East Africa IeDEA Regional Consortium

描述（由申请人提供）： 东非leDEA区域联盟内的三个国家自2003年全球抗逆转录病毒疗法（ART）推出以来，估计需要ART的人群的覆盖率急剧增加（根据2006年世卫组织指南），从2003年基本上没有病人，到2009年底，肯尼亚的覆盖率为65%，乌干达为53%，坦桑尼亚为44%。虽然艾滋病毒治疗的这种急剧扩大对死亡率产生了积极影响，但在患者参与护理的整个过程中，从ART前阶段到ART启动、对ART的初始临床反应和方案持久性（不良事件和耐药性的发生），到长期维持、失访（LTFU）和死亡，仍然存在关键问题。该联盟的长期目标是为临床医生、项目和卫生部认为对其长期艾滋病毒护理和治疗战略的演变和可持续性至关重要的问题提供答案。在下一个资助周期，我们将通过加强关键领域的数据收集以及合并现有数据来源来解决这些问题，以更好地评估和通报东非的ART推广情况。我们最适合领导这一奋进，因为我们的联盟包括代表性的艾滋病毒诊所，协调的区域数据库，以及医生，流行病学家和分析师，他们具有实施研究的专业知识，并对现有数据源的优势和局限性有着深刻的理解。我们在EA-leDEA联盟下一阶段的首要任务是：目标1：确定成人和儿童沿着整个艾滋病毒护理范围的短期和长期结果，并检查与这些结果相关的患者和地点一级因素;目标2：评估预防母婴传播艾滋病毒（pMTCT）战略的实施率和结果;目标3：监测将证据转化为实践，以管理合并感染，重点是结核病（TB）;目标4：确定东非恶性肿瘤的患病率、发病率、决定因素和结局，重点是卡波西肉瘤（KS）和宫颈癌。 相关性： 通过这些努力，我们将加强对撒哈拉以南非洲艾滋病毒流行情况的了解，提供有关护理和治疗方案的最佳结构和影响的见解，扩大可用于在资源有限的情况下为实施和业务研究提供信息的工具集，并为该地区各级利益攸关方和决策者以及更广泛的艾滋病毒/艾滋病科学界提供政策信息。

DESCRIPTION (provided by applicant): The three countries within the East African leDEA Regional Consortium (Kenya, Uganda, Tanzania) have adult HIV prevalence rates ranging between 5-10%.Since the advent of the global antiretroviral therapy (ART) rollout in 2003, there has been a dramatic increase in the percent coverage of those estimated in need of ART (based on the 2006 WHO guidelines), from essentially no patients on in 2003, to 65% coverage in Kenya, 53% in Uganda, and 44% in Tanzania by the end of 2009. Though this dramatic scale-up of HIV treatment has had a positive impact on mortality rates, key questions remain throughout the course of a patient's engagement in care, from the pre- ART period through ART-initiation, initial clinical response to ART and regimen durability (occurrence of adverse events and drug resistance), to long-term maintenance, loss to follow-up (LTFU), and death. It is the long-range goal of this consortium is to provide answers to the questions that clinicians, programs, and ministries of health consider fundamental to the evolution and sustainability of their long term HIV care and treatment strategies. In the next funding cycle, we will address these questions by enhancing data collection in key areas as well as merging existing data sources to better assess and inform the ART rollout in East Africa. We are optimally placed to lead this endeavor as our consortium includes representative HIV-clinics, a harmonized regional database, as well as physicians, epidemiologists, and analysts with expertise in implementation research and a solid understanding of the strengths and limitations of existing data sources. Our top priorities for the next phase of the EA-leDEA Consortium are to: Aim 1: Determine the short and long-term outcomes of adults and children along the entire spectrum of HIV care and examine patient and site-level factors associated with these outcomes; Aim 2: Assess the penetrance and outcomes of prevention of mother to child transmission of HIV (pMTCT) strategies; Aim 3: Monitor the translation of evidence into practice for managing co-infections with an emphasis on Tuberculosis (TB); Aim 4: Determine the prevalence, incidence, determinants and outcomes of malignancies in East Africa with a focus on Kaposi's sarcoma (KS) and cervical cancer. RELEVANCE: Through these efforts, we will enhance our understanding about the HIV-epidemic in its sub- Saharan Africa context, provide insights on the optimal structure and impact of care and treatment programs, expand the set of tools available to inform implementation and operations research in resource-constrained settings and inform policy among stakeholders and decision makers at every level in the region as well as the broader HIV/AIDS scientific community.