Researchers at Albert Einstein College of Medicine and the City University of New York Graduate School of Public Health and Health Policy (CUNYSPH) have been awarded a five-year, $14.5 million grant from the National Institutes of Health (NIH) to continue leading and expand their research on HIV treatment and care in five Central African nations.

The new award builds on previous NIH-funded work by the Central Africa International epidemiology Databases to Evaluate AIDS (CA-IeDEA), a large-scale study involving more than forty researchers and tens of thousands of patients living with HIV/AIDS in Burundi, Cameroon, the Democratic Republic of Congo, the Republic of Congo, and Rwanda. The effort began more than a decade ago and has been co-led by Kathryn Anastos, M.D., professor of medicine, of epidemiology & public health, of obstetrics & gynecology and women's health at Einstein, co-director emerita of the Global Health Center, and an internist at Montefiore Health System.

CA-IeDEA is one of seven regional centers that belong to a larger global research consortium, the International epidemiology Databases to Evaluate AIDS (IeDEA). The IeDEA teams consolidate and analyze vast amounts of health data so that researchers can study high-priority questions on HIV treatment and care. CA-IeDEA focuses on determining successful strategies that lead to improved outcomes for people living with HIV. These approaches include: timely diagnosis and enrollment into care; engaging and keeping patients in care; and rapid initiation of antiretroviral therapy (ART) to reduce the risk of death and further transmission of the virus.

More than 86,000 people have enrolled in CA-IeDEA at participating sites in the five countries since the program was launched in 2006. There are nearly 40,000 people currently receiving HIV care at 21 CA-IeDEA sites. The five countries that comprise the center are among those with the greatest burden of HIV infection in the world.

In addition to Dr. Anastos, the two other principal investigators on the new CA-IeDEA grant are Marcel Yotebieng, M.D., Ph.D., M.P.H. associate professor of medicine at Einstein, and Denis Nash, Ph.D., M.P.H., distinguished professor of epidemiology and executive director of the Institute for Implementation Science in Population Health (ISPH) at CUNY SPH.

Combating HIV/AIDS in Central Africa

The grant will provide continued support for CA-IeDEA's existing projects and fund three new initiatives: the collection of data on cardiovascular and other noncommunicable diseases to understand how these conditions affect older African adults living with HIV; a research program for adolescents living with HIV, including those who were infected around the time of birth; and studies of people co-infected with tuberculosis that will measure lung function impairment and risk of recurrence after successful treatment.

This new award will allow us to expand our clinical reach and research focus, enrolling more children and adults with HIV/AIDS who visit health clinics in urban and rural areas in our five partner countries. Our overall goal is to increase access to HIV services and improve outcomes for patients, including not only successful initiation of ART, but also diagnosis and treatment of metabolic and cardiovascular diseases."

Dr. Kathryn Anastos, M.D., professor of medicine, of epidemiology & public health, of obstetrics & gynecology and women's health at Einstein

Researchers will share anonymized data sets with public health experts and non-governmental organizations such as the World Health Organization (WHO). "Larger samples from a variety of patients can help us understand critical questions," said Dr. Yotebieng. "For example, what are the experiences of adolescents living with AIDS, how do they transition to adult care, and how can they benefit more from treatments? A major aim we have is leveraging implementation science approaches-;looking at ways services are delivered, what gaps exist, and how to close them."

Mentoring researchers

A key part of the grant supports training local scientists and building capacity to sustain research initiatives. "In any country, it takes decades to 'grow' a new community of researchers, and it requires an infrastructure that can nurture them," said Dr. Anastos. "We're putting in place a system to mentor and provide statistical and study design assistance to junior investigators in Africa, so they can ask and answer the questions they want to tackle."

Multiregional research

Dr. Nash will lead the team's involvement in multiregional research that includes assessing the varying success rates of antiretroviral therapy across the seven IeDEA regions. This has included CA-IeDEA's leadership in assessing "Treat All," the 2015 World Health Organization guidelines to treat all individuals upon diagnosis of HIV regardless of CD4 cell count, as well as the development of IeDEA's consensus statement on research priorities to optimize the guideline's impact on people living with HIV.

The CA-IeDEA team is also seeking additional funding to examine the influence of climate change on HIV care and outcomes among the more than 2 million patients who have enrolled at IeDEA-participating sites in 44 countries since 2004. The team will compare data on global temperature and rainfall with that from IeDEA to determine the effect of extreme weather, if any, on patients. "National governments, normative bodies, and global funders, including WHO, UNAIDS, and PEPFAR, have not adequately factored climate-related data into short- and long-term planning, largely because studies like the one we are planning have not been done," said Dr. Nash.