DESCRIPTION (provided by applicant): The promise of antiretroviral therapy (ART) to provide renewed health is now being realized for millions of Africans. As HIV care and treatment programs are implemented throughout Africa, careful monitoring of their effectiveness is of crucial importance, so that care and treatment resources can be deployed to optimal benefit. Immunologic and clinical responses to ART, retention in care, and behavioral components (e.g., treatment adherence) need to be elucidated and predictors of survival defined. The impact of HIV and ART on cancers in Africa is essentially undescribed, and interactions with major ambient co-morbidities such as malaria are poorly understood. We propose a new Central Africa leDEA (CA-leDEA), designed to optimize and augment scientific productivity and rapid, high-impact publications; we will 1.) Compile and manage secondary source patient-level data on a large volume of patients through a.) extraction from existing electronic data, or b.) new on-the-ground systems for efficient capture of clinical data in low-resource clinical settings; 2.) Develop a creative and flexible scientific process that fosters high throughput of many analyses of data to answer epidemiologic, operational and other HIV-related research questions, culminating in high- impact publications; and 3.) Develop capacity for independent research, data management, analysis and publication in each of the Central African countries over five to ten years, ensuring the sustainability of CA-leDEA. Our team brings a long history in the region of research productivity and operational success, as well as innovative IT development to support research, with complementary skills and experience to optimize the activities of CA-leDEA. Four of our partners are the implementers of HIV care services (i.e., the governments) and the fifth partner, WE-ACTx Rwanda, brings patient volume, research experience and special resources to investigate AIDS malignancies. We will develop an administrative and data management infrastructure that supports the implementation of epidemiologic and implementation science to answer key questions in HIV care and treatment in lower-resource settings, with integrated research teams in the US, Cameroon and Rwanda.

Sub-Saharan Africa bears the greatest burden of HIV disease globally. Research to define clinical and epidemiologic predictors of treatment success is needed to guide clinicians caring for persons with HIV. In addition, implementation science can guide policy makers and program implementers on service delivery mechanisms to provide most efficient use of treatment resources and the optimal gain to the public's health.