International Epidemiologic Databases to Evaluate AIDS
Link to West Africa Publications in PubMed
François Dabis, co-Principal Investigator and Chairman
Emmanuel Bissagnene, co-Principal Investigator
Institute of Public Health, Epidemiology & Development (ISPED)
Bordeaux Cédex, France
The WADA (West African Data Base on Antiretroviral Therapy) Collaboration is a unique collaboration among cohorts in West Africa with a mission to conduct hypothesis-driven epidemiological research on the prognosis and outcome of HIV type 1 and 2 infected people, including adults, pregnant mothers and children. The research will focus on scientific questions requiring a large sample size of patients which the contributing cohorts cannot answer individually and which do not overlap with existing projects. Activities during Year 1 will focus on cross-sectional analyses of existing data, a comprehensive examination of the available data in terms of completeness of core items at baseline and during follow-up, and the development of instruments to standardize, harmonize and improve data collection across sites.
The research agenda and specific hypotheses for Years 2-5 will be finalized based on the results of Year 1 activities, with a focus on the following four areas: programmatic issues (access to antiretroviral treatment and losses to follow up); monitoring and outcomes of treatment in adults, children, and pregnant women; clinical response, with a special interest for tuberculosis, opportunistic infections, immune reconstitution syndrome and hepatitis B co-infection; care of HIV-2 infection. Additional research questions will be focused in the subsequent years, with the expectation to address around 30 completed projects and analyses over five years. A total of 17 cohorts in six major cities in six West African counties – each ongoing and with their own internal governance structure and financial support- have agreed to contribute data collected already over the past years form a collective number of 2,345 HIV-infected children and 33,245 adult patients.
The regional coordinating center is located in Bordeaux, France. This university team has long lasting experience in epidemiological HIV cohort research in West Africa, with an office in Abidjan, Cote d’Ivoire. It also has extensive experience with international collaborations of this kind including the Ghent Group on HIV in Women and Children and the ART-LINC Collaboration. ISPED will be responsible for the implementation of the WADA Collaboration. Data will be collected from affiliated cohorts every year and once merged into a main WADA database, data extracts will be made for the various projects and analyses. This process will be repeated annually allowing for the analysis of the most contemporary data collected in the affiliated cohorts. WADA is an unprecedented undertaking in West Africa, with a unique design, lead by investigators with extensive experience, that will advance the public health knowledge required to better understand and treat HIV-infected persons of all ages, genders and backgrounds in sub-Saharan Africa, the continent with the largest unmet needs but with on-going rapid and massive roll-out of HIV treatment programs.
BACKGROUND: The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities.
BACKGROUND: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally.
BACKGROUND: Viral load and CD4% are often not available in resource-limited settings for monitoring children's responses to antiretroviral therapy (ART). We aimed to construct normative curves for weight gain at 6, 12, 18, and 24 months following initiation of ART in children, and to assess the association between poor weight gain and subsequent responses to ART.
PMID: 25636349 [PubMed - in process] PMCID: PMC4312354
BACKGROUND: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries.
INTRODUCTION: HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide.
SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.
OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.