Research to guide practice: Enhancing HIV/AIDS platforms to address NCDs in low-resource settings (the HIV/NCD Integration Project) aims to bring together researchers, implementers and government representatives to articulate practical goals, approaches and a related research agenda to incorporate prevention, care and treatment for noncommunicable diseases (NCDs) into HIV/AIDS platforms in sub-Saharan Africa (SSA).
The NIH, with leadership from the
Center for Global Health Studies (CGHS) at Fogarty conducted the project in collaboration with the President's Emergency Plan for AIDS Relief (PEPFAR) and the
partners listed below. The program focuses on people living with HIV (PLHIV), many of whom are being treated successfully for HIV but are increasingly experiencing comorbid diseases.
The rapidly rising burden of NCDs in low- and middle-income countries (LMICs) threatens to create a new epidemic that the global community can begin to address by establishing the evidence base necessary to leverage existing HIV investments in LMIC health systems. The existing human capital, health infrastructure, and data systems developed to confront the HIV/AIDS crisis could be enhanced, with the help of scientific evidence, to start to address patient management and prevention of NCDs for PLHIV. Research gaps, identified through a three-stage process, will guide and support interventions that build on the existing HIV/AIDS investments to address the dual disease burden facing PLHIV.
This endeavor was led by a steering committee of subject matter experts from the U.S. and LMICs, and supported by an NIH-led, interagency secretariat. The HIV/NCD Integration Project is a collaborative effort with representatives from NIH Institutes, Centers and Offices, PEPFAR implementing agencies, and the Office of the Global AIDS Coordinator, which involves researchers, program implementers, funders, nongovernmental organizations, multilaterals, policymakers, universities, and ministry officials from LMICs and the U.S. that are all working together to develop and implement a research agenda addressing the rising NCD burden in PLHIV in LMICs.
- Wafaa El-Sadr, Columbia University, Member of Fogarty Advisory Board
- Robert Ferris, USAID
- Eric Goosby, University of California, San Francisco (UCSF)
- Naomi Levitt, University of Cape Town, South Africa
- Beatrice Mwagomba, Ministry of Health, Malawi
- Miriam Rabkin, Columbia University
- Sonak Pastakia, Purdue University
- Pragna Patel, U.S. Centers for Disease Control and Prevention
- William Tierney, University of Texas at Austin Dell Medical School
- Gerald Yonga, Aga Khan University, Kenya
Landscape Analysis and Research Agenda
The HIV/NCD Integration Project, comprised of more than 40 members, first identified four priority NCDs (i.e., cardiovascular disease, cervical cancer, depression, and diabetes) based on available data, known patho-physiological connection with HIV, associated HIV outcomes, along with other factors. These members conducted scoping reviews of what is currently being done in the field of NCD prevention, care, and treatment for PLHIV in SSA by examining peer-reviewed and gray literature focused on the four selected NCDs. The resulting analysis reported and identified gaps for integration of NCDs into the HIV clinical continuum of care, piloting and scaling-up an integrated chronic care health system, and enhancing HIV/NCD community engagement and health promotion efforts.
In addition to these landscape analysis, researchers, program implementers and policymakers from eight countries in SSA met to share lessons learned from existing, evidence-based integrated models of HIV and NCD care. Through this process, they developed an implementation science research agenda that identified priority questions related to enhancing NCD and HIV services to optimize patient and program outcomes.
Subject matter experts engaged in the project reviewed the findings from the landscape analysis and the integrated HIV/NCD modeling workshop to develop a prioritized research and activity agenda for the project. The result of this work is a 12-article supplement published in AIDS in July 2018 presented through health system building blocks that represent the foci of research activities necessary for developing an integrated chronic care platform. In addition, several NIH ICs issued RFAs that included support for researchers addressing the integration of NCDs and HIV.
HIV/NCD Data Modeling (2016-2018)
In response to the need for more data, in 2016 the HIV/NCD Integration Project launched a
call for modeling proposals by CRDF Global, specifically supporting the development of models to estimate the burden of cervical cancer, diabetes, depression and/or cardiovascular disease in PLHIV in sub-Saharan Africa - a research area identified as a priority under the project. After an extensive review by modeling experts, the following awards were made:
- Preparing for the Noncommunicable Disease Burden Among HIV-positive Persons in Kenya
Principal Investigator: Timothy Hallett, Imperial College London, UK
- Assessing the Burden of Noncommunicable Diseases for People Living with HIV in Uganda
Principal Investigator: Stephane Verguet, Harvard School of Public Health
- Integrated Modeling of Epidemiologic and Economic Long-term Outcomes in Africa
Principal Investigator: Omar Galarraga, Brown University
The results of the Fogarty-supported modeling projects and some other closely related projects from the
International AIDS Society-Lancet Commission report "Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals" were presented at an NIH meeting in December 2018 attended by about 40 participants from eight NIH entities.
The workshop generated a table of contents for the articles that would form the basis of the special issue of the
Journal of the International AIDS Society (JIAS),
Integrating services for HIV and related comorbidities: modelling to inform policy and practice. The issue launched at a Fogarty-supported satellite session on July 6, 2020 during the AIDS 2020 Conference,
Integrating services for HIV and related comorbidities: modelling to inform policy and practice. The supplement demonstrates what types of information can be generated from mathematical modeling and how it can inform evidence based decision making in LMICs regarding integrated care for HIV and related comorbidities.
HIV/NCD Data Modeling Training in LMIC (2021)
Training Workshop on the Use of Mathematical Modeling to Inform HIV Integrated Care A Call for Collaborative Proposals for In-Country Mathematical Modeling Training Workshop.
To increase the probability of the sustainability of the mathematical models developed for the previous CRDF Global RFA “PEPFAR-NCD Call for Modeling Proposals" a new CRDF Global call “Modeling to Guide Practice: Training on the Use of Mathematical Modeling to Inform HIV/NCD Integrated Care" was developed to implement a “virtual mathematical model training workshop in an LMIC." A grant was awarded by CRDF Global in February 2021.
Linda Kupfer, Ph.D.
Fogarty Division of International Science Policy, Planning and Evaluation
Updated July 2021