Central Africa International Epidemiology databases to Evaluate AIDS

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Project Summary As HIV care and treatment programs are implemented throughout sub-Saharan Africa (SSA), critical advances in research and policy are needed so that care and treatment resources can be deployed to optimal benefit: decreasing new HIV transmissions, HIV-related morbidity and mortality, and illness from non-communicable disease (NCD). Coverage of antiretroviral therapy in the 'Treat All' era varies widely in our region, from 87% in Rwanda to 25% in Republic of Congo, the lowest coverage among all IeDEA countries in SSA. Our research agenda is designed to generate actionable knowledge to help close these gaps. Our regional cohort database includes longitudinal data for 81,183 adults and 11,789 children ever enrolling in HIV care at 22 sites in Burundi, Cameroon, the Democratic Republic of Congo, Republic of Congo and Rwanda. We propose to supplement this database with linked cohorts to address a range of investigations relevant to our region including: 1) leveraging implementation science approaches to inform strategies aimed at improving HIV prevention, care and treatment outcomes in the region (Aim 1); 2) conducting in-depth clinical investigations of HIV-related outcomes and infectious (e.g. TB) and non-infectious (e.g. NCDs) comorbidities (Aim 2); 3) leading and supporting an innovative multiregional scientific agenda within the larger IeDEA network (Aim 3); and 4.) providing scientific and career mentoring to early stage investigators and researchers from Central Africa and from the US (Aim 4). Central Africa IeDEA has a diverse scientific team with broad and deep expertise in implementation science, epidemiology and clinical research. We have been highly productive scientifically with >45 publications across a range of topics, and have continued to foster African leadership and build local research capacity. Themes in our application include an emphasis on ‘treat all’ policy implementation, mental health and substance use (alcohol), PMTCT and pediatric and adolescent HIV, tuberculosis, HIV prevention through PrEP, and NCDs in aging people living with HIV (e.g. kidney disease).