International Mentored Scientist Award

In Uganda, people living with HIV(PLWH) are growing into old age owing to increased access to antiretroviral therapy. Despite this success, living with HIV has been associated with a substantial burden of non-communicable diseases like diabetes mellitus, hypertension, and they are particularly three times likely to get chronic kidney disease (CKD) than the HIV-negative population.

Despite increasing access to rapid, accurate tuberculosis (TB) diagnostics, 37% (2.5 million) of global TB notifications in 2022 were clinically diagnosed (i.e., lacking bacteriological confirmation). A key challenge in accurately diagnosing TB without bacteriological confirmation is that the clinical and radiological presentation of TB often mimics other conditions.

Sub-Saharan Africa (SSA) continues to be the region with the highest burden of HIV with over 69% of people living with HIV residing in the continent. Kenya is among the top four countries with high HIV burden. Key populations, which includes sexual and gender minorities accounting for the highest HIV prevalence in Kenya compared to the general population.

Despite steady improvements over time, TB treatment success rate remains lower among HIV-coinfected patients (77%) compared to 86% of the general TB population globally. Successful treatment of TB in HIV co-infected individuals is limited by varying levels of immunosuppression, drug-drug interactions, increased pill burden, in addition to a poor quality of life in the psychological domain.

Despite catastrophic predictions of the impact of the COVID-19 pandemic in Sub-Saharan Africa, SARS-CoV-2 transmission levels unexpectedly appeared to remain low across several variant waves. However, recent evidence from several African countries has demonstrated that as much as 50-80% of individuals have been infected with SARS-COV-2. Such persons are at risk for post-acute sequelae of COVID-19 (PASC, e.g., “Long COVID”), which may contribute to a decreased quality of life and productivity.

Adolescents represent a growing share of people living with HIV in sub-Saharan Africa (SSA), yet they have lower engagement in care, poor adherence to medication and viral suppression (VS) compared to adults. We postulate that to achieve optimal adherence, interventions that are tailored to the dynamic social and cognitive needs of adolescents as they pass through life-stages need to be culturally adapted and promoted. Mindfulness and acceptance based interventions are slowly gaining traction as appropriate for adolescents.

People with HIV (PWH) in sub- Saharan Africa are living longer due to increased access to anti-retroviral therapy (ART). Nevertheless, there are high rates of age-related complications in adults with HIV partly due to persistent low-grade chronic inflammation. HIV is associated with premature onset of frailty, which occurs earlier and more frequently than in people without HIV. There is a paucity of published data on frailty in sub-Saharan Africa among persons with HIV, with studies reporting a wide range of prevalence estimates and few have focused on older adults.

One-third of women who initiate or continue antiretroviral treatment (ART) during pregnancy are lost to follow up with in six months [1, 2]. ART tablets and pill containers a potential for HIV status disclosure and stigma [1-4] which has stimulated interest in alternate modes of administration including long-acting injections [3, 5] Willingness to use injectable antiretroviral therapy (ART) among women in prevention of mother-to-child transmission (PMTCT) programs in Uganda is unknown.

There has been improved survival of HIV patients globally and very importantly in sub-Saharan Africa where the HIV incidence and prevalence is notably high. This could be attributed to the scale up of anti-retroviral therapy (ART) programs and improved ART efficacy and tolerability over time. With aging and cumulative side effects of ART, the burden of non-communicable diseases (NCDs) in people living with HIV (PLHIV) has been on the rise.

The overall objective of the parent study led by PIH is to evaluate the impact of a comprehensive primary care health systems strengthening intervention in Kono District, Sierra Leone. PIH’s evaluation compares 4 intervention with 7 non-intervention clinics in Kono District. The PIH intervention is a health-systems strengthening intervention that will horizontally integrate clinical and related services in a highly vertical donor-driven system; this includes infrastructure, mentorship, training, and supply chain management.