Program Director/Principal Investigator (Anastos, Kathryn Nash Denis): Project Summary Elimination of HIV infection as a cause of human illness and death, and achieving zero HIV transmission have been embraced by the AIDS research and treatment communities as achievable. As HIV care and treatment programs are implemented throughout Africa, critical advances in research and policy are needed, so that care and treatment resources can be deployed to optimal benefit: decreasing both new HIV transmissions and HIV-related morbidity and mortality. Among the most important challenges to maximizing the public health benefits of HIV care and treatment programs are late diagnosis of HIV-infection, low rates of linkage to care, and high rates of late ART initiation which in turn are associated with high rates of mortality, more costly clinical management and continued HIV transmission. In addition there remain unanswered clinical questions for persons living with HIV (PLWH) even with optimal ART. For PLWH in SubSaharan Africa (SSA), ART has been highly effective in decreasing HIV-related morbidity (and mortality), but the association of HIV with metabolic diseases and other conditions of aging (e.g. cancers), and the impact of under- or over-nutrition are not well defined. Newly funded as CA-IeDEA four years ago, we have built a new Central Africa IeDEA (CA- IeDEA), and have 1.) Compiled and managed secondary source patient-level data on ~52,000 patients through both extraction from existing electronic data and new on-the-ground systems for efficient capture of clinical data in low-resource clinical settings; 2.) Been highly productive scientifically with >20 publications even while data collection was in development, and 3.) have continued to foster African leadership and build local research capacity. We propose now to increase the database modestly (to ~80,000 patients) to increase the representativeness of HIV in the region geographically and in service delivery strategies and success and to expand our implementation science approaches to optimize short- and long-term HIV care outcomes both in Central Africa and globally, continue to investigate epidemiologic questions with clinical impact, with a focus on the comorbidities of aging and women's reproductive health. OMB No. 0925-0001/0002 (Rev. 08/12 Approved Through 8/31/2015) Page Continuation Format Page

Public Health Relevance

Anastos, Kathryn, Mary Project Narrative Sub-Saharan Africa bears the greatest burden of HIV disease globally. Research to define the most effective service delivery strategies is key to decreasing HIV as a cause of illness and death. Such research is critical to guide policy makers and program implementers on service delivery mechanisms to provide most efficient use of treatment resoures and the optimal gain to the public's health. OMB No. 0925-0001/0002 (Rev. 08/12 Approved Through 8/31/2015) Page Continuation Format Page

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01AI096299-11S1
Application #
10086223
Study Section
Program Officer
Zimand, Lori B
Project Start
2011-07-15
Project End
2021-06-30
Budget Start
2020-03-01
Budget End
2020-06-30
Support Year
11
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Albert Einstein College of Medicine
Department
Type
DUNS #
081266487
City
Bronx
State
NY
Country
United States
Zip Code
10461
Kimmel, April D; Bono, Rose S; Keiser, Olivia et al. (2018) Mathematical modelling to inform 'treat all' implementation in sub-Saharan Africa: a scoping review. J Virus Erad 4:47-54
Yumo, Habakkuk Azinyui; Kuaban, Christopher; Ajeh, Rogers Awoh et al. (2018) Active case finding: comparison of the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated-testing and counseling of HIV among children and adolescents in Cameroon. BMC Pediatr 18:309
Vreeman, Rachel C; Ayaya, Samuel O; Musick, Beverly S et al. (2018) Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa. PLoS One 13:e0191848
Parcesepe, Angela M; Mugglin, Catrina; Nalugoda, Fred et al. (2018) Screening and management of mental health and substance use disorders in HIV treatment settings in low- and middle-income countries within the global IeDEA consortium. J Int AIDS Soc 21:e25101
Bailey, Stephanie L; Bono, Rose S; Nash, Denis et al. (2018) Implementing parallel spreadsheet models for health policy decisions: The impact of unintentional errors on model projections. PLoS One 13:e0194916
Hu, Yirui; Hoover, Donald R (2018) Non-randomized and randomized stepped-wedge designs using an orthogonalized least squares framework. Stat Methods Med Res 27:1202-1218
Wandeler, Gilles; Coffie, Patrick A; Kuniholm, Mark H et al. (2018) Issues with measuring hepatitis prevalence in resource-limited settings. Lancet 391:835-836
Ross, Jonathan; Edmonds, Andrew; Hoover, Donald R et al. (2018) Association between pregnancy at enrollment into HIV care and loss to care among women in the Democratic Republic of Congo, 2006-2013. PLoS One 13:e0195231
IeDEA and COHERE Cohort Collaborations (2018) Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs. Clin Infect Dis 66:893-903
Haas, Andreas D; Zaniewski, Elizabeth; Anderegg, Nanina et al. (2018) Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes. J Int AIDS Soc 21:

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