Following the expansion of treatment eligibility criteria and the news WHO guidelines on viral load use for follow-up of PLHIV and on introduction to DTG in HIV treatment, WA-IeDEA investigators have been leading research initiatives aiming to adress new treatment outcomes as well as to explore barriers associated with the continuum of HIV care in PLHIV, from HIV testing to retention in care and viral suppression, throughout West Africa in this context.

Current priorities for this research stream include :

• Documenting the effective access to viral load in routine follow-up of PLHIV in IeDEA WA participating clinics.
• Documenting the effective access and the switch to DTG containing regimen in IeDEA West Africa participating clinics and assessing its impact on treatment outcomes in PLHIV, including body weight changes over time, virologic failure and attrition.
• Studying the continuum of HIV care including retention in care and viral suppression :
  • To describe individual and structural barriers associated with the continuum of HIV care, from HIV testing to retention in care and viral suppression throughout West Africa
  • To assess the impact of the WHO latest recommendations related to differentiated dispensing of ARVs and viral load measurements, on attrition, adherence to treatment and viral suppression.
  • To assess the impact of COVID-19 pandemic on treatment outcomes of PLHIV and HIV care continuum in IeDEA West Africa adult sites.
  • To assess Biological sex differences in predictors of virologic failure, time-to-switch, and retention-in-care of adults on first line and second line antiretroviral therapy in West Africa. (FIMPer’s project).

The IeDEA cancer working group in West Africa is led by researchers, clinicians and epidemiologists from the University of Bordeaux, France and Abidjan, Ivory Coast. This working group is part of a strong partnership with the national cancer control program of Côte d'Ivoire. Based on their regional importance and their link with HIV infection, the main cancers studied in this group are cervical cancer, non-Hodgkin lymphomas and liver cancers.

All the scientific productions from this group can be consulted on the following link:
https://www.ncbi.nlm.nih.gov/sites/myncbi/1T7rbicWes8AQ/collections/61683242/public/

The objectives planned for the 2021-2026 period are as follows: i) to pursue observational studies aimed at characterizing the risk factors for HIV-associated cancers. ii) Describe the continuum of cancer care and the barriers in access to diagnosis and care in the West African context iii) Conduct evaluative research focusing on cervical cancer in order to better understand the impact of new screening strategies to prevent these cancers. This research agenda is based on questions identified as priorities at a national and regional level.

On a programmatic level, our group's general objective is to contribute to improving the collection of data related to cancers and their screening at a national level in Côte d'Ivoire and also at a regional level within the participating HIV care centers affiliated to the IeDEA West Africa collaboration.

IeDEA West Africa investigators are advancing a research agenda across the region focused on the epidemiology of cognitive impairment observed in older people living with HIV (PLHIV), the epidemiology of depression and axiety in newly diagnosed patients and the screening and management of depression in PLHIV adults.

Research initiatives include:

• Assessing the prevalence and the factors associated with neurocognitive impairment in PLHIV on antiretroviral treatment and aged 50 years and above in Senegal and Cote d’Ivoire.
• Evaluating the impact of cardiovascular disease and risk factors on neurocognitive functioning in those patients in Senegal and Nigeria.
• Evaluating the prevalence and factors associated with depression and anxiety in newly diagnosed PLHIV in Senegal and Cote d’Ivoire. The impact of psychosocial determinants (social support, stigmatization, coping) is evaluated. A qualitative approach is adopted to investigate barriers to health care access.
• Evaluating feasibility and acceptability of the group interpersonal therapy to treat depression in PLHIV adults in Senegal. The therapy is conducted by trained and supervised social workers or community workers. A first study was conducted in a level 3 hospital. A second study will start in a level 1 hospital and a health care center. A qualitative approach and a cost study will be conducted.
• Evaluate the sensitivity and specificity of Patient Health Questionnaire (PHQ-9) as a screening and diagnostic tool for depression in Senegal and Côte d'Ivoire.

The IeDEA Sentinel Research Network (SRN)is a prospective observational cohort that will enroll people living with HIV (PLHIV) aged 40 years and older, in care at IeDEA sites in low-and middle-income countries. This project was initiated with additional funding provided by several NIH institutes in 2019. The SRN intends to document on non-communicable diseases such as cardiometabolic diseases, mental health, alcohol and substance use, and liver diseases within the East Africa, Central Africa, South Africa, West Africa, Asia Pacific, and South America regions. The SRN specific aims are:

• To determine the prevalence, incidence and predictors of cardio-metabolic disorders including diabetes mellitus, hypertension and dyslipidemia in PLHIV during a three-year follow-up period using standardized reporting tools
• To characterize the onset, chronicity and severity of mental health and alcohol and substance use problems among older PLHIV over time as well as their influence on the HIV care continuum
• To determine prevalence, incidence and progression over three years of liver enzyme (ALT/AST) elevation, noninvasive biomarkers of liver fibrosis (APRI, FiB-4, Fibroscan) and liver steatosis (CAP, Fatty Liver Index) as well as their associated factors

As part of the West Africa SRN site, 600 participants are planned to be recruited in Côte d'Ivoire (CMSDS-Abidjan) and Togo (EVT-Lomé). These participants will be followed over a three-year period.

Tuberculosis (TB) and HIV/AIDS are the two leading infectious causes of death worldwide (1). TB is the most common opportunistic infection among people living with HIV (PLHIV), and the leading cause of morbidity and mortality among PLHIV in low- and middle-income countries (LMICs) (2). Mycobacterium tuberculosis (MTB) is responsible for both pulmonary and extrapulmonary forms of TB. Although effective treatment regimens exist for most people with TB, these regimens can have significant toxicities and are lengthy, and cases of drug-resistant TB (DR-TB) are even more difficult to treat and cure. Following TB treatment, individuals may be at risk for post-TB lung disease (PTLD) and an increased risk of death (3-5). This disease has been defined as "evidence of a chronic respiratory abnormality, with or without symptoms, attributable at least in part to previous pulmonary tuberculosis" (6). PTLD results in varying degrees of physiological, structural, and functional impairment (7-9). Despite the significant evolution of TB treatment approaches, we are witnessing an increase in DR-TB. Thus, research is needed to better understand the outcomes of TB treatment to guide future prevention and treatment policies and practices.

Primary Objective: To evaluate pulmonary tuberculosis treatment and longer-term outcomes in HIV-positive and HIV-negative individuals.

Specific objectives

1. To collect and analyze clinical and therapeutic data from individuals treated for pulmonary tuberculosis with or without HIV co-infection, in order to improve understanding of tuberculosis prognosis and health outcomes, including quality of life and survival.
2. To evaluate the effects of HIV and antiretroviral therapy (ART) on TB symptomatology, diagnosis, response to treatment, and survival.
3. To describe post TB lung disease (PTLD), to study its association with HIV, diabetes, other chronic respiratory diseases and tobacco and alcohol use, and to measure physiological, structural and functional disorders, their impact on quality of life and survival.
4. To assess the virological efficacy of ART and its adherence in PLWH treated for TB ; to document in a subgroup of patients and health care workers their perspectives on the specific difficulties and issues related to adherence in patients co-treated for HIV and TB
5. Assess the potential diagnostic and prognosis value of new biomarkers of disease progression (severity and response to treatment) in PLWH with TB, as well as the impact of exposure to TB treatment, and to antiretrovirals in PLWH, on response to treatment for TB and HIV infection

STUDY DESIGN

• Prospective, observational, non-interventional, open to recruitment of PLWH and HIV-negative persons with Clinically diagnosed or microbiologically confirmed active pulmonary TB.
• Participants will provide clinical data for research purposes, including biological specimens at specified time points.
• Participants will be followed during the TB treatment period and for 12 months after completion of treatment.

STUDY POPULATION :

SIZE OF THE STUDY POPULATION: 2,600 participants will be included in six prospective cohorts of IeDEA and associated TB treatment centers. In West Africa, 300 patients will be included, including 100 in Côte d'Ivoire.

DURATION OF THE STUDY: 24 months.

STUDY SITES: 17 sites in 6 IeDEA regions : Asia-Pacific (3 sites), CCASAnet (5 sites), Central Africa (1 site), East Africa (2 sites), Southern Africa (4 sites), and West Africa (2 sites : Cepref in Yopougon, Abidjan and CHU Sourou Sanon in Bobodioulasso, Burkina Faso)

Background: Despite significant biomedical advancements in the prevention, diagnosis, and treatment of HIV, there were 870,000 individuals infected with HIV in sub-Saharan Africa in 2020 and 460,000 deaths due to AIDS. Understanding and addressing the persistent sociobehavioral and structural barriers to HIV testing and treatment is critical to strengthening the HIV care cascade and ending the HIV epidemic.

Approach: We will utilize mixed methods approaches to develop an in-depth understanding of the sociobehavioral and structural factors that impact the HIV care cascade in West Africa. A subset of individuals enrolled in our ongoing prospective cohorts in Côte D’Ivoire, Senegal, Nigeria, Burkina Faso, and Benin will participate in in-depth, semi-structured interviews. Interviews will explore social, cultural, and structural barriers to testing and treatment, experiences with adherence and retention, coping strategies, perceptions of care, health seeking behaviors, and health beliefs. Participants will also be asked to provide input about potential strategies to address barriers to HIV testing, retention in care, and adherence to ART. Quantitative assessments will be used to identify sociobehavioral and structural predictors of retention in care, adherence to ART, and viral suppression. Qualitative and quantitative findings will be integrated and used to develop and implement targeted intervention strategies to improve HIV outcomes in the region.

Capacity building: In collaboration with local investigators, we will integrate a social worker and Early Stage Investigator (ESI) from each site into the study procedures. Through ongoing partnership and mentorship, we will contribute to capacity building and will help to train future researchers in qualitative and mixed methods approaches.

With continuous NIH support since 2006, the pediatric West Africa Database on AIDS (pWADA) addresses high priority research questions and streamlines pediatric and adolescent HIV/AIDS research in West Africa.

We propose to build on this previous work, to address specific research questions include documenting prospectively and analyzing the determinants of access to HIV-care and long-term health outcomes in children, adolescents and youth living with HIV in West Africa.

The objectives planned for the 2021-2026 period are as follows:

1. To document and identify individual and structural factors associated with the cascade of care, from HIV testing to retention in care
2. To document long-term HIV disease progression and correlates in people living with HIV
3. To document the introduction of new antiretrovial drugs and their impact on treatment outcomes (adverse events, viral suppression).

This work will contribute to identfying models of care aimed to improve access to, uptake of and retention in care in people living with HIV, and factors that impact their success and to evaluating the most effective and cost-effective treatment to implement new guidelines in people living with HIV.

IeDEA West Africa’s work on children and adolescents living with HIV is led by Dr. Valériane Leroy (University of Toulouse 3, National Institute for Health and Medical Research (INSERM) UMR 1219, Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Toulouse, France).