Expanding the pool of Independent Investigators in Implementation Science in Nigeria throug h HIV research training (EXPAND)

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PROJECT SUMMARY The research proposal on facility-based screening for Hypertension and Associated Non-communicable Diseases in young adults living with HIV/AIDS (HANDY) speaks to the aims of the parent training grant EXPAND (D43TW012280), whose goal is to establish long-term structured hard and soft skills training and mentoring to guide early-career Nigerian researchers for independent investigator-ship and research leadership at the International Research Center of Excellence at the Institute of Human Virology Nigeria (IRCE-IHVN). Dr. Ahmad Aliyu, a former Fogarty trainee who currently serves as the Senior Technical Advisor (STA) for Monitoring and Evaluation (M&E) at IHVN will lead the execution of this supplement. In addition to support from the MPIs with relevant expertise in studying adolescents with HIV (Dr. Sam Agudu) and HIV exposed uninfected persons (Dr. Abimiku); Dr. Aliyu will be mentored by two additional faculty; Dr. Dakum at IHVN and Dr. Stafford at University of Maryland School of Medicine (UMSOM), both Associate Professors of Epidemiology and Public Health at UMSOM with expertise in HIV and aging. The proposed supplement will address critical gaps in our understanding of the impact of comorbidities such as non-communicable diseases (NCDs) on general health and aging among Adolescents And Young Adults Living with HIV (AYALWH). Access to durable and tolerable antiretroviral therapy (ART) has transformed HIV into a chronic condition and has dramatically increased life expectancy.1 Today a young person with HIV and on ART can expect an overall lifespan similar to the general population; however, they are likely to have a shorter comorbidity-free life expectancy than young people without HIV. Approximately 12% of the 1.9 million people living with HIV in Nigeria are adolescents (UNICEF, 2019) and annual HIV incidence is highest among adolescents and young adults ages 15-34 years.2 There is overwhelming evidence from the literature that demonstrates accelerated biological aging due to HIV infection and associated clinical manifestations among perinatally- infected person with HIV (PHIV) and PLWH in general.3 Indeed, a characteristic phenotype of NCDs is accelerated aging from DNA damage, telomere shortening and irreversible oxidative damage.4 Additional evidence also shows that HIV infection and use of ART potentiate early onset of geriatric syndrome and recommends early screening and further studies on comorbidities with non-communicable diseases (NCD) among PLWH on ART.5,6 Studies on HIV and aging are scanty in Nigeria and even less in adolescents and young adults. Available studies also recommend further studies on NCDs among PLWH on ART. HANDY will be conducted within the context of Presidents’ Emergency Plan for AIDS Relief (PEPFAR) program implementation by IHVN, and would address a priority area in the National Multi-sectoral Action Plan (NMSAP) for the Prevention and Control of NCDs 2019-2025. HANDY will focus on these two specific aims: 1. To determine the prevalence of hypertension and associated metabolic disorders among PHIV compared to HIV-exposed and uninfected (HEU) and HIV-unexposed and uninfected (HUU) young adults. 2. To improve early detection of hypertension and associated metabolic disorders among AYALWH, and linkage to care for appropriate management and care Using a cross-sectional study design, HANDY will recruit 450 participants from three groups: 150 PHIV, 150 HEU and 150 HUU young adults aged 18-24 years. The source population of potential study participants are engaged in care PEPFAR-supported Operation triple zero (OTZ) sites in Federal Capital Territory (FCT) and Nassarawa supported by IHVN, where 7,127 eligible individuals are currently receiving care. (Refer to Table 1). Data will be collected on history of prior HIV exposure in-utero, HIV sero-status, antiretroviral therapy (ART) status, anthropometry, BP measurement, and screening for metabolic disorders. HANDY achieves the following 1) early detection of HTN and associated metabolic disorders 2) referral for specialized care and management to prevent complications to prevent early and late of sequelae 3) reducing morbidity and mortality among those with associated NCDs. The project reduces the burden of NCDs and increases access to care and treatment