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; Thirumurthy, Harsha; Moracco, Kathryn E et al. (2016) Conditional Cash Transfers to Increase Retention in PMTCT Care, Antiretroviral Adherence, and Postpartum Virological Suppression: A Randomized Controlled Trial. J Acquir Immune Defic Syndr 72 Suppl 2:S124-9
Hu, Yirui; Hoover, Donald R (2016) Non-randomized and randomized stepped-wedge designs using an orthogonalized least squares framework. Stat Methods Med Res :
Yotebieng, Marcel; Tabala, Martine; Batumbula, Marie Louise et al. (2016) Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo. Tuberc Res Treat 2016:1027570
Yotebieng, Marcel; Thirumurthy, Harsha; Moracco, Kathryn E et al. (2016) Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: a randomised controlled trial. Lancet HIV 3:e85-93
Freeman, Esther; Semeere, Aggrey; Wenger, Megan et al. (2015) Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa. BMC Cancer 16:65
Mutimura, Eugene; Hoover, Donald R; Shi, Qiuhu et al. (2015) Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women: a longitudinal analysis. PLoS One 10:e0123936
Mutimura, Eugene; Addison, Diane; Anastos, Kathryn et al. (2015) Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda. AIDS 29:67-76
Sinayobye, Jean d'Amour; Hoover, Donald R; Shi, Qiuhu et al. (2015) Prevalence of shingles and its association with PTSD among HIV-infected women in Rwanda. BMJ Open 5:e005506
Dusingize, Jean Claude; Hoover, Donald R; Shi, Qiuhu et al. (2015) Association of Abnormal Liver Function Parameters with HIV Serostatus and CD4 Count in Antiretroviral-Naive Rwandan Women. AIDS Res Hum Retroviruses 31:723-30
Yotebieng, Marcel; Meyers, Tammy; Behets, Frieda et al. (2015) Age-specific and sex-specific weight gain norms to monitor antiretroviral therapy in children in low-income and middle-income countries. AIDS 29:101-9

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