On November 5 and 6, 2017, researchers from the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) and the Albert Einstein College of Medicine organized the second All Africa meeting of the NIH funded International epidemiology Databases to Evaluate AIDS (IeDEA) network in Kigali, Rwanda.
The meeting convened with over 200 attendees from sub-Saharan Africa (SSA), the US, France, and Switzerland to advance knowledge and strengthen collaborations that leverage research to optimize the implementation of universal testing and treatment (UTT) for HIV in the region.
Dr. Denis Nash, a professor at CUNY SPH and the Executive Director of CUNY’s Institute for Implementation Science in Population Health, as well as one of the architects of the IeDEA All Africa meeting, is conducting research with colleagues to evaluate and improve the implementation of HIV treatment in sub-Saharan Africa. Nash and collaborators in the IeDEA network[i] have begun focusing their efforts on new expanded policies and implementation strategies in the region aimed at reaching more and more persons living with HIV.
A true paradigm shift in HIV care and treatment, UTT—or ‘Treat All’—represents an important strategy for SSA, which has over 25 million people living with HIV, the highest rates of HIV incidence and mortality, and the greatest numbers of people living with undiagnosed and untreated HIV infection.[ii] World Health Organization (WHO) HIV treatment guidelines, which initially recommended antiretroviral therapy (ART) for only the sickest persons with HIV infection, have progressively expanded over the last decade or so, and now call for treating all persons with HIV regardless of their disease stage or immunodeficiency.
Few groups are better positioned to conduct research that covers nearly the entire sub-Saharan African region than the IeDEA network and its 4 sub-Saharan African regional collaborations. The IeDEA network includes data from 140 clinics in 23 countries in SSA, representing over 1 million patients accessing HIV care in the region, many of whom have not yet initiated HIV treatment, and is providing some of the first data on the uptake and outcomes of the UTT approach in the real world and at scale. Most SSA countries have adopted some form of WHO’s Treat All recommendation in the last 2 years. “Rapidly identifying and addressing critical knowledge gaps and research priorities for ‘Treat-all’ implementation in the sub-Saharan African region will increase the likelihood that the benefits of earlier HIV treatment, meaning fewer deaths and reduced HIV transmission, can be realized sooner rather than later,” explains Dr. Nash, who also co-leads the Central African region of IeDEA.
The IeDEA All Africa meeting brought together researchers and thought leaders from across the continent to forge consensus around research priorities that will help advance Treat All implementation in the region. Attendees came from Ministries of Health, the NIH, PEPFAR, the End AIDS Coalition, and WHO. The Rwandan Minister of Health, Dr. Diane Gashumba, attended the meeting and spoke about the implementation of ‘Treat All’ there, “Rwanda is among the first African countries to implement ‘Treat All’ [and the] strategy is on track. This has helped us to avert around 17,800 new infections up to 2030. Our health personnel is working tirelessly that every Rwandan who becomes infected can expect to have a near-normal lifespan with access to lifelong, uninterrupted HIV treatment. [sic]”
A key output of the Kigali meeting is to formalize and disseminate a consensus statement regarding research priorities to help inform ‘Treat All’ implementation in sub-Saharan Africa, and guide the research agenda of IeDEA, as well as that of other researchers, Ministries of Health, normative bodies (WHO, UNAIDS, PEPFAR), and funders and donors. “There was an incredible amount of experience and perspective around research and implementation represented among the meeting’s attendees. In addition to hearing about the inspiring success of Rwanda, attendees from other countries shared their own experiences around ‘Treat All’ implementation and related knowledge gaps with one another,” Dr. Nash explains. Meeting attendees engaged in intensive small group discussions aimed at narrowing and refining a draft set of ‘Treat All’ research priorities that were shared with attendees in advance of the meeting.
“The meeting has already greatly informed our work to finalize the consensus statement on ‘Treat All’ research priorities, which we hope to publish in early 2018. We are very thankful to the many individuals and organizations who helped make this meeting a huge success,” said Dr. Nash.
The IeDEA All Africa meeting was organized by teams at the CUNY Institute for Implementation Science in Population Health and the Albert Einstein College of Medicine with an R13 conference grant from NIH and support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) (NIH Grant Number R13AI134393). Dr. Denis Nash at CUNY and Dr. Kathryn Anastos of Einstein oversee the research activities of the Central Africa IeDEA region (NIH Grant Number U01AI096299).
[i] The International epidemiology Databases to Evaluate AIDS (IeDEA) is an international research consortium established in 2005 by the National Institute of Allergy and Infectious Diseases (NIAID) to provide a rich resource for globally diverse HIV/AIDS data. IeDEA is a trans-NIH initiative that collaborates with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA). Sites in various regions throughout the world collaborate to collect and define key variables, and implement methodology to effectively analyze data as a cost-effective means of generating large data sets to address the high priority HIV/AIDS research questions that are unanswerable by a single cohort. For more information, please go to www.iedea.org.