Kara Wools-Kaloustian and Constantin Yiannoutsos, Principal Investigators

Paula Braitstein and Rachel Vreeman, Co-Principal Investigators

Indiana University School of Medicine

East African IeDEA Regional Data & Coordinating Center

Indiana University School of Medicine serves as the East African IeDEA Regional Data & Coordinating Center in the United States. It provides overall coordination for the East African Consortium including data management and statistical analysis support. In addition the site provides mentoring and practical support to the data managers and biostatisticians at East Africa IeDEA sites.

Mission and Vision Statement:
With 67% of the estimated 33 million people living with HIV/AIDS globally, sub-Saharan Africa remains the region most significantly impacted by the epidemic. In Kenya, Uganda and Tanzania, the three countries within the East African IeDEA Consortium have adult HIV prevalence rates ranging between 5-10%. Since the advent of the global antiretroviral therapy (ART) rollout in 2003, there has been a dramatic increase in the percent coverage of those estimated in need of ART (based on the 2006 WHO guidelines), from essentially no patients on in 2003, to 65% coverage in Kenya, 53% in Uganda, and 44% in Tanzania by the end of 2009. Though this dramatic scale-up of HIV treatment has had a positive impact on mortality rates, key questions remain throughout the course of a patient’s engagement in care, from the pre- ART period through ART-initiation, initial clinical response to ART and regimen durability (occurrence of adverse events and drug resistance), to long-term maintenance, loss to follow-up (LTFU), and death. It is the long-range goal of this consortium to provide answers to the questions that clinicians, programs, and ministries of health consider fundamental to the evolution and sustainability of their long term HIV care and treatment strategies.

Our priority areas for the next phase of the EA-IeDEA Consortium are:
Determine the short and long-term outcomes of adults and children along the entire spectrum of HIV care and examine patient and site-level factors associated with these outcomes.

In ART-naïve patients:
Assess the incidence of ART initiation and quantify the impact of patient and site-level determinants of failure to initiate ART.

In patients initiating ART:
Quantify the types of regimens started, the incidence and determinants of treatment failure, and overall survival.
Assess the cost-effectiveness of various ART monitoring and HIV prevention strategies.

Issues related to loss to follow-up:
Because the rate of losses to follow-up in HIV treatment programs throughout sub-Saharan Africa is a significant threat to the validity of the work done by IeDEA, in East Africa we will enhance our data collection by expanding the sampling-based methods developed during the first grant period, to accommodate losses to follow-up at several sites in our region.

Penetrance and outcomes of prevention of mother to child transmission of HIV (PMTCT) strategies:

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