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In 2013, MHRP initiated a large, long-term cohort study at multiple African sites that evaluates HIV prevention and treatment services it supports through local facilities, funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The African Cohort Study (AFRICOS) —the first of its kind in sub-Saharan Africa — takes place at sites in Kenya, Nigeria, Tanzania, and Uganda. 

Study participants are drawn from health facility clinic patient populations, allowing MHRP to monitor the impact of HIV-directed health and preventive services that fall under national guidelines. 

“AFRICOS helps us capture the broader picture of the overall health of our HIV-infected patients,” said COL Julie Ake, M.D., the study’s lead investigator. “Researchers are gaining a better understanding of what leads to the best clinical outcomes, which in turn facilitates the sharing of best practices between sites.” 

AFRICOS will recruit 4,200 volunteers, including 3,500 HIV-infected and 700 HIV-uninfected adults and adolescents. The 15-year study is designed to collect retrospective data at enrollment, and participants will then be followed prospectively every six months.

Study sites:

MHRP is enrolling volunteers at 12 HIV clinical treatment sites in four countries:

Kayunga District Hospital

South Rift Valley, Kenya
Tenwek Mission Hospital
Kericho District Hospital
Kapkatet District Hospital
AIC Litein Mission Hospital
Nandi Hills District Hospital
Kapsabet District Hospital

Kisumu, Kenya
Kombewa County Hospital

Mbeya Zonal Referral Hospital
Mbeya Regional Referral Hospital

Defense Headquarters Medical Centre, Abuja
68 Nigerian Army Reference Hospital, Lagos

Specifically, researchers are studying current national treatment regimens and long-term outcomes such as time to progression to AIDS and mortality. They also will evaluate comprehensive demographics, social and behavioral risk factors and aspects of adherence. Another critical component is the collection of data regarding co-infections such as malaria and tuberculosis, as well as non-infectious co-morbidities such as cognitive decline and cardiovascular complications. 

Broad primary objective: “To longitudinally assess the impact of clinical practices, biological factors and socio-behavioral issues on HIV infection and disease progression in an African context.”

  • Evaluation tool for MHRP PEPFAR program
  • HIV pathogenesis and impact of comorbidities
  • Measurement of long term outcomes

MHRP developed a substudy mechanism that facilitates collaboration. For more information, or to inquire about collaborating on AFRICOS, please contact

Protocol Chair: COL Julie Ake

Protocol Co-Chair: Dr. Christina Polyak MD, MPH

For more information, or to inquire about collaborating on AFRICOS, please refer to our collaboration info sheet.

AFRICOS Protocol