Project Summary/Abstract: Our primary goal continues to be the provision of answers to questions that clinicians, governments, programs and international organizations consider central to the evolution and sustainability of their long term HIV care and treatment strategies for achieving the UNAIDS 2030 targets of 95-95-95 in the midst of the SARS-CoV-2 pandemic and changes in public health funding priorities. Our central hypothesis is that retention in the HIV care cascade and treatment outcomes are influenced by patient-level demographic, clinical, developmental, and behavioral factors, as well as, factors within the ambient health care and broader contextual environment. We will leverage our strengths, including robust working relationships with HIV treatment programs, a substantial harmonized regional database, plus broad experience in sampling-based methodologies and novel analytical approaches. Over the course of this research we will: SA-1: Describe movement through the HIV care cascade with a focus on identifying broader and health care environment contextual factors that influence optimal retention in care and viral suppression, in the face of global disruption due to the COVID-19 pandemic and changes in donor funding priorities. The Post COVID-19 Double-Sampling Cohort (Post COVID) will address the impact of broader contextual factors (COVID-19) while the Telehealth and Structural Adaptations project will address the impact of health care structure. SA-2: Examine the impact of developmental stage and behavioral factors on retention in the cascade and subsequent outcomes. The multiregional Adolescent and Young Adult Network of IeDEA (AYANI) and regional Measuring Adverse Pregnancy and Newborn Congenital Outcomes (MANGO) cohorts will assess the impact of developmental stage on the cascade, while the Syndemics cohort will address the impact of mental health on the cascade.SA- 3: Examine the immediate and long-term outcomes of people diagnosed with Tuberculosis (TB) with a focus on identifying and addressing factors associated with patient outcomes. The multiregional TB Sentinel Research Network (TB-SRN) will focus on understanding TB outcomes and long-term pulmonary complications including associated factors. SA-4: Explore the use of new technologies, including eHealth and machine (deep) learning to diagnose and manage HIV-associated cancers with a focus on Kaposi’s Sarcoma (KS) and Cervical Cancer. The KS Project will assess implementation of a Dermatology Telehealth Program and the Cervical Cancer Project will assess the implementation of cervical image capture with machine learning for cancer diagnoses and management. SA-5: Examine the epidemiology of NCD comorbidities and ART complications with a focus on the oldest and youngest-age groups affected by HIV. The multi-regional Sentinel Research Network (SRN) will address non-communicable diseases in people living with HIV (PLHIV) > 40 years and the regional MANGO Cohort will address complications of ART/HIV exposure on HIV-Exposed Infants.

Project Narrative: Through our efforts, we will enhance our understanding of the HIV care cascades and the outcomes of care in East Africa, provide insights on the optimal structure and impact of care and treatment programs, expand the set of tools available to inform implementation and operations research in resource-constrained settings and inform policy among stakeholders and decision makers at every level in the region as well as the broader HIV/AIDS scientific community.