Atlanta, due to the large size of its HIV epidemic, will serve as the ideal site to recruit HIV-infected and at-risk women who are representative of the Southern epidemic into the Women's Interagency Health Study (WIHS). Inclusion of Atlanta will expand the WIHS research expertise and agenda to include areas for which the Emory faculty are leading experts nationally. The potential of an Emory CRS is evident from the experience and excellent track record in the accrual of hundreds of women into HIV research including the DAIDS supported networks (ACTG, HPTN, HVTN) trials, and from the availability of state-of-the-art research capacity relevant to women's health (colposcopy, DXA and fMRI, carotid intima ultrasound, cardiac CT, local specimen repository, etc.). The size of our HIV clinical activities, which include 7,921 patients (22% women), 950 whom are newly diagnosed and antiretroviral treatment naive, offers a unique opportunity to diversify the WIHS cohort. Through long-standing collaboration between Emory investigators, county health departments, and community based organizations in the state, the Emory WIHS CRS will attract eligible subjects from rural Georgia and from the hard-to-reach communities to better characterize the changing demographics of the epidemic in the South. Innovative approaches guided by principles aligned with community-based participatory research will be employed to recruit, link, and retain women in the WIHS cohort. The overarching focus of the Emory WIHS application is "HIV/AIDS secondary prevention for women through immunological, clinical, pharmacological, epidemiological and behavioral research." Our vision is to make major contributions in effective behavioral and clinical interventions, and explore immunologic, epidemiological and pharmacological activities confronting women living with HIV. This vision is operationalized in our multisite research proposal "The Emory SWEET Trial," an innovative implementable smartphone intervention designed to enhance antiretroviral adherence, promote harm reduction, reduce STDs incidence, and improve overall clinical and biomedical outcomes among HIV-infected and at-risk women. The site-specific projects engage the expertise of leading scientists at Emory to explore using the local WIHS cohort, the intracellular pharmacokinetics of commonly used antiretroviral drugs in HAART and PrEP, define the dyadic features that impact the lives of women living with HIV through couple voluntary counseling and HIV testing, and examine B cell subsets, PD- 1 expression, and serologic memory in peripheral blood and the female genital tract of HIV-infected women, to better characterize the impact of HIV infection on genital mucosal immunity.
The purpose of this proposal is primarily to demonstrate the capability of an Emory WIHS CRS to recruit and retain a diverse cohort of eligible women representative of the local epidemic in the state of Georgia into the WIHS cohort. A capability that is evidenced by our experience and track record of success in the accrual of hundreds of women into HIV research, availability of research resources and expertise in women's health, and access to a large and diverse pool of infected and at risk women. Secondarily, to develop a WIHS research at Emory that is innovative, responsive to the local and national epidemic, and encourages cross discipline translational research in women's health and HIV/AIDS.
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