientist of the National Institute for Medical Research (NIMR) with BA and MA Social Sciences and...
National Institute for Medical Research, Tanzania
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