The promise of antiretroviral therapy (ART) to provide renewed health is now being realized for millions of Africans. As HIV care and treatment programs are implemented throughout Africa, careful monitoring of their effectiveness is of crucial importance, so that care and treatment resources can be deployed to optimal benefit. Immunologic and clinical responses to ART, retention in care, and behavioral components (e.g., treatment adherence) need to be elucidated and predictors of survival defined. The impact of HIV and ART on cancers in Africa is essentially undescribed, and interactions with major ambient co-morbidities such as malaria are poorly understood. We propose a new Central Africa leDEA (CA-leDEA), designed to optimize and augment scientific productivity and rapid, high-impact publications;we will 1.) Compile and manage secondary source patient-level data on a large volume of patients through a.) extraction from existing electronic data, or b.) new on-the-ground systems for efficient capture of clinical data in low-resource clinical settings;2.) Develop a creative and flexible scientific process that fosters high throughput of many analyses of data to answer epidemiologic, operational and other HIV-related research questions, culminating in high- impact publications;and 3.) Develop capacity for independent research, data management, analysis and publication in each of the Central African countries over five to ten years, ensuring the sustainability of CA-leDEA. Our team brings a long history in the region of research productivity and operational success, as well as innovative IT development to support research, with complementary skills and experience to optimize the activities of CA-leDEA. Four of our partners are the implementers of HIV care services (i.e., the governments) and the fifth partner, WE-ACTx Rwanda, brings patient volume, research experience and special resources to investigate AIDS malignancies. We will develop an administrative and data management infrastructure that supports the implementation of epidemiologic and implementation science to answer key questions in HIV care and treatment in lower-resource settings, with integrated research teams in the US, Cameroon and Rwanda.

Public Health Relevance

Sub-Saharan Africa bears the greatest burden of HIV disease globally. Research to define clinical and epidemiologic predictors of treatment success is needed to guide clinicians caring for persons with HIV. In addition, implementation science can guide policy makers and program implementers on service delivery mechanisms to provide most efficient use of treatment resources and the optimal gain to the public's health.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZAI1-BB-A (M2))
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Zimand, Lori B
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Albert Einstein College of Medicine
Internal Medicine/Medicine
Schools of Medicine
United States
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Yotebieng, Marcel; Behets, Frieda; Kawende, Bienvenu et al. (2017) Continuous quality improvement interventions to improve long-term outcomes of antiretroviral therapy in women who initiated therapy during pregnancy or breastfeeding in the Democratic Republic of Congo: design of an open-label, parallel, group randomized BMC Health Serv Res 17:306
GBD 2016 DALYs and HALE Collaborators (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1260-1344
Kimmel, April D; Nash, Denis (2017) HIV prevention resources: time to move toward affordability. Lancet HIV 4:e191-e193
Semeere, Aggrey; Freeman, Esther; Wenger, Megan et al. (2017) Updating vital status by tracking in the community among patients with epidemic Kaposi sarcoma who are lost to follow-up in sub-Saharan Africa. BMC Cancer 17:611
Yotebieng, Marcel; Moracco, Kathryn E; Thirumurthy, Harsha et al. (2017) Conditional Cash Transfers Improve Retention in PMTCT Services by Mitigating the Negative Effect of Not Having Money to Come to the Clinic. J Acquir Immune Defic Syndr 74:150-157
Yotebieng, Kelly A; Fokong, Kunuwo; Yotebieng, Marcel (2017) Depression, retention in care, and uptake of PMTCT service in Kinshasa, the Democratic Republic of Congo: a prospective cohort. AIDS Care 29:285-289
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1211-1259
GBD 2016 Mortality Collaborators (2017) Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1084-1150
GBD 2016 Causes of Death Collaborators (2017) Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1151-1210
Coffie, Patrick A; Egger, Matthias; Vinikoor, Michael J et al. (2017) Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa. BMC Infect Dis 17:706

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