PROJECT SUMMARY/ABSTRACT The Asia-Pacific region has struggled to keep up with global efforts to end AIDS as a public health threat by 2030. Only 60% of the 5.8 million people living with HIV (PLHIV) in the region are on antiretroviral therapy. In addition, with high burdens of chronic hepatitis B and C and tuberculosis, and the emergence of COVID-19, there is increasing local competition for limited health resources. In order to achieve long-lasting health gains for Asia-Pacific PLHIV and move us closer to ending AIDS in the region, data-driven public health approaches are needed that efficiently integrate clinical care and research across diseases, and target communities at greatest risk of the poorest outcomes. Working with a network of over 50 clinical centers in 13 countries, the IeDEA ASIA-PACIFIC RESEARCH COLLABORATION will implement a cross-cutting research portfolio of innovative studies on the quality and durability of HIV treatment and prevention efforts, as well as on co-infections and co-morbidities. The primary aims are: 1) to understand what it will take to end AIDS in the Asia-Pacific; 2) to characterize what is stopping PLHIV in the region from thriving with HIV over a lifetime; and 3) to improve implementation approaches to prevention and treatment interventions for HIV and related conditions. The secondary aims are: 1) to more efficiently collect and curate data to optimize research and maximize data utilization; and 2) to secure the next generation of Asia-Pacific HIV researchers through training and mentorship. The proposed research will inform clinical practice and public health policy through a combination of national, regional, and multiregional longitudinal cohort studies, registry and database linkages, and priority sub-studies. Specifically, hypothesis-driven analyses of cohort data sources and data registries will characterize HIV disease and a range of co-infections and co-morbidities in children, adolescents, and adults, and study their impact on long-term HIV treatment durability and mortality. Analyses will especially consider risks and outcomes of non-communicable diseases associated with HIV and aging. Approaches to optimizing lung and anal cancer screening will be assessed. Studies focusing on young men who have sex with men and transgender communities will characterize behaviors and co-infections that increase HIV acquisition risk. To better understand the intersections between HIV and the use of alcohol, tobacco, and other substances, cohort data collection will be expanded to capture a broader range of health measurements and exposures to support analyses of physical and mental health outcomes. Investigators will study implementation strategies for increasing uptake of, and adherence to, TB preventive therapy, mental health care, and HIV pre-exposure prophylaxis. In addition, cohort research methods will be adapted to optimize the balance between cohort size and data completeness, and improve data harmonization to facilitate cross-cohort research. Training and mentorship for early-stage investigators will help them to develop scientific questions and data analysis skills, and engage with regional and global HIV research networks.

PROJECT NARRATIVE IeDEA Asia-Pacific will study the effects of HIV, co-infections, and co-morbidities on long-term HIV treatment outcomes in order to inform clinical practice and public health policy in the region. Research also will assess strategies to improve HIV-related treatment and prevention service delivery for high-risk and vulnerable populations. Data from the research program will guide efforts to achieve and sustain long-lasting health gains for people living with and at risk of HIV in the Asia-Pacific.