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Large Multinational HIV Cohort Study Begins in Africa

February 25, 2013
MHRP initiated a large, long-term cohort study at multiple African sites that will evaluate HIV prevention care and treatment services it supports through local facilities.

The U.S. Military HIV Research Program (MHRP) has initiated a large, long-term cohort study at multiple African sites that will evaluate HIV prevention, care and treatment services it supports through local facilities, funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Named the African Cohort Study (AFRICOS), the study—the first of its kind in sub-Saharan Africa—is taking place at sites in Kenya, Nigeria, Tanzania, and Uganda.

Study participants will be drawn from health facility clinic patient populations, allowing MHRP to monitor the impact of HIV-directed health and preventive services falling under national guidelines. “AFRICOS will help us capture the broader picture of the overall health of our HIV-infected patients,” said Maj. Julie Ake, M.D., the study’s lead investigator. “Researchers will gain a better understanding of what leads to the best clinical outcomes, which will facilitate the sharing of best practices between sites,” said Ake. 

AFRICOS will recruit 3,600 volunteers, including 3,000 HIV-infected and 600 HIV-uninfected individuals. The 15-year study is designed to collect retrospective data at enrollment, and participants will then be followed prospectively every six months.

Specifically, researchers will look at current national treatment regimens and long-term outcomes such as time to progression to AIDS and mortality. They also will evaluate comprehensive demographics, social and behavioral risk factors and aspects of adherence. Another critical component is the collection of data regarding co-infections such as malaria and tuberculosis, as well as non-infectious co-morbidities such as cognitive decline and cardiovascular complications. 

Data from existing HIV cohort studies in the U.S. and Europe have made many important contributions to our understanding of HIV and disease progression. However, these studies are conducted in resource-rich settings featuring clade B predominant infections. “Africa has more diverse sub-types including A, C, D, G and co-infections that are very different,” said Keith Crawford, R.Ph., Ph.D., Assistant Chief of Public Health Research at MHRP. “We’re going to gain information that has broad utility across the African continent on how to provide the best possible care in the context of limited resources and a number of obstacles such as stigma and accessibility that complicate our care.”

MHRP currently conducts HIV cohort and vaccine studies at or near the participating sites, which will support this study. According to Ake, “we can leverage existing research expertise and laboratory capacity to perform high quality evaluation in the care and treatment setting.”