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In 2013, MHRP initiated a large, long-term cohort study at multiple African sites that evaluates HIV prevention and treatment services it supports through local facilities, funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The African Cohort Study (AFRICOS) —the first of its kind in sub-Saharan Africa — takes place at sites in Kenya, Nigeria, Tanzania, and Uganda. 

Study participants are drawn from health facility clinic patient populations, allowing MHRP to monitor the impact of HIV-directed health and preventive services that fall under national guidelines. 

“AFRICOS helps us capture the broader picture of the overall health of our HIV-infected patients,” said LT COL Julie Ake, M.D., the study’s lead investigator. “Researchers are gaining a better understanding of what leads to the best clinical outcomes, which in turn facilitates the sharing of best practices between sites.” 

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.

Study sites:

MHRP is enrolling volunteers at 11 HIV clinical treatment sites in four countries:

Makerere University – Walter Reed Program (MUWRP), Uganda
Kayunga District Hospital

KEMRI/MHRP Kenya (Kericho)
District Hospitals: Kericho, Kapkatet, Nandi Hills, Kapsabet Mission Hospitals: AC Litein, Tenwek 

KEMRI/MHRP Kenya (Kisumu)
Kisumu West District Hospital

MHRP Nigeria
Defence Headquarters Medical Center, Abuja
68th Nigerian Army Reference Hospital, Lagos

MHRP Tanzania, Southern Highlands
Mbeya Referral Hospital

Specifically, researchers are studying 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. 

Broad primary objective: “To longitudinally assess the impact of clinical practices, biological factors and socio-behavioral issues on HIV infection and disease progression in an African context.”

  • Evaluation tool for MHRP PEPFAR program
  • HIV pathogenesis and impact of comorbidities
  • Measurement of long term outcomes

MHRP developed a substudy mechanism that facilitates collaboration. For more information, or to inquire about collaborating on AFRICOS, please contact

Protocol Chair: LTC Julie Ake

AFRICOS Protocol