Gabriel Mabou and Larissa Mbah
Summary
The Central Africa – International Epidemiology Databases to Evaluate AIDS (CA-IeDEA) is an initiative aimed at improving the health of Central Africa People Living with HIV (CA-PLWH) through high-quality implementation and clinical research. The objectives of the CA-IeDEA Regional Meeting this year were to 1) Stimulate ideas by sharing the scope of activities related to Central Africa IeDEA studies and 2) Share updates on capacity-building efforts in the region.
The 2024 edition of the CA-IeDEA regional meeting took place from April 1-2 at the Best Western Plus Soaho Hotel in Douala. This edition brought together all the multiple principal investigators (mPIs-United States) and the US team, country PIs from 5 different countries (Burundi, Cameroon (CMR), Democratic Republic of Congo (DRC), The Republic of Congo (ROC) and Rwanda) and government authorities, stakeholders and partners from the host country, Cameroon. A total of 79 people were invited to the regional meeting from those different countries. The event was organized over two days, with overviews, linked and supplemental studies and research priorities for co-epidemics on day-1, and capacity building, mental health, working group reports and the closing ceremony on day-2. These sessions were enriched with discussions arising from the outstanding contributions of the various participants and speakers, all this under the oversight and supervision of the Ministry of Public Health.
Introduction
The International epidemiology Databases to Evaluate AIDS (IeDEA) is an international research consortium established in 2006 by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) to identify and address high-priority HIV/AIDS research questions. The Central Africa IeDEA (CA-IeDEA) cohort involves HIV researchers and care and treatment partners in five countries—Burundi, Cameroon, the Democratic Republic of Congo, the Republic of Congo, and Rwanda. The CA-IeDEA cohort includes more than 86,000 patients who ever enrolled into HIV care at participating sites, with close to 40,000 active patients—patients who are currently receiving HIV care at 21 CA-IeDEA sites. Utilizing longitudinal data from participating sites and implementation science approaches, CA-IeDEA partners are examining HIV care and treatment outcomes among an observational cohort of adult and pediatric HIV patients in order to:
- Identify effective strategies for optimizing HIV care outcomes, including timely diagnosis and care enrollment, care retention, ART initiation and viral suppression.
- Conduct clinical epidemiologic investigations of co-morbidities of aging among people living with HIV/AIDS (PLWH).
IeDEA-CA also leads and contributes to multi-regional IeDEA projects, and it maintains updated population-based data from various sources for use in examining contextual determinants of HIV outcomes.
CA-IeDEA research is jointly led by Prof Kathryn Anastos (Montefiore Medical Center, Albert Einstein College of Medicine), Prof Denis Nash (CUNY Institute of Implementation Science in Population Health), and Prof Marcel Yotebieng (Albert Einstein College of Medicine), in partnership with investigators from the Centre National de Reference en Matière de VIH/SIDA (Burundi); the Kinshasa School of Public Health and Kalembelembe Pediatric Hospital (DRC); the Centre de Traitement Ambulatoire de Pointe Noire and Centre de Traitement Ambulatoire de Brazzaville (Republic of Congo); the Clinical Research Education Networking and Consultancy (CRENC) Foundation (Cameroon), Rwanda Military Hospital (Rwanda), Data Solutions LLC, Vanderbilt University, Columbia University, the Ohio State University, and Virginia Commonwealth University [1, 2].
Day 1: April 1st, 2024
CA-IeDEA Regional Meeting launched with the opening words from Prof Anastase (CMR PI) who gave the floor to the different PIs to present their teams. Prof Kathryn Anastos (United States PI) introduced the team arriving from the US. Prof Marcel Yotebieng (US PI) and Prof Denis Nash (US PI) also introduced themselves respectively. Later on, Prof Pélagie Babakazo (DRC PI) presented the DRC team. Dr Gad Murenzi (Rwanda PI) did the same, followed by Dr Dominique Nsonde (ROC PI) and Prof Niyongabo Théodore (Burundi PI). Prof Anastase later on presented the CMR team, followed by the stakeholders (Ministry of Public Health (MINSANTE), Division of Operational Health Research (DROS), Coordination of HIV, TB and Malaria, National AIDS Control Committee (NACC), The National Ethics Committee (NEC)) and ended with the partners from EGPAF, CBCHS and PAMJ. Dr Peter Ebasone (CRENC-IeDEA/CMR) and Abena Bosompem (US) reviewed the meeting logistics (program, moderators and panelists, break/lunch and working group sessions). The sessions were as follows:
Session 1: Introduction and Reviews
The session was chaired by Prof Kathryn Anastos (US PI), Prof Denis Nash (US PI) and Prof Marcel Yotebieng (US PI). The purpose of this session was to have an overview of CA-IeDEA. Prof Marcel Yotebieng presented the CA-IeDEA highlights on points related to the global IeDEA core activities, the various countries where the project is being carried out, the vision, aims, organization, research areas, scientific team, core data and capacity building of the CA-IeDEA project. He emphasized that one doesn’t need to be a member of the IeDEA project to get access to the database. To access the database, the following steps need to be carried: 1) Write a concept sheet, 2) Submit the concept sheet, 3) The committee will review the concept sheet and if it’s accepted, 4) Access will be granted to the database. Drs Batya Elul (US) and Gad Murenzi (PI Rwanda) gave an overview of the AYANI (Adolescent and Young Adult Network of IeDEA) project presenting the challenges faced such as food insecurity, sexual reproductive and mental health among the study population. Nana Mbonze (DRC) and Dr Natalie Zotova (US) presented on the TB-SRN (Tuberculosis Sentinel Research Network) and Dr Gad Murenzi concluded the session with a presentation on the SRN project on different aspects such as obesity, alcohol and substance use, mental disorders and liver diseases. After discussions, the CA-IeDEA regional meeting was officially opened by the Secretary General of the Ministry of Public Health, Prof Louis Richard Njock and the Director of the Division of Operational Health Research, Prof Anne-Cécile Bissek.
Session 2: Linked and supplemental studies
After the family picture [FIGURE 01] and the coffee break, the next session took place and was chaired by Dr Gad Murenzi, Dr Dominique Nsonde and Dr Peter Ebasone. Prof Adebola Adedimeji (US) made a presentation on the Tracing Study (Lost-To-Follow Up Among Patients in HIV Care and ART) with updates from Cameroon and Rwanda sites and is still to launch the study in the 3 other countries. Dr Jonathan Ross later on presented the PrEP (Pre-Exposure Prophylaxis) study, with a focus on Men Having Sex with Men (MSM) and Female Sex Workers (FSW). The next was a presentation on DTG RESIST (HIV-1 Subtype-Specific Drug Resistance in Patients failing Dolutegravir-Based First-line, Second-line or Third-line Regimens) study by Dr Dominique Nsonde, followed by the HPV Cervical Cancer study by Dr Jean Claude Dusingize (US/Rwanda/Australia) with an accent on the global 2030 cervical cancer elimination 90-70-90 targets. Prof Denish Nash (US) and Dr Gad Murenzi concluded the session with a presentation on Extreme Weather Events and HIV care Outcomes in the IeDEA Cohort Collaboration. The end of the session was marked by discussions followed by lunch.
Figure 01: Family Picture of the CA-IeDEA Regional Meeting
Session 3: Research priorities for co-epidemics of HIV and cardiometabolic disease and other non-communicable diseases
The last session of the day was chaired by Prof Anastase Dzudie and Prof Théodore Niyongabo. This session was separated into 02 parts. Starting with the first part, Prof Marcel and Anastase were charged with working groups for concurrent activities. 04 groups were designed, led by a group of experts. Group 1 was on HIV and Non-Communicable Diseases (NCDs) like Cardiovascular diseases (CVDs), cancer and others, led by Profs Anastase Dzudie and Pelagie Babakazo. Group 2 was on HIV and co-infections (Hepatitis B and C virus, Tuberculosis and others), led by Nana Mbonze and Dr Mark Kuniholm. Group 3 focus was on HIV and Mental Health and substance use by Dr Angela Pascesepe (US) and Dr Rogers Ajeh (CMR). Group 4 was on Data collection, harmonization and analysis by Dr Stephany Duda (US) and Lionel Ngamani (CMR). After assigning members and discussing on their respective activities, challenges and perspectives, it was agreed that each group will present and submit a report on day-2. The second part of the session was engaged by Dr Ellen Brazier (US), Dr Batya Elul and Dr Stephany Duda on the concept process and the CA-IeDEA regional hub, highlighting what is a concept proposal, the various strategies involved in writing a concept proposal, how to obtain it from the CA-IeDEA website and how to submit it for revisions. Prof Denis Nash ended the event by giving a summary of the various presentations and highlighting the importance of collaborations.
Day 2: April 2nd, 2024
Session I: Capacity Building
The second day of the meeting started with its first session on Capacity building, chaired by Prof Anastase Dzudie and Dr Gad Murenzi. In this session, four main topics were presented. The first one on Cameroon capacity building by Dr Ebasone Peter and Prof Anastase Dzudie outlined Studentship, Internship, E-learning and Weekly Research calls programs happening in Cameroon. The second was on the population-based research training by Drs Mark Kuniholm, Jean Claude Dusingize and Gad Murenzi on the objective of this program, the selection criteria, the instructors, the program and the pre-post evaluation results. The third presentation was on qualitative research capacity building by Dr Jonathon Ross, Dr Natalie Zotova and Prof Adebola Adedimeji showing the need for extensive qualitative training from data collection to data interpretation in qualitative research. The last presentation was on the Fogarty IeDEA Mentorship Program (FIMP) introduced by Prof Adebola, comprising 3 sub-presentations on Factors associated with HIV status disclosure among people entering into care at IeDEA study sites in Cameroon: A cross-sectional study by Gabriel Mabou (Cameroon), Mortality and loss of follow-up of HIV-Infected Adolescents on Antiretroviral Therapy in Rwanda: A Cohort study by Eulade Rugengamanzi (Rwanda) and Evaluating timeliness of viral load testing and factors associated by Annabelle Niyongabo (Burundi). All the FIMPers showed progress in their respective concept sheets and perspectives to consider.
Session II: K01 – Mental Health and HIV care outcomes among People with HIV care in Cameroon
This session was chaired by Prof Anne-Cécile Bissek, Prof Wilfred Mbacham, Dr Anoubissi Jean de Dieu, Dr Denis Nsame, and Dr Annereke Nyenti. Drs Angela Parcesepe (US) and Peter Ebasone had an astonishing presentation on Mental health and HIV care outcomes among people with HIV in Cameroon, presenting the evidence and recommendations from the research conducted in Cameroon. They found that viral non-suppression was significantly higher among those with anxiety symptoms in the overall sample of PLWH who were retained in care and among men retained in care. Also, diagnosis with HIV likely serves as an acute stressor, but those with persistent symptoms are also important to identify as they may need different types of intervention, Strategies to partner with informal sources of care, including religious leaders, could help bridge people to formal sources of mental health care. They also stated that strategies to address common psychosocial stressors including IPV, household hunger, trauma, and HIV-related stigma are needed Finally, Mental health and safety interventions are urgently needed to support the well-being of people entering HIV care.
Session III and IV: Working Group Reports and discussion/planning for new research questions generated and Open discussion of other issues to enhance the status of CA-IeDEA within IeDEA, and wrap up
Session 3 was chaired by Prof Marcel Yotebieng (US) and Prof. Théodore Niyongabo (Burundi) and made up of panellists such as Dr Dominique Nsonde (Republic of Congo), Dr Gad Murenzi (Rwanda), and Dr Patricia Lelo (DRC). It consisted for the working groups to submit their reports after their last discussions. Group work 1 on HIV and NCD (CVD, Cancer), represented by Prof Anastase Dzudie and Prof Pélagie Babakazo (DRC) who wishes to prioritise research in populations, behaviours and health systems. Group work 2 on HIV and Co-infection (HBV, TB), represented by Dr Mark Kuniholm and Nana Mbonze showed the priorities to focus on Hepatitis, Tuberculosis, Malaria and sexually transmitted diseases (STDs) such as HPV. Dr Angela Parscepe represented group work 3 on HIV and Mental health and substance use to foster studies on 4 main topics which are 1) the urgent need for integration of mental health screening, 2) understanding more about how to implicate providers and their clinics, 3) leveraging systems of support on mental health and 4) having more focus on children and adolescents. Finally, Group Work 4 on Data collection, harmonization, and analysis, represented by Dr Stephany Duda and Lionel Ngamani on new approaches to providing feedback about data. Discussion and brainstorming about future research proposals, revised lists of “essential” variables, exploring the impact of the changes of data dictionary in a longitudinal project, support for formal training of new data entry personnel and establishing quarterly meetings (Zoom) of data managers.
The last session (session 4), chaired by Profs Kathryn Anastos (US), Denis Nash (US) and the Country PIs consisted to discuss of other issues to enhance the status of CA-IeDEA within IeDEA like the restitution of results for policy and guideline making, with the help of CAM-HERO [3–6], strong collaboration between the project and local authorities and building research leadership and capacity building [7, 8]. A wrap-up was done by Prof Kathryn to end the day.
Dinner Reception and Awards Ceremony
The day was crowned with the customary CA-IeDEA Awards. It was presided over by the Director of the DROS/MINSANTE, Prof Anne Bissek on behalf of the Ministry of Public Health, Prof Anastase Dzudie and Dr Peter Ebasone. An official good retirement to Prof Théodore was made by Prof Kathryn and Prof Marcel. All the participants received Certificates of Participation and a handful of prominent researchers were awarded certificates of achievement in recognition of their tireless dedication to HIV/AIDS research in Cameroon and Central Africa. Special awards of excellence in leadership were offered to Dr Manaouda Malachie (Minister of Public Health Cameroon), Prof Louis Richard Njock (Secretary General MINSANTE), Prof Anne Bissek (DROS), Prof Kathryn Anastos (mPI US), Prof Denis Nash (mPI US), Prof Marcel Yotebieng (mPI US), Prof Adebola Adedimeji (US), Dr. Gad Murenzi (PI Rwanda) Prof Pélagie Babakazo (PI DRC), Dr Dominique Nsonde (PI ROC), Prof Niyongabo Théodore (PI Burundi) Prof Anastase Dzudie (PI Cameroon), Prof Wilfred Mbacham (CNERSH), Dr Denis Nsame (Bamenda Regional Hospital), Dr Annereke Nyenti (Limbe Regional Hospital), Dr Joseph Fokam (CIRCB), Dr. Jon Ross (US), Dr Natalie Zotova (US), Dr Ellen Brazier (US), Dr Batya Elul (US), Dr Stephany Duda (US), Dr Angela Parcesepe (US), Dr. Mark Kuniholm (US), Dr Jean Claude Dusingize (Australia) and Mr Ashu (CRENC-IeDEA).
Conclusion
The 2024 edition of CA-IeDEA brought different countries, partners and key stakeholders together to share knowledge of what happened and what was done in the CA-IeDEA regions, discussing national and international research findings, and refining HIV/AIDS research. It featured working groups, capacity building, linked and supplemental studies, mental health and co-morbidities and research priorities, as well as opportunities for collaboration and innovation. The highlight of the event was the commencement of the process towards the development and adoption of new research questions and capacity building, aimed at enhancing the quality of research projects.
References
1. Central Africa IeDEA – Improving health outcomes of individuals living with HIV/AIDS. Central Africa IeDEA. https://ca-iedea.org/. Accessed 10 Apr 2024.
2. Adedimeji AA, Hoover DR, Shi Q, Kim H-Y, Brazier E, Ross J, et al. Trends in demographic and clinical characteristics and initiation of antiretroviral therapy among adult patients enrolling in HIV care in the Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) 2004 to 2018. J Int AIDS Soc. 2021;24:e25672.
3. Tchendjou P, Ebasone PV, Dzudie A, Khan EM, Fokam J, Muffih PT, et al. Evidence for an enhanced HIV/AIDS policy and care in Cameroon: proceedings of the second Cameroon HIV Research Forum (CAM-HERO) 2021. The Pan African Medical Journal. 2022;43.
4. Tchounga B, Ajeh R, Djikeussi T, Ebasone P, Tchendjou P, Anoubissi J, et al. Outcomes of the first meeting of the CAMEROON HIV RESEARCH FORUM (CAM-HERO). The Pan African Medical Journal. 2021;40.
5. Dzudie A, Tchendjou P, Khan EM, Ajeh R, Thienemann F, Tiam A, et al. Research for Health Care and Policy on HIV/AIDS: proceedings of the third edition of the Cameroon HIV Research (CAM-HERO) 2022, Kribi, Cameroon, from 1st to 3rd December 2022. The Pan African Medical Journal. 2023;46.
6. Dzudie A, Tchounga B, Ajeh R, Kouanfack C, Ebasone PV, Djikeussi T, et al. Research priorities for accelerating the achievement of three 95 HIV goals in Cameroon: a consensus statement from the Cameroon HIV Research Forum (CAM-HERO). The Pan African Medical Journal. 2021;40.
7. Ebasone PV, Tiam A, Tchendjou P, Foaleng M, Khan EM, Ajeh R, et al. Assessment of knowledge and self-efficacy among health professionals and clinical scientists following the Cameroon HIV/AIDS Research Forum (CAM-HERO 2022) research methodology and bioethics training. The Pan African Medical Journal. 2024;47.
8. Dzudie A, Njume E, Ajeh R, Yone-Pefura EW, Divine B, Adedimeji A, et al. A report on the research leadership and scientific writing training organized in Yaounde by the Clinical Research Education, Networking and Consultancy (CRENC) and the IeDEA-Cameroon team. The Pan African Medical Journal. 2018;29.
