Building a Collaborative Research and Training Platform for HIV and Rheumatic and Musculoskeletal Diseases in Uganda

PROJECT SUMMARY/ABSTRACT Sub-Saharan Africa bears the greatest burden of the global human immunodeficiency virus (HIV) epidemic. Uganda is no exception, with over 1.5 million persons with HIV (PWH), comprising 5.8% of the population. Improved access to antiretroviral therapy (ART) has transformed HIV from a fatal condition to a

chronic disease with long-term survival approaching that of uninfected individuals. In this setting, increased morbidity and non-AIDS mortality arising from non-communicable disease co-morbidities is a growing challenge in the care of patients with HIV. Rheumatic and musculoskeletal diseases (RMDs) encompass a broad group of conditions commonly affecting

the muscles, bones or joints. Collectively, these disorders are the leading cause of years of life lived with disability and the fifth highest driver of disability-adjusted life years globally. In Sub-Saharan Africa the burden of RMDs is growing due to changing demographic patterns against a backdrop of resource limitation. The interplay of RMDs

and HIV remains a challenge: interactions between the two are diverse and relatively poorly understood, creating barriers to management, and leading to negative health outcomes. Written in response to “HIV-associated Non-Communicable Diseases Research at Low- and Middle-Income Country Institutions (PAR-23-191)”, this proposal aims to establish a novel registry of patients with HIV and

RMDs, which will provide a unique platform for epidemiological and clinical studies of patients with co-morbid HIV and RMD. Building upon the expertise of the study PIs in HIV, RA and osteoporosis, we further propose a demonstration project focused on patients with co-existing HIV and RA to illustrate the feasibility of this platform

to support innovative hypothesis-driven research. The two independent but related aims will leverage a new patient registry at the Rheumatology Clinic at Mulago National Hospital, a well-established HIV Clinic at the same hospital, a rich history of collaboration between Makerere University College of Health Sciences and Yale

University School of Medicine, an outstanding Advisory Committee, and the infrastructure and network of the Uganda Initiative for NCDs. Taken together, the proposed project has significant public health importance. It will provide the prerequisite data, training, and infrastructure needed to advance research on RMD burden among PWH. Creation of this

unique research and training platform will foster critical local capacity and an integrated network in Uganda for future prospective studies investigating this important but previously under recognized problem. This will build the foundation for future longitudinal studies to assess the burden, biology, spectrum, and the progression of

RMDs in HIV.