GHTM has been a pioneer in Portugal in studying health determinants of migrant populations, one of the vulnerable groups increasingly highlighted in the literature, especially in the current context of humanitarian crises caused by armed conflicts and environmental disasters linked to climate change.

Professor Maria do Rosário Martins, leader of the Research Group on Population Health, Policies, and Services, has dedicated over 10 years to this subject. She emphasizes that one of the initial groundbreaking steps was examining the health of the adult immigrant population. However, significant methodological limitations existed, such as a lack of comparability with native populations and insufficient longitudinal data. Recognizing childhood as a crucial period for effective health interventions, another gap became evident: most studies focused solely on adult populations.

Starting in 2019, GHTM has been implementing several studies to address these limitations. We adopted a cohort approach, following over 1,200 children in five municipalities of the Lisbon Metropolitan Area. The immigrant participants predominantly come from Brazil, Cabo Verde, Angola, Guinea-Bissau, or São Tomé and Príncipe. Approximately half of the cohort comprises native children, facilitating comparative analyses. Additionally, we have maintained close collaborations with migrant non-profit organizations, the Directorate-General for Health, health centers, and hospitals.

One of our main objectives is to analyze the health trajectories of immigrant and native children and investigate the impact of the COVID-19 pandemic on their health indicators and the socioeconomic dynamics of their families. We linked three databases: questionnaires administered by the study, clinical data collected in health centers and hospitals. We have included data on various health outcomes, ranging from dietary patterns, mental health, and psychomotor development to the most frequent illness episodes.

During the pandemic, our study facilitated interventions by the Ministry of Health and the Government to improve the situation of these vulnerable populations. The impact of our work is reflected not only in numerous publications but also in the awarding of the Human Rights Medal by the Portuguese Parliament in 2020.

Future research includes meta-analyses of child health through the assessment of multiple cohorts, including those in Amazonia, Brazil, Cape Verde, Guinea-Bissau and Denmark.

In the early 2010s, significant challenges emerged in the fight against HIV, particularly in Portuguese-speaking African countries where healthcare infrastructure struggled to provide adequate access to antiretroviral therapy (ART). The lack of ART availability in these countries at that time led to poorer health outcomes for those living with HIV. Now, with ART widely available, but with deficient clinical and laboratory follow-up of patients, the emergence and spread of drug resistance mutations pose a serious threat. Concurrently, the tuberculosis (TB) pandemic evolved into a crisis, characterized by increasing cases of drug-resistant TB, with Portugal experiencing one of the highest incidences of TB in Western Europe, raising alarms about multidrug-resistant TB (MDR-TB).

Recent Work on HIV

To address the pressing issue of HIV-1 drug resistance, GHTM collaborators Anne-Mieke Vandamme and Ricardo Camacho have focused on developing diagnostic tools and clinical decision-making algorithms tailored to patients with drug resistance mutations. One notable achievement is RegaDB, an open-source bioinformatics platform designed to store, manage, and analyze HIV patient data by integrating clinical and virological information. The collaboration between Camacho, Vandamme, the World Health Organization (WHO), and other leading international groups, such as those in Utrecht and Stanford, has also been pivotal for developing and standardizing testing and interpretation algorithms for HIV drug resistance, thereby influencing treatment protocols now employed internationally.

The BEST HOPE study, conducted in partnership with hospitals across Portugal, established a cohort of newly diagnosed HIV patients to examine the prevalence of transmitted drug resistance (TDR) and analyze factors associated with the transmission of HIV infection and the spread of HIV-1 drug-resistant strains. The research team, including GHTM members Ana Abecasis, Maria do Rosário Oliveira Martins, Marta Pingarilho, and Victor Pimentel, found that a significant portion of patients exhibited resistance to at least one class of antiretroviral drugs. These findings underscore the critical need for ongoing monitoring to inform effective first-line treatments. Insights gained from this initiative have enhanced the understanding of HIV transmission dynamics and drug resistance in Portugal, paving the way for more targeted treatment and prevention strategies nationwide.

Recent Work on TB

In collaboration with the London School of Hygiene and Tropical Medicine – Faculty of Infectious and Tropical Diseases, led by Prof. Taane Clarke, GHTM researchers have identified thousands of mutations linked to resistance against both first and second-line anti-TBdrugs thata are now gathered in the WHO Catalogue of mutations in Mycobacterium tuberculosis complex and their association with drug resistance. 

Notably, since 2017, Portugal has not reported any cases of extensively drug-resistant TB (XDR-TB), and instances of multidrug-resistant TB (MDR-TB) are minimal, with therapeutic success rates for TB exceeding 85%. This success highlights the impact of ongoing research and effective public health strategies in combatting TB.

Partnerships with Portuguese-Speaking Countries

Additionally, GHTM has actively promoted the dissemination of cutting-edge knowledge through TB networks such as REDE-TB-Brasil, RIDES TB and CPLP-TB, in close collaboration with European entities like the European Society of Mycobacteriology and the European Society of Clinical Mycobacteriology and Infectious Diseases. These partnerships are crucial for enhancing regional capabilities in managing both HIV and TB, ultimately improving health outcomes across Portuguese-speaking nations.

The starting point for this story is the discovery of Human Immunodeficiency Virus (HIV). This virus significantly weakens the immune system, making individuals more susceptible to develop active tuberculosis (TB). TB is one of the leading causes of death among people living with HIV, as the compromised immune system struggles to combat Mycobacterium tuberculosis.

The co-infection of HIV and TB presents a major public health challenge globally, requiring integrated treatment and prevention strategies to manage both diseases effectively. GHTM & IHMT-NOVA researchers have been at the forefront of HIV & TB research in Portugal and at a global level.

Crucial Role in Understanding the Virus and the Discovery of HIV-2

In 1984, Dr. Kamal Mansinho and Dr. Jaime Nina, under the leadership of Professor Champalimaud at Egas Moniz Hospital, made groundbreaking strides in HIV research. Their diligent collection of samples from immunocompromised patients who tested negative for HIV (later redignated as  HIV-1) was crucial in the discovery and isolation of HIV-2.

Continuing this legacy, researcher Anne-Mieke Vandamme has advanced our understanding of the virus’s zoonotic origins. Kamal Mansinho, Ricardo Camacho and Ana Abecasis, on the other hand, have focused on the impact of conflicts in Portuguese-speaking African countries on the spread of HIV-2.

Professor Ana Abecasis, specialist in Molecular Epidemiology, highlights the contributions of her team in studying the emergence and ignition of HIV-1 epidemic  in Angola. Their research identified Angola as one of the three initial epicenters of the HIV-1 pandemic. This pivotal finding has opened new avenues for exploring the phylogenetic history of HIV and the potential development of antiretroviral drug resistance.

Addressing Tuberculosis Outbreaks

The surge in HIV cases led to a corresponding increase in TB prevalence, with Portugal being notably affected. The Institute of Hygiene and Tropical Medicine (IHMT) and its research unit, responded by investing in infrastructures for the early and accurate diagnosis of tuberculosis and its resistant forms, using newly developed molecular biology assays for direct detection and rapid liquid culture, which was critical for a systematic approach to this dual epidemic.

Professor Miguel Viveiros, GHTM Scientific Coordinator and leading expert in the field, emphasized the essential role of GHTM researchers in combating TB in Portugal and globally. They described and characterized hundreds of cases of extensively drug-resistant tuberculosis and their intrinsic mutations for resistance in hundreds of antibiotic targets. These were basis for the WHO catalogue for M. tuberculosis antibiotic resistance mutations. It was in our laboratory that the transmission chain of the highly virulent and resistant “Lisboa strain” was identified, which has since become a global reference point in M/XDR-TB research.

A fight in multiple fronts

These combined efforts have significantly advanced our understanding of HIV and its intersection with tuberculosis. Their pioneering work continues to influence global health strategies and offers hope for more effective treatments and interventions.

Professor Jorge Seixas takes us on a journey through the latest developments in the treatment for Human African Trypanosomiasis, commonly known as sleeping sickness.

He highlights two significant projects led by Drugs for Neglected Diseases Initiative (DNDi), with participation from GHTM-IHMT-NOVA and financed by EDCTP 2, aimed at expanding   treatment options for a broader range of patients, including those with the more neglected form of the disease.

This new set of tools is a game-changer, offering easier-to-implement treatments and raising hopes for the sustained elimination of sleeping sickness.

VIASEF is a biocontainment infrastructure designed to facilitate research and development activities with invasive, exotic, or transgenic arthropods and human/animal pathogens transmitted by them that may pose biosecurity risks. Its a convertible infrastructure, able to address different types of public health emergencies. This was evidenced when, within the first six months of its inauguration, VIASEF focused its research on SARS-CoV-2, while establishing mosquito colonies of medical importance.

VIASEF has made significant contributions to vector-borne disease research and control.

Projects have focused on innovative vector control strategies, within the framework of insecticides, repellents, and trapping methods have shown enhanced efficacy in reducing vector populations and disease transmission. Moreover, VIASEF has contributed for the testing of innovative compounds as mosquito repellents/larvicides and is part of a project led by the University of California Malaria Initiative (UCMI) in São Tomé and Príncipe, involving field research on malaria mosquito vectors and capacity building on transgenic technologies, as a novel tool to eliminate malaria transmission in the region. Also, it is involved in developing an artificial diet (BLOODless) as an alternative to vertebrate blood which is traditionally used to feed mosquitoes, currently being tested in various African countries to assess its applicability and sustainability.

Achievements include innovations like a bloodless mosquito diet and a spatial repellent for malaria control.

Furthermore, VIASEF acts as a hub for teaching and collaborations with local communities and healthcare professionals, fostering knowledge transfer and capacity building. This has allowed individuals and institutions to effectively manage vector-borne diseases, leading to improved prevention and control. The UCMI in São Tomé and Príncipe, for example, facilitates the exchange of knowledge and expertise among partners. VIASEF also provides an exceptional environment for the development of MSc and PhD theses, with 3 MSc theses concluded and supporting 2 ongoing PhD theses thus far. Findings have informed public health policies at both regional and national levels.

VIASEF has improved disease surveillance, diagnostic tools, and knowledge transfer, improving public health and societal well-being.

The impact achieved is a proof of collaborative efforts, significant funding, partnerships with various stakeholders and dissemination through scientific publications and conferences. Overall, VIASEF, the only one of its kind in Portugal, has changed vector-borne disease research and control, leading to significant advancements in vector control strategies, disease surveillance, diagnostics, and policy influence.

Click here to visit VIASEF and get updates on the most recent projects.

We develop Workshops and provide dedicated Mentoring. Our Training in Cientific communication is available online and is taught by GHTM-IHMT researchers.

The network counts with women from Angola, Cabo Verde, Mozambique and Portugal.

Female participation in science, including biomedical scienc­es, has increased, but still presents various challenges. The MulhereSTrop network was launched in 2015 to support women scientists in African Portuguese speaking countries (PALOP) in Tropical Health. The network has offered work­shops on scientific writing and has encouraged scientific article submission, with awards for the best. Through the website, the network provides access to training in scientific writing, and information. The long-term maintenance of the network should significantly contribute to boost female scientific advancement in the PALOP.

You can find out more on our website or contact us via e-mail.