1921
Volume 104, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The Walter Reed Army Institute of Research (WRAIR) supports more than 350,000 people on lifesaving HIV treatment in Kenya, Nigeria, Tanzania, and Uganda through funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Here, we review and synthesize the range of impacts WRAIR’s implementation science portfolio has had on PEPFAR service delivery for military and civilian populations since 2003. We also explore how investments in implementation science create institutional synergies within the U.S. Department of Defense, contributing to broad global health engagements and improving health outcomes for populations served. Finally, we discuss WRAIR’s contributions to PEPFAR priorities through use of data to drive and improve programming in real time in the era of HIV epidemic control and public health messaging that includes prevention, the 95-95-95 goals, and comorbidities.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. WHO, 2019. Global Health Observatory (GHO) Data: HIV/AIDS. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/gho/hiv/en/. Accessed September 26, 2019.
    [Google Scholar]
  2. UNAIDS, 2019. Global HIV and AIDS Statistics—2019 Fact Sheet. Geneva, Switzerland: UNAIDS. Available at: https://www.unaids.org/en/resources/fact-sheet. Accessed September 26, 2019.
    [Google Scholar]
  3. United States Department of State, Office of Inspector General, 2010. Report of Inspection: Review of the President’s Emergency Plan for AIDS Relief (PEPFAR) at Select Embassies Overseas. Washington, DC: Office of the Inspector General.
    [Google Scholar]
  4. Daschle T, Frist B, 2015. The Case for Strategic Health Diplomacy: A Study of PEPFAR Bipartisan Policy Center. Washington, DC: Bipartisan Policy Center.
    [Google Scholar]
  5. U.S. Department of State Office of the U.S. Global AIDS Coordinator and Health Diplomacy, 2019. The United States President’s Emergency Plan for AIDS Relief 2019 Annual Report to Congress. Washington, DC: U.S. Department of State Office of the U.S. Global AIDS Coordinator and Health Diplomacy.
    [Google Scholar]
  6. Reilly LUS, 2010. Military HIV research program: successfully integrating HIV vaccine research with prevention, care, and treatment. Mil Med 175 (Suppl 7): 4244.
    [Google Scholar]
  7. Rerks-Ngarm S et al., 2010. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med 361: 22092220.
    [Google Scholar]
  8. National Institute of Allergy and Infectious Diseases, 2016. Large-scale HIV vaccine trial to launch in South Africa. NIH-funded study will test safety, efficacy of vaccine regimen. Available at: https://www.nih.gov/news-events/news-releases/large-scale-hiv-vaccine-trial-launch-south-africa. Accessed September 29, 2019.
    [Google Scholar]
  9. Office of the Under Secretary of Defense for Policy, 2017. DOD Instruction 2000.30 Global Health Engagement (GHE) Activities. Washington, DC: Office of the Under Secretary of Defense for Policy.
    [Google Scholar]
  10. United States Government, 2019. United States Government Global Health Security Strategy. Washington, DC: United States Government.
    [Google Scholar]
  11. Padian NS, Holmes CB, McCoy SI, Lyerla R, Bouey PD, Goosby EP, 2011. Implementation science for the US President’s emergency plan for AIDS Relief (PEPFAR). J Acquir Immune Defic Syndr 56: 199203.
    [Google Scholar]
  12. United States Agency for International Development, 2019. DREAMS: Partnership to Reduce HIV/AIDS in Adolescent Girls and Young Women. Washington, DC: United States Agency for International Development. Available at: https://www.usaid.gov/global-health/health-areas/hiv-and-aids/technical-areas/dreams. Accessed September 29, 2019.
    [Google Scholar]
  13. Dellar RC, Dlamini S, Karim QA, 2015. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc 18 (2 Suppl 1): 19408.
    [Google Scholar]
  14. Larson B, Tindikahwa A, Mwidu G, Kibuuka H, Magala F, 2015. How much does it cost to improve access to voluntary medical male circumcision among high-risk, low-income communities in Uganda? PLoS One 10: e0119484.
    [Google Scholar]
  15. Thomas AG, Tran BR, Cranston M, Brown MC, Kumar R, Tlelai M, 2011. Voluntary medical male circumcision: a cross-sectional study comparing circumcision self-report and physical examination findings in Lesotho. PLoS One 6: e27561.
    [Google Scholar]
  16. WHO, 2019. HIV/AIDS: Mother to Child Transmission of HIV. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/hiv/topics/mtct/about/en/.
    [Google Scholar]
  17. Barnhart DA et al., 2019. Association of the US president’s emergency plan for AIDS relief’s funding with prevention of mother-to-child transmission of HIV in Kenya. JAMA Netw Open 2: e1911318.
    [Google Scholar]
  18. Larson BA, Bii M, Tsikhutsu I, Halim N, Wolfman V, Coakley P, Sugut W, Sawe F, 2018. The Enhanced Mentor Mother ProgrAm (EMMA) for the prevention of mother-to-child transmission of HIV in Kenya: study protocol for a cluster randomized controlled trial. Trials 19: 594.
    [Google Scholar]
  19. Larson BA, Bii M, Halim N, Rohr JK, Sugut W, Sawe F, 2018. Incremental treatment costs for HIV-infected women initiating antiretroviral therapy during pregnancy: a 24-month micro-costing cohort study for a maternal and child health clinic in Kenya. PLoS One 13: e0200199.
    [Google Scholar]
  20. Joint United Nations Programme on HIV/AIDS, 2017. Ending AIDS: Progress towards the 90–90–90 Targets. Geneva, Switzerland: UNAIDS.
    [Google Scholar]
  21. Justman JE, Mugurungi O, El-Sadr WM, 2018. HIV population surveys–bringing precision to the global response. N Engl J Med 378: 18591861.
    [Google Scholar]
  22. Rosen S, Fox MP, Larson BA, Brennan AT, Maskew M, Tsikhutsu I, Bii M, Ehrenkranz PD, Venter WF, 2017. Simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE): protocol for a randomised evaluation. BMJ Open 7: e016340.
    [Google Scholar]
  23. Brennan AT, Maskew M, Larson BA, Tsikhutsu I, Bii M, Vezi L, Fox MP, Venter WD, Ehrenkranz PD, Rosen S, 2019. Who is seeking antiretroviral treatment for HIV now? Characteristics of patients presenting in Kenya and South Africa in 2017–2018. J Int AIDS Soc 22: e25358.
    [Google Scholar]
  24. Sereti I et al., 2019. Prospective international study of incidence and predictors of immune reconstitution inflammatory syndrome and death in people with HIV and severe lymphopenia. Clin Infect Dis 71: 652660.
    [Google Scholar]
  25. Esber AL et al., 2020. Decreasing time to antiretroviral therapy initiation after HIV diagnosis in a clinic-based observational cohort study in four African countries. J Int AIDS Soc 23: e25446.
    [Google Scholar]
  26. Sawe FK et al., 2015. Kericho CLinic-based ART Diagnostic Evaluation (CLADE): design, accrual, and baseline characteristics of a randomized controlled trial conducted in predominately rural, district-level, HIV clinics of Kenya. PLoS One 10: e0116299.
    [Google Scholar]
  27. Sawe F et al., 2013. Superiority of Routine Viral Load Monitoring in Rural Kenya: the Kericho Clinic-based ART Diagnostic Evaluation (CLADE) Trial. Conference on Retroviruses and Opportunistic Infections. Atlanta, GA: Conference on Retroviruses and Opportunistic Infections.
    [Google Scholar]
  28. WHO, 2019. HIV Drug Resistance Report. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  29. Crowell TA et al., 2020. Pre-treatment and acquired antiretroviral drug resistance among persons living with HIV in four African countries. Clin Infect Dis ciaa1161. doi: 10.1093/cid/ciaa1161.
    [Google Scholar]
  30. Esber A, Polyak C, Kiweewa F, Maswai J, Owuoth J, Maganga L, Adamu Y, Hickey PW, Ake JA, Crowell TA, 2019. Persistent low-level viremia predicts subsequent virologic failure: is it time to change the third 90? Clin Infect Dis 69: 805812.
    [Google Scholar]
  31. Tanzanian National AIDS Control Programme, 2019. National Guidelines for the Management of HIV and AIDS, 7th edition. Dar es Salaam, Tanzania: National AIDS Control Programme.
    [Google Scholar]
  32. National AIDS & STI Control Program, Ministry of Health Kenya, 2019. Guidance on Viral Load Monitoring for People Living with HIV Who Are on Antiretroviral Therapy in Kenya. Nairobi, Kenya: Ministry of Health.
    [Google Scholar]
  33. Shaffer DN, Obiero ET, Bett JB, Kiptoo IN, Maswai JK, Sawe FK, Carter EJ, 2012. Successes and challenges in an integrated tuberculosis/HIV clinic in a rural, resource-limited setting: experiences from Kericho, Kenya. AIDS Res Treat 2012: 238012.
    [Google Scholar]
  34. Parkin DM, Sitas F, Chirenje M, Stein L, Abratt R, Wabinga H, 2008. Part I: cancer in indigenous Africans--burden, distribution, and trends. Lancet Oncol 9: 683692.
    [Google Scholar]
  35. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM, 2010. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127: 28932917.
    [Google Scholar]
  36. George W. Bush Institute, 2019. Go Further: Working to Effectively End AIDS and Cervical Cancer Texas. Dallas, TX: George W. Bush Presidential Center. Available at: https://www.bushcenter.org/explore-our-work/taking-action/partnership-to-end-aids-and-cervical-cancer.html. Accessed September 29, 2019.
    [Google Scholar]
  37. Ake JA et al., 2018. Noninfectious comorbidity in the African cohort study. Clin Infect Dis 69: 639647.
    [Google Scholar]
  38. Meffert SM et al., 2019. East African HIV care: depression and HIV outcomes. Glob Ment Health (Camb) 6: e9.
    [Google Scholar]
  39. Nowak RG et al., 2019. Individual and sexual network predictors of HIV incidence among men who have sex with men in Nigeria. J Acquir Immune Defic Syndr 80: 444453.
    [Google Scholar]
  40. Keshinro B et al., 2016. High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria. J Int AIDS Soc 19: 21270.
    [Google Scholar]
  41. Crowell TA et al., 2018. Asymptomatic lymphogranuloma venereum among Nigerian men who have sex with men. Sex Transm Infect 94: 578581.
    [Google Scholar]
  42. Hardick J et al., 2018. Molecular screening for Neisseria gonorrhoeae antimicrobial resistance markers in Nigerian men who have sex with men and transgender women. Int J STD AIDS 29: 12731281.
    [Google Scholar]
  43. Rodriguez-Hart C et al., 2017. Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM. AIDS 31: 24152420.
    [Google Scholar]
  44. Rodriguez-Hart C et al., 2018. The synergistic impact of sexual stigma and psychosocial well-being on HIV testing: a mixed-methods study among Nigerian men who have sex with men. AIDS Behav 22: 39053915.
    [Google Scholar]
  45. Crowell TA, Keshinro B, Baral SD, Schwartz SR, Stahlman S, Nowak RG, Adebajo S, Blattner WA, Charurat ME, Ake JA, 2017. Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria. J Int AIDS Soc 20: 21489.
    [Google Scholar]
  46. Rodriguez-Hart C et al., 2018. Sexual stigma patterns among Nigerian men who have sex with men and their link to HIV and sexually transmitted infection prevalence. AIDS Behav 22: 16621670.
    [Google Scholar]
  47. Nowak RG et al., 2020. Multiple HPV infections among men who have sex with men engaged in anal cancer screening in Abuja, Nigeria. Papillomavirus Res 10: 100200.
    [Google Scholar]
  48. Havlir DV et al., 2011. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. New Engl J Med 365: 14821491.
    [Google Scholar]
  49. Swindells S et al., 2019. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. New Engl J Med 380: 10011011.
    [Google Scholar]
  50. Lockman S et al., 2010. Antiretroviral therapies in women after single-dose nevirapine exposure. New Engl J Med 363: 14991509.
    [Google Scholar]
  51. Sawe F et al., 2017. Excellent retention, virologic and clinical outcomes after transitioning from an antiretroviral treatment clinical trial to locally-provided care and treatment in Africa. Int J Clin Trials 4: 3944.
    [Google Scholar]
  52. Office of the U.S. Global AIDS Coordinator and Health Diplomacy, 2018. Progress Report: PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017–2020). Washington, DC: US Department of State.
    [Google Scholar]
  53. Daschle T, Frist B, 2018. Building Propserity, Stability and Security through Strategic Health Diplomacy: A Study of 15 Years of PEPFAR. Washington, DC: Bipartisan Policy Center.
    [Google Scholar]
  54. Meribe SC et al., 2020. Sustaining tuberculosis preventive therapy scale-up through direct supportive supervision. Public Health Action 10: 6063.
    [Google Scholar]
  55. Odume B, Meribe SC, Odusote T, Ifunanya M, Debem H, Amazue-Ezeuko I, Ogbanufe O, Adamu Y, Onotu D, 2020. Taking tuberculosis preventive therapy implementation to national scale: the Nigerian PEPFAR Program experience. Public Health Action 10: 710.
    [Google Scholar]
  56. Uthman OA, Okwundu C, Gbenga K, Volmink J, Dowdy D, Zumla A, Nachega JB, 2015. Optimal timing of antiretroviral therapy initiation for HIV-infected adults with newly diagnosed pulmonary tuberculosis: a systematic review and meta-analysis. Ann Intern Med 163: 3239.
    [Google Scholar]
  57. Charurat ME et al., 1999. Uptake of treatment as prevention for HIV and continuum of care among HIV-positive men who have sex with men in Nigeria. J Acquir Immune Defic Syndr 68 (Suppl 2): S114S23.
    [Google Scholar]
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  • Received : 26 May 2020
  • Accepted : 09 Sep 2020
  • Published online : 09 Nov 2020
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