Research to guide practice: Enhancing HIV/AIDS platforms to address NCDs in low-resource settings

A medical worker seated across from a patient in a clinic
Photo by Hugue-Robert Marsan for Fogarty/NIH

NIH and its partners are working to establish research
evidence that existing resources supporting people living
with HIV can be used to help treat NCDs.

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 low- and middle-income countries (LMICs).​

The NIH, with leadership from the Center for Global Health Studies (CGHS) at Fogarty, is conducting 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 who are increasingly experiencing comorbid diseases.

Context

The rapidly rising burden of NCDs in 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 help address patient management and prevention of NCDs for PLHIV. Research gaps, identified by HIV/NCD Integration Project participants including LMIC stakeholders, will guide and support interventions that build on the existing HIV/AIDS investments to address the dual disease burden facing PLHIV.

Activities and Implementation

This endeavor is 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 and Centers (ICs), PEPFAR implementing agencies, and the Office of the Global AIDS Coordinator and involving researchers, program implementers, funders, non-governmental organizations, multilaterals, policymakers, university, 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.

Landscape Analysis and Research Agenda

The HIV/NCD Integration Project, comprised of more than 60 members, examined peer-reviewed and grey literature and developed landscape analyses reviewing the evidence for integrating the priority NCDs into existing HIV health systems and care protocols in LMICs. The goal of these papers was to determine gaps in practice and knowledge and identify opportunities for future research to address those gaps. Subject matter experts engaged in the project reviewed these findings and developed a prioritized research and activity agenda for the project. In support of this research agenda, several NIH ICs issued RFAs that included support for researchers addressing the integration of NCDs and HIV.

Workshop on Integrated HIV/NCD Models

Researchers, program implementers and policy makers from eight countries in Sub-Saharan Africa (SSA) met to share lessons learned from existing, evidence-based integrated models of HIV and NCD care. They developed an implementation science research agenda that identified priority questions related to enhancing NCD and HIV services for the purpose of optimizing patient and program outcomes.

NCD Data Modeling

The HIV/NCD Integration Project, through a call for modeling proposals by CRDF Global, is supporting the development of models to estimate the burden of NCDs like cervical cancer, diabetes, depression and 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 have been 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

Partners

The following partners are participating in the PEPFAR-NCD Project:

  • AMPATH (Kenya)
  • FHI360
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria
  • ICAP
  • Jhpiego, an affiliate of Johns Hopkins University
  • Management Sciences for Health
  • Partners in Health
  • PATH
  • SEARCH
  • U.S. Department of State, Office of the U.S. Global AIDS Coordinator
  • U.S. National Institutes of Health (NIH)
    • Fogarty International Center
    • National Cancer Institutes (NCI)
    • National Heart, Lung, and Blood Institute (NHLBI)
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
    • National Institute of Allergy and Infectious Diseases (NIAID)
    • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
    • National Institute of Mental Health (NIMH)
    • National Institute of Neurological Disorders and Stroke (NINDS)
    • National Institute of Nursing Research (NINR)
    • National Institute on Minority Health and Health Disparities (NIMHD)
    • NIH Office of AIDS Research
    • NIH Office of Research on Women's Health
  • U.S. Centers for Disease Control and Prevention (CDC) Division of Global HIV/AIDS
  • UNAIDS
  • University of Washington
  • USAID
  • World Health Organization (WHO)

Steering Committee

  • Atalay Alem, Addis Ababa University, Ethiopia
  • Wafaa El-Sadr, Columbia University, Member of Fogarty Advisory Board
  • 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
  • Doreen Ramogola Masire, University of Botswana
  • William Tierney, University of Texas at Austin Dell Medical School
  • Gerald Yonga, Aga Khan University, Kenya

Inquiries

Linda Kupfer, Ph.D.
Senior Scientist
Fogarty Division of International Science Policy, Planning and Evaluation
Email: Linda.Kupfer@nih.gov

Susan Vorkoper, M.P.H., M.S.W.
Global Health Research and Policy Analyst
Fogarty Division of International Science Policy, Planning and Evaluation
Email: Susan.Vorkoper@nih.gov

Updated December 2017

Footer