I was trained as a medical doctor and GP in Spain. In 2010 I joined LSHTM, for the first time, as a student of the MSc in Tropical Medicine and International Health (TMIH) and Diploma of Tropical Medicine and Hygiene (DTMH). Following my training at LSHTM I worked for three years in Mozambique as a clinician and researcher at the Manhiça Health Research Centre (CISM). It was in Mozambique that my research career started. At that time I was mostly focused in the effects of HIV and malaria in pregnant women and their children, which was the topic of my PhD. Following my time in Mozambique I completed my PhD at the University of Barcelona with the Barcelona Institute for Global Health (ISGlobal). After my PhD, I worked for some time as research associate at the University of Cambridge, and as teaching fellow of the Master of Public Health at Imperial College. In 2018 I joined back again LSHTM again as research fellow in TB/HIV epidemiology in the TREATS project (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for Active TB). Since then my research focus has shifted to HIV/TB in low and middle-income settings, more specifically to evaluation of diagnostic and screening tools for these two conditions.
Affiliations
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Teaching
I have been Teaching Fellow at the MPH at Imperial College, London, where I coordinated the Global Health module.
At LSHTM I have been co-organiser of the HIV-module in the MSc programme for several years. Additionally, I have given lectures in the HIV-module, have been supervisor for MSc summer projects and have mentored MSc students and junior staff in different research projects
Research
Malaria/HIV
My initial research and PhD explored the impact of malaria and Intermittent Preventive Treatment in pregnancy (IPTp) and of HIV and ART in pregnancy, on infant's health. The studies that composed my thesis were part of the MiPPAD trial, which aimed to evaluate the safety, tolerability and efficacy of mefloquine (MQ) as an alternative to SP used for Intermittent Preventive Treatment in pregnancy (IPTp) in combination with Long Lasting Insecticide Treated Nets (LLITNs) in Benin, Gabon, Kenya, Mozambique and Tanzania. It also involved HIV-infected pregnant women and aim to better understand the interactions between antimalarial treatment and HIV. MiPPAD is one of the studies under the umbrella of the global Malaria in Pregnancy (MiP) Consortium that evaluates new and improved existing interventions for the prevention and treatment of malaria in pregnancy, and was, mostly, funded by EDCTP. Importantly, outcomes had an important impact and contributed in guiding WHO recommendations for preventing malaria in pregnancy. I also worked on the “Assessment on the Safety of Antimalarial Drug use in early Pregnancy" (ASAP) study funded by Bill and Melinda Gates Foundation, evaluating adverse pregnancy outcomes after artemisinin-based treatment (ABT) versus non-ABTs in the first trimester of pregnancy in Burkina Faso, Kenya and Mozambique.
HIV and ART drug resistances:
In Mozambique I led the IeDEA (International epidemiology Databases to Evaluate AIDS) cohort of HIV exposed uninfected children which investigated nutritional status, morbidity and mortality in children born to mothers living with HIV who were not HIV-infected. This population being of particular interest with the increase of antiretroviral treatment during pregnancy and breastfeeding and the reduction rates of mother-to-child transmission. In addition I conducted two important studies on HIV drug resistance, one in adults and one in pregnant women, in collaboration with Irsi Caixa. The one in pregnant women was conducted at a time when guidelines for preventing mother-to-child transmission of HIV had just shifted paradigm to universal access. It was the first study to describe patterns of antiretroviral resistances in pregnant women in Mozambique, and provided key insights for guiding the national HIV programme. Similarly the one in adults was the first comprehensive and well-powered study addressing the clinical and determinants of virological failure and drug resistance in Mozambique after the ART roll-out, and was included in the WHO HIV drug resistance report 2017.
I am currently coordinator and co-investigator of the AMPHEUS (Analytics and Microbiology for Precision Health and Epidemiology) project in Zambia, which is an integrated platform for clinical microbiology, real-time epidemiology and intervention research to fight infectious pathogens in low income setting. Within this project a scalable laboratory infrastructure has been developed, initially in Zambia, for rapid diagnostics and whole genome viral sequencing. We are now about to start the implementation and evaluation of this platform for HIV/AIDS and ART clinical decision-making. This project is in collaboration with Oxford University and funded by Bill and Melinda Gates Foundation.
TB
My research is mostly focused on better ways to screen and diagnose TB in settings with limited resources. I coordinated the TREATS project (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for Active TB) which aimed to measure the impact of the PopART intervention (HIV/TB preventive intervention in the community) on the burden of TB in Zambia and South Africa () and within TREATS I led specific studies on the evaluation of diagnostic and screening tools, such as CRP, AI-CAD or Xpert for detecting TB. In line with new ways to screen and detect TB I am now coordinator and co-researcher of the POCUS4TB project (NIHR-Global Health Group on AI-assisted point-of-care ultrasound (AI-POCUS) for TB screening) in Zambia, Mozambique, Peru and Bolivia, which is looking at the potential of AI-supported point-of-care ultrasound for detecting TB in different epidemiological contexts, with the overall aim of developing a simple, cheap and scalable imaging solution to screen for TB.
COVID-19
During and after the COVID-19 pandemic I participated in several COVID-related projects, one awarded by EDCTP COVID-19 emergency fund, of which I was clinical leader and WP leader and one funded by The Botnar Research Centre for Child Health (BRCCH) and EDCTP of which I was WP leader. In addition, I was the PI of the study “Evaluation of Ag-RDT to detect SARS-CoV-2 infection in Zambia” partially funded by FIND diagnostics, and for which I was awarded with the LSHTM COVID Funding Response Grant, and also PI of the operational research study on implementing TB and COVID-19 bidirectional screening in Zambia in collaboration with the MoH. Outputs from these studies have been important for guiding in-country policy making and global response against COVID19.