The 2.5 million children and adolescents living with HIV (CALHIV), most residing in sub-Saharan Africa, have unacceptably high rates of late diagnosis, treatment failure and death, compared to their adult counterparts. CALHIV are a vulnerable group who have been left behind adults in testing new treatment options, different modes of ART delivery, novel diagnostics and adherence strategies. The CHAPAS-5 trial is a sustainable multi-country adaptive platform trial in Mozambique, Uganda and Zimbabwe, to assess novel treatment regimens in ART-naïve and treatment-experienced viraemic children aged 4 weeks to <20 years of age. CHAPAS-5 employs an innovative Personalised Randomised Controlled Trial (PRACTical) design, randomising participants between appropriate ART regimens based on their clinical status, ART history, genotypic resistance and drug availability by weight band. The trial's primary outcome is: alive with viral load <400 c/mL at 48 weeks. CHAPAS-5 will evaluate novel oral and first generation long-acting injectable (LAI) treatment regimens and, subsequently, through its adaptive design, second-generation promising long-acting therapeutics. Nested pharmacokinetics will evaluate dosing for children, as needed. Social science, health economics and capacity strengthening are fully integrated through the project. Workpackages will explore options for community-delivery of LAIs, and employment of diagnostics, including POC CD4, near-POC viral load and resistance tests. Community groups and young people will be involved in our dissemination and communication activities. We will exploit project outputs and facilitate technology transfer for treatments and diagnostics from innovators to African manufacturers. CHAPAS-5 aims to improve health and well-being of CALHIV, to inform clinical guidelines, and to strengthen health systems through capacity development. Our trial platform will provide a long-term resource for studies seeking to improve outcomes in CALHIV.

There are major gaps in surveillance of climate change and health in the EU and globally, making it difficult to track health burdens and policy outcomes. The HIGH Horizons project, over four years, involves 5 partners in the EU, 3 in Africa and 2 international organisations (WHO and UNICEF). It centres on pregnant and postpartum women, infants, and health workers, groups heavily affected by climate change. We quantify and monitor direct and indirect health impacts of extreme heat; test a personalised Early Warning System (EWS); and implement integrated adaptation-mitigation actions in health facilities. Analyses of heat impacts and data science predictive modelling using data from Sweden; Lazio Italy, and health facilities in Kenya and South Africa underpin all activities. These analyses and systematic reviews inform testing and selection of global, EU and national indicators. Analyses also inform cut-off thresholds for EWSs, stratified by risk groups. A smartphone app (ClimApp-MCH) will deliver warnings and setting-specific messages, co-designed locally. The app will be evaluated among 200 mothers and infants in Sweden, South Africa and Zimbabwe, from antepartum through 12 months of infant age. Simultaneously, we will document impacts of heat exposure on health worker wellbeing, health, productivity and quality of care, including through time-motion studies. Modifications to health facilities will be co-designed and modelled to reduce heat exposure for health workers and to limit facilities carbon emissions. Health worker outcomes and facility emissions will be compared pre- and post-intervention. Analyses weighing costs and benefits cut across all activities. Throughout we will disseminate project findings to relevant stakeholders, prioritising EU and global policy makers and leveraging existing networks. The final set of indicators on climate change and maternal, newborn and child health will be released in a WHO, UNICEF and UNFPA guidance document. In order to optimise synergies, avoid overlaps and increase the impact of the projects selected for funding from the call HORIZON-HLTH-2021-ENVHLTH-02-03 (Health impacts of climate change, costs and benefits of action and inaction, Horizon Europe projects 101057843 HIGH Horizons, 101057131 CATALYSE, 101057764 BlueAdapt, 101057690 CLIMOS, 101057554 IDAlert and 101057739 TRIGGER), the projects will form a cluster. Common cluster activities will include the following: 1 . Common kick-off meeting of the six projects, to be organized in cooperation between DG R&I and the cluster; 2. Annual cluster meetings and periodic report of joint activities (delivered at each reporting period); 3. Common dissemination and communication activities, including a common dissemination and communication strategy for the cluster, cluster web portal and visual identity, cluster brochure, cluster newsletters, stakeholder list, Shared individual Data Management Plans between cluster partners, Policy Strategy of the cluster, including joint policy briefs and Scientific strategy of the cluster. The penholder and project responsible for each joint deliverable will be decided in the document setting out the Modalities for Implementation of the Cluster to be agreed on during 2022. 4. Thematic workshops/trainings on issues of common interest to be defined in the context of the scientific strategy of the cluster; 5. Working groups on topics of common interest (e.g., data management, communication and dissemination, science-policy link): to be defined in the context of the scientific strategy of the cluster;