International Mentored Scientist Award

In sub-Saharan Africa (SSA) sub-optimal care engagement among youth living with HIV (YLWH) aged 15 – 24 years presents a challenge for the control of the HIV epidemic. Mobility is a chief contributor to the lags in the last two 90 of the 90-90-90 UNAIDS target in SSA- home to the largest intra-continental movement of people, largest youth population, and the highest burden of HIV/AIDS. The majority of YLWH in SSA access care within systems largely designed for adult and stable populations; service provision fails to meet their unique needs, leading to lapses in care and non-adherence.

Although antiretroviral therapy (ART) has been established as a highly successful HIV prevention tool and despite international calls to prioritize programs that will ensure HIV diagnosis, ART prescription, and viral suppression,1 only a small number of programs to improve ART uptake, retention in care, and adherence to medication have been successfully integrated into health systems.

Current antiviral regimens for HIV have been highly successful in limiting viral HIV replication and reducing viral loads to undetectable levels in most patients. However, these antiviral drug regimens do not cure the infection because HIV is able to establish a latent reservoir within memory CD4 cells that are not attacked by combined anti-retroviral therapy (cART).

Background: More than 40% of all new HIV infections are among adolescents and of these nearly two-thirds occur in adolescent girls and young women (AGYW) living in sub-Saharan Africa. Food insecurity, poverty and parental HIV/AIDS have been identified as important drivers of HIV risk and vulnerability among AGYW. Household level interventions that target poverty and food insecurity offer many advantages over individual centered approaches by reducing AGYW sexual risk taking and improving psychosocial wellbeing.

Poor retention in HIV care programs is an obstacle in achieving the last two 90s in UNAIDS' 90-90-90 targets and end HIV by 2030. Peer support represents a potentially widely generalizable and cost effective strategy to enhance engagement in HIV care, but to date, a wide variety of peer-based interventions exist and the most effective specific use of peers is not well understood.

Therapeutic drug monitoring (TDM) of antiretroviral drugs has optimized treatment of HIV-infected patients in resource-rich countries especially in selected ‘difficult to treat’ situations (1). The measurement of drug levels in serum samples enables timely diagnosis of low drug levels, which put patients at risk of developing treatment failure, as well as too high levels which foster toxicity of the drugs.

There is an urgent global goal to eliminate new HIV infections among children by 2015 and to keep their mothers alive, with the targets of providing antiretroviral therapy to all HIV-infected pregnant women and children. Yet, barely a year away from the 2015 deadline, HIV programs are far from reaching these targets. A substantial proportion of HIV-positive pregnant women in sub-Saharan Africa are lost to follow-up after delivery.

Bacterial vaginosis (BV), a disruption of the normal vaginal flora, has recently been associated with a greater than 3-fold increased risk of female-to-male HIV-1 transmission in a manner not accounted for by plasma HIV-1 RNA load(1). We hypothesize that compared to cervicovaginal fluid (CVF) from healthy individuals, BV CVF induces an elevated pro-inflammatory and pro-chemotactic response in cells of the foreskin which may facilitate transmission.

Trichomoniasis, caused by the protozoan parasite, Trichomonas vaginalis (TV), is the most common, curable sexually transmitted infection worldwide with a particularly high prevalence of up to 35% among women in Sub-Saharan Africa (SSA). This region of the world is also home to almost 70% of new human immunodeficiency virus (HIV) infections occurring worldwide and most of these infections occur in women. Recent studies showed that TV infection in African women is associated with a 1.5 ? 2.7-fold increased risk for HIV infection.

Protection of operating theatre personnel from bloodborne pathogens has been neglected in Uganda. Nature, frequency, risk factors, and preventive measures for perioperative exposure of theatre personnel will be identified by conducting a 6 month cross-sectional study in Mulago Hospital, Uganda. Multiple logistic regression will analyze risk factors for exposure. Case exposure rate and cumulative risk of seroconversion of HIV will be calculated. Surveys of theatre personnel will assess knowledge, attitude, and practice for risks of perioperative bloodborne infections.