Biography

Dr Angela Loyse trained in infectious diseases and works on clinical trials, implementation science projects, large scale implementation and advocacy initiatives mainly in low- and middle-income countries.  She is passionate about locally led, patient-centred health system strengthening.  Angela was the chief investigator of the DREAMM implementation science project (www.dreamm.net) that reduced by 50% short term mortality from central nervous system infections in 5 public hospitals in Malawi, Tanzania and Cameroon.  In 2023, Angela launched the End AIDS Action Group (www.endaidsaction.group) that expands upon (in terms of geographic and disease areas) the work of the Cryptococcal Meningitis Action Group (CryptoMAG).  As chair and lead of cryptoMAG since 2013, she lobbied DNDi to develop a slow-release formulation of the lifesaving medicine flucytosine and is now the deputy director and access lead for the EDCTP-funded DNDi coordinated 5FC HIV Crypto project.  From 2019 to December 2022, Angela was the sole technical advisor to Unitaid's Advanced HIV disease programme that was implemented by the Clinton health Access Initiative.  She led the technical development of the Global Advanced HIV Diseases toolkit incorporating many DREAMM educational materials and devised the 'hub-and spoke-' model of care for advanced HIV disease.

Measures of esteem

• Reviewer for ECCMID, La Caixa, EDCTP, MRC(UK).
• Faculty member MRC(UK) for applied science.
• Fellow of the Royal College of Physicians (nominated)
• Awarded best research publication 2022-2023 by SGUL for Lancet HIV published DREAMM headline mortality results.
• September 2023 Member of WHO expert consultation on the landscape of Advanced HIV disease management.
• November 2017 Member of WHO Expert review committee on 2018 WHO Guidelines for the diagnosis, prevention, and management of cryptococcal disease in HIV-infected adults, adolescents and children.
• In October 2019 Angela was invited by the head of EDCTP Dr Makanga to speak at the World Health Summit, Berlin, Germany and to participate in a panel discussion with the WHO Chief Scientist, Global Fund CEO, GHIT CEO and German Ministry of Health on ‘Tackling Unmet Medical Needs of Vulnerable and Neglected Populations: Accelerating R&D of Innovative and Effective Medical Interventions through Partnerships and Strategic Alliances’.  Title of talk:  DREAMMS of implementation: Reducing advanced HIV deaths in African Low- & Middle- Income Countries.
• Angela regularly gives invited talks and has spoken at the following meetings, training sessions and conferences: South African Clinicians' Society, Trends in Medical Mycology, International AIDS Society, Nigerian Ministry of Health training on AHD , Institut Pasteur, Elizabeth Glazer Paediatric AIDS Foundation, Unitaid donor meeting on AHD, IS Global, Kenyan Biannual Ministry of Health HIV conference, ICAP/CHAI AHD conference,PAHO/WHO Expert Workshop on Policy Options for Innovations in Diagnostics and Service Delivery for Impact in HIV, STIs, TB and Malaria, International Conference on Cryptococcus and Cryptococcosis, Clinton Health Access Initiative Forum Goa, India, AIDS Mycoses, CDC, Unitaid & CHAI Echo series on Advanced HIV disease, 9th EDCTP conference etc...
• Angela teaches on SGUL's Global Health module and also on 'Strategies to end AIDS deaths' at the London School of Hygiene & Tropical Medicine. She also teaches on advocacy initiatives to end AIDS deaths on Wits' DTM&H Cryptococcosis seminar.

Current roles

• EDCTP-funded 5FC HIV Crypto project.  Deputy director of a 3.7 million Euro  project to develop a slow release formulation of the life-saving medicine flucytosine (5FC) for cryptococcal meningitis in collaboration with the Drugs for Neglected Diseases Initiative (DNDi).  5FC HIV Crypto spans phase I and phase II drug registration trials, submission to WHO prequalification, local capacity building and access work for 5FC.  The project was instigated by Angela's lobbying of DNDi as lead CryptoMAG.  Angela conceptualised the 'End crypto deaths by 2030' and 'Why are so many people dying from AIDS?' IAS 2021 satellite sessions, and leads the 5FC HIV Crypto advocacy work.
• Lead End AIDS Action project (www.endaidsaction.group). Angela launched the End AIDS Action group in 2023 to expand the geographic and disease scope of the successful CryptoMAG advocacy group outlined below. The group's scope includes diseases such as histoplasmosis, talaromyces, pneumocystis jirovecii pneumonia etc...that continue to cause unacceptable and preventable HIV-related mortality.        
• Honorary Infectious Diseases Consultant St George’s Hospital Angela works in St George's Hospital Courtyard Clinic performing HIV clinics and participating in multi-disciplinary meetings on antiretroviral therapy.   
• Co-investigator EFFECT trial, Imprint project.

Previous roles

• Chief investigator DREAMM (Driving Reduced AIDS-associated meningo-encephalitis Mortality) (www.dreamm.net).  Angela conceptualised, codesigned and delivered the Lancet HIV-published DREAMM project which is to our knowledge the first implementation science project on HIV-related CNS infection in 5 sites in Malawi, Tanzania and Cameroon.  The approach adopted was novel and draws upon Theory of change, health system engineering, mixed methodology and trial methodology.  DREAMM reduced short term mortality from HIV-related CNS infection by 50%. The open access DREAMM training program has been viewed over 7,000 times (https://figshare.com/projects/DREAMM_Clinical_Training/127199), with many tools incorporated in the global AHD toolkit (see below).  
• Sole strategic advisor to the Clinton Health Access Initiative (CHAI) on a 20 million USD grant from Unitaid to cut deaths from advanced HIV disease (AHD) in 8 African low- and middle- income countries (LMICs) and India. Lead on development of a toolkit on AHD with global health partners.  Angela devised the ‘hub and spoke’ framework for AHD that is widely used across African LMICs at the core of the global AHD toolkit.  Global AHD toolkit: https://www.differentiatedservicedelivery.org/resources/the-global-advanced-hiv-disease-toolkit/.
• CryptoMAG advocacy group chair (nominated)  Angela provided leadership, vision and coordination. CryptoMAG aims to improve access to diagnostics and therapies for cryptococcal disease and has proven to be a powerful vehicle for advocacy with notable achievements including accelerating translating the latest cutting-edge data into international policy, advocating for availability of life saving 5FC, and catalyzing the development of key projects to slash HIV-related deaths and drive the development of better adapted and new antifungals (e.g Unitaid's AHD program, 5FC HIV Crypto). Stakeholders include leaders from CDC (lead role), Médecins sans Frontières Access Campaign, GAFFI, DNDi, NICD SA, academic experts from SGUL, University of Minnesota etc,.
• Diagnostic test development and evaluation in resource limited settings. Conceptualised idea for polyvalent tests (HIV/cryptococcal antigen (CrAg and CrAg/S.pneumoniae).  Prototype evaluation within DREAMM.  In addition, the implementation of the following technologies are being evaluated for the diagnosis of HIV-related meningo-encephalitis within the DREAMM project:  Xpert MTB/RIF Ultra Xpert Ultra, Chembio DPP assay for syphilis, urinary lipoarabinomannan (LAM), S.pneumoniae rapid diagnostic test (RDT). 
• Co-investigator Ambition trial (Responsible for senior oversight of serious adverse event reporting),TRIP implementation project.

1. I.I Osaigbovo, N.P Govender, A.R Jordan…..A. Loyse…..R. Oladele. The Nairobi Declaration 2023: A commitment to address deadly yet neglected fungal diseases in Africa. Medical Mycology, Volume 62, Issue 1, January 2024, myad141, https://doi.org/10.1093/mmy/myad141
2. P Sephton-Clark, E Temfack, J.L Tenor….A Loyse…..C.A Cuomo. Genetic diversity and microevolution in clinical Cryptococcus isolates from Cameroon. Med Mycol 2023 Dec 1;61(12):myad116. doi: 10.1093/mmy/myad116.
3. C Kanyama, S Phiri, B.W Matola, A Banda, A Loyse. How to DREAMM and end HIV-related deaths. Lancet Glob Health. 2023 Dec;11(12):e1857-e1858.doi: 10.1016/S2214-109X(23)00429-1. Epub 2023 Oct 4.
4. S Mfinanga, C Kanyama, C Kouanfack…..A Loyse. Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study. Lancet HIV. 2023 Oct;10(10):e663-e673. doi: 10.1016/S2352-3018(23)00182-0.
5. A Lehman, J Ellis, E Nalintya, N.C. Bahr, A Loyse, Radha Rajasingham (joint last author) Advanced HIV disease: A review of diagnostic and prophylactic strategies. HIV Med. 2023 Aug;24(8):859-876.doi: 10.1111/hiv.13487. Epub 2023 Apr 11.
6. R Rajasingham, N.P Govender, A Jordan, A Loyse et al. The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis. Lancet Infect Dis 2022;22: 1748–55; https://doi.org/10.1016/S1473-3099(22)00499-6.
7. J.N Jarvis, D.S Lawrence, D.B Meya….A Loyse……T.S Harrison for the Ambition Study Group. Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis. N Engl J Med 2022; 386:1109-1120. DOI: 10.1056/NEJMoa2111904.
8. N Kalata, J Ellis, C Kanyama, C Kuoanfank, E Temfack, S Mfinanga, S Lesikari, D Chanda, S Lakhi, T Nyazika, A K Chan, JJ van Oosterhout, T Chen, M C Hosseinipour, O Lortholary, D Wang, S Jaffar, A Loyse et al. Short-term mortality outcomes of HIV-associated cryptococcal meningitis in antiretroviral therapy-naive and -experienced patinets in Sub-Saharan Africa. Open Forum Infect Dis 8(10)397 Oct 2021.
9. Shroufi A, Govender NP, Meintjes G, Black J, Nel J, MoosaM-YunusS, Menezes C, Dawood H, Wilson D, Trivino Duran L, Ajose O, Murphy RA, HarrisonT, Loyse A, Ruffell C, Van Cutsem G, Time to embrace access programmes for medicines: Lessons from the South African flucytosine access programme, International Journal of Infectious Diseases 2020 doi:https://doi.org/10.1016/j.ijid.2020.02.057
10. K Manalan, N Green, A Arnold, G.S. Cooke, M Dedicoate, M Lipman, A Loyse, T.S. Harrison, OM Kon.  A cost comparison of amikacin therapy with bedaquiline, for drug-resistant tuberculosis in the UK.  Journal of infection January 2020; 80, Issue 1:38–41
11. Shiri T, Loyse A (joint 1st author), Mwenge L, Chen T et al Addition of flucytosine to fluconazole for the treatment of cryptococcal meningitis in Africa: a multi-country cost-effectiveness analysis. Clin Infect Dis. 2019 Feb 28. pii: ciz163. doi: 10.1093/cid/ciz163.
12. A. Loyse, J. Bury, J. Cohn et al. Leave no one behind Response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries.  The Lancet Infectious Diseases 2019;19(4):e143-e147.
13. S.F Molloy, C Kanyama, RS Heyderman, A Loyse (joint 1^st author) Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa.  New England Journal of Medicine N Engl J Med 2018; 378:1004-17.  DOI: 10.1056/NEJMoa1710922.
14. E Temfack, C Kouanfack, L Mossiang, A Loyse et al Cryptococcal Antigen Screening in Asymptomatic HIV-Infected Antiretroviral Naïve Patients in Cameroon and Evaluation of the New Semi-Quantitative Biosynex CryptoPS Test.  Frontiers in Microbiology. 2018 Mar 13; 9:409. doi: 10.3389/fmicb.2018.00409. eCollection 2018. 
15. SF Molloy, T Chiller, GS Greene….A Loyse. Cryptococcal meningitis: A neglected NTD? PLoS Negl Trop Dis 2017; 11(6): e0005575.https://doi.org/10.1371/journal.pntd.0005575.
16. R Rajasingham, RM Smith, BJ Park, JN Jarvis, NP Govender, TM Chiller, DW Denning, A Loyse, DR Boulware. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis.  Lancet Infect Dis 2017; 17: 873–81.
17. P.Williamson, JN Jarvis, AA Panackal, MC Fisher, SF Molloy, A Loyse, TS Harrison.  Cryptococcal meningitis: Epidemiology, immunology, diagnosis and therapy.  Nature Review Neurology 2016 doi:10.1038/nrneurol.2016.167.
18. T. Bicanic, C. Bottomley, A.Loyse et al.  Toxicity of Amphotericin B deoxycholate-based induction therapy in patients with HIV-associated meningitis.  Antimicrobial Agents and Chemotherapy 2015; 59 (12): 7224-7231.
19. A Loyse, A Moodley, P Rich et al. Neurological, visual, and MRI brain scan findings in 87 South African patients with HIV-associated cryptococcal meningoencephalitis.  Journal of Infection 2014.   doi: 10.1016/j.jinf.2014.10.007.
20. J Jarvis, T Bicanic, A Loyse et al.   Determinants of Mortality in a Combined Cohort of 501 Patients with HIV-Associated Cryptococcal Meningitis: Implications for Improving Outcomes.  Clinical Infectious Diseases 2014; 58 (5): 736-745.
21. A Loyse, H Thangaraj, P Easterbrook et al.  Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries. The Lancet Infectious Diseases 2013;13 (7):629-637.
22. A Loyse, F Dromer, J Day, O Lortholary, T.S Harrison.  Flucytosine and cryptococcosis: time to urgently address the worldwide accessibility of a 50-year-old antifungal.  Journal of Antimicrobial Chemotherapy 2013;68(11) :2435-44.
23. A Loyse, T Bicanic, J N Jarvis.  Combination Antifungal Therapy for Cryptococcal Meningitis. NEJM Letter 2013;368: 2522-252.
24. A Moodley, W Rae, A Bhigjee, C Connolly, N Devparsad, A Michowicz, T Harrison, A Loyse. Early clinical and subclinical visual evoked potential and Humphrey's visual field defects in cryptococcal meningitis. PLoS One 2012; 7(12):e52895.
25. Loyse A, Wilson D, Meintjes G, Jarvis JN, Bicanic T, Bishop L, Rebe K, Williams A, Jaffar S, Bekker LG, Wood R, Harrison TS.  Comparison of the early fungicidal activity of high-dose fluconazole, voriconazole, and flucytosine as second-line drugs given in combination with amphotericin B for the treatment of HIV-associated cryptococcal meningitis.  Clin Infect Dis. 2012 Jan 1;54(1):121-8. doi: 10.1093/cid/cir745.