International Mentored Scientist Award

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.

In human immunodeficiency virus type 1 (HIV-1)-infected patients treated with combination antiretroviral therapy (cART), the persistence of latent viral reservoirs remains the major barrier to virus eradication1. The molecular mechanisms that govern HIV-1 latency at the transcriptional level are not well characterized, but a key player is the HIV-1 Transactivator of transcription (Tat) protein, which promotes viral gene transcription. The sequence of Tat can vary within and between viral subtypes2,3, and this has been shown to translate into differential Tat activity4,5.

In Uganda, children below 18 years of age have been estimated to be 55% of the Uganda population. Many women who engage in high risk sexual behaviour (WHR) for money and commodities are mothers and they have to manage childcare and their maternal identity at the same time as sex work. One of their most significant challenges is supporting their children emotionally, financially and developmentally. Children of WHR are seldom talked about in discussions around key populations, yet they are as equally affected as their mothers.

The high risk of transfusion-transmitted HIV infection is partially due to inadequate deferral of potential blood donors because of inappropriate risk behavior questionnaires. This is unfortunate because pre-donation medical screening is the least expensive and one of the most effective strategies for the blood-borne HIV infection in limited resources countries.

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.