ABSTRACT One quarter of the global population is infected with the bacillus Mycobacterium tuberculosis and is at risk of developing active tuberculosis (TB) disease and death, especially persons living with HIV (PLWH). Alcohol use is increasingly being recognized as a driver of the TB epidemic, and may be a vital means to mitigate HIV/TB morbidity and mortality. TB preventive therapy (TPT) is an important approach in preventing the progression of latent TB infection to active TB disease. However, TPT does not prevent new or repeat TB infection, thus PLWH who drink alcohol may remain at increased risk for TB acquisition, even after receipt of TPT. Heavy alcohol use is common among persons living with HIV (PLWH). While the increased risk for active TB is attributed to alcohol-related immunosuppression leading to latent TB re-activation, the role of alcohol use in acquiring new or repeat TB infection and progression to active TB disease after TPT has not been extensively examined, including among PLWH. Those who complete TB treatment have extensive post-TB morbidity and almost a 4-fold higher risk of mortality. The role of both heavy alcohol use and HIV in promoting lung disease after TB treatment is not clear. The central goal of the International Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Center is to examine the role of alcohol use on new TB acquisition, occurrence of active TB disease after TPT, and post-TB lung disease among PLWH. This new knowledge will enable future development of interventions that can reduce alcohol’s impact on TB- related morbidity and mortality among PLWH. The Center will be comprised of 4 components (Administrative Core, Biostatistics and Data Management [BDM] Core, Uganda Project, Russia Project) that will work synergistically to accomplish the following primary objectives: 1) Examine the role of alcohol use in driving the acquisition of new TB infection and the occurrence of active TB disease after TPT in PLWH in Uganda (Uganda Project). This new knowledge will inform potential new interventions to reduce risk of TB acquisition and active disease; 2) Determine the relationship between alcohol use and lung disease after treatment for active TB disease among PLWH and qualitatively evaluate factors to tailor alcohol and smoking interventions in the setting of TB treatment in PLWH (Russia Project); 3) Conduct high quality data management and statistical analyses for HIV/alcohol research (BDM Core); 4) Foster multidisciplinary international collaborations to promote innovative and rigorous HIV/alcohol research (Administrative Core); and 5) Provide ongoing training and mentoring to develop junior and mid-career investigators into future leaders in HIV/alcohol research (Administrative Core). The structure of the International URBAN ARCH Center will ensure effective administrative and scientific integration of a broad range of activities designed to synergistically grow the field of HIV/alcohol/TB prevention and treatment.

NARRATIVE The International Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Center will generate new generalizable knowledge about the complex relationship between TB, HIV, and alcohol use in order to accelerate the future development of interventions that can reduce alcohol’s impact on TB-related morbidity and mortality among PLWH.