Although the life expectancy of HIV-infected individuals increases with effective antiretroviral therapy (ART) use, they remain at higher risk of multi-morbidity and mortality than the general HIV-uninfected population. Long-term ART-related toxicity, persistent inflammation, and lifestyle have been hypothesized as mechanisms for non-AIDS defined conditions such as cardiovascular disease (CVD), chronic kidney diseases (CKD), and neuropsychiatric disease (NPD), which are increasing in frequency with the aging of the HIV-infected population. Very little research has been conducted to quantify the burden of these three HIV-comorbidities or to design and evaluate the effectiveness and cost-effectiveness of preventive and treatment strategies in sub-Saharan Africa. Moreover, South Africa, the country with the highest burden of HIV globally, unfortunately has a paucity of qualified investigators to effect change in these HIV-comorbidities. The overall objective of the University of Pittsburgh HIV-comorbidities Research Training Program in South Africa (Pitt-HRTP-SA) is to build a critical mass of the next generation of basic, translational, clinical, and public health researchers at Stellenbosch University in Cape Town, to conduct high-quality research, generate new knowledge, improve outcomes, and become successful, independent investigators. The specific aims are: 1) To gain research methodology, ethics, leadership and management skills; 2) To conduct mentored HIV-CVD, CKD, and NPD research that address new, locally relevant questions and test meaningful hypotheses; 3) To become proficient in scientific presentations and writing, grantsmanship, research ethics and management; 4) To evaluate the outcomes of the program and make adjustments as needed and acquire skills to translate research findings into clinical practice and public health policies. We will achieve these aims using an innovative North-South and South- South triangular mentoring model. Each trainee will have one South African core mentor (affiliated with SU or University of Cape Town) and one US co-mentor (University of Pittsburgh; Johns Hopkins University; Harvard University; University of California, San Francisco; University of California, Los Angeles), short- term training experience at one of the collaborating US institutions. The strategies utilized to build and enhance research capacity will include: didactic coursework (Masters and/or PhD), mentored high-caliber research, experiential learning, pilot research grants, workshops, seminars, journal clubs, scientific writing retreats, and Pitt-HRTP-SA website resources. A Steering Committee, after consultation with an independent Training Advisory Committee, will approve the recruitment, research, monitoring, and evaluation of twelve highly competitive trainees, each of whom will be provided a seed research grant and up to 50% of protected research time up to 5 years. Each trainee will have an individualized career development plan that will be monitored and tracked throughout their tenure and after completion of the program.

Clinical research career tracks are lacking at many universities in sub-Saharan Africa. Pitt-HRTP-SA aims to build career opportunities for promising junior South African faculties and postdocs to prevent the “brain drain” and increase the number and quality of the next generation of independent investigators focused on 3 HIV-comorbidities (Cardiovascular, Chronic Kidney Disease and Neuropsychiatry) in South Africa; taking advantage of the combined outstanding intellectual resources and research infrastructures at Stellenbosch University and collaborating institutions. Given the limited expertise in these 3 NIH priority selected priority areas, we anticipate that this program will fill have a high impact by filling an important expertise gap and ultimately contribute further to decreasing morbidity, mortality and societal costs associated with these major emerging health threats as HIV become a chronic disease in the successful ART era.