Edwin Charlebois, PhD, MPH

Professor

As a senior scientist at the UCSF Center for AIDS Prevention Studies (CAPS) my research program focuses on the epidemiology and prevention of HIV infection and its consequences. Overarching this focus are translational science efforts to improve the methodology and evaluation of research and interventions aimed at controlling and eventually eliminating the domestic and international spread of HIV.

Domestic HIV Research: My most recent domestic HIV prevention research is an evaluation of the potential effect of expanded ART and HIV testing strategies on reducing the number of new HIV infections in San Francisco. In this computational biology modeling paper published in CID in 2011 (with an accompanying editorial) we estimated significant reductions in new HIV infections are likely with expanded HIV treatment of those already in care and even greater gains with more frequent at-risk community HIV testing. This research along with the results of recent clinical trials were cited as evidence for a change in treatment policy in San Francisco to offer ART to all HIV infected persons. Our studies relate well with a recent editorial we published in 2010 in Archives of Internal Medicine wherein we highlight the importance of linking HIV infected persons into care and the associated potential HIV prevention benefits.

Another priority research area for me is the development of methods for the evaluation of combination HIV prevention interventions. Combination HIV prevention interventions are specifically called for in the US National HIV/AIDS Strategy (NHAS) and specific evaluation methods for them have been identified as significant scientific gap in our recently published 2011 editorial in JAIDS on setting the NIH research agenda for the NHAS. Specifically, I have received developmental funding to pursue novel evaluation methods for community-level combination HIV prevention interventions that involve surveillance measurements of community HIV viral load, intervention process measures and structural equation modeling. In addition I will be co-directing a research team assisting in the evaluation of the San Francisco implementation of the HRSA and CDC’s 12-city project – a combination HIV prevention intervention comprising 14 interventions. In the fall of 2011 I will be leading a national round-table on the state-of-the-art and future research directions for evaluation methods for combination HIV prevention interventions to be hosted by the UCSF Center for AIDS Prevention Studies.

International HIV Research: Internationally, my research focus is on HIV and co-infections/interaction with Tuberculosis and Malaria. Primarily working in East Africa, I am Principal Investigator of three NIH sponsored grants and co-investigator on several more. I am currently studying effective strategies for diagnosing HIV among outpatient TB evaluation patients and their family and household members in a 2,000 person randomized trial of home-based versus TB clinic based HIV testing and utilization of same-day rapid HIV tests. I am also involved in studying interactions between HIV protease inhibitor treatment and malaria incidence in two additional randomized HIV treatment trials among HIV infected children and HIV infected pregnant women. On a broader scale I am co-leading the development of a three country research collaboration, SEARCH (Sustainable East Africa Research in Community Health) to study the community level effectiveness of a program of community-wide HIV testing and universal HIV treatment to all HIV infected persons and its effect on HIV, TB, Malaria incidence and community economic and educational productivity. My area of research within the collaboration focuses on the 40 community-cluster randomized design, its HIV specific end-points of HIV incidence and community HIV viral load, and the development and evaluation of streamlined HIV care and evaluation.

Training the Next Generation of HIV Scientists: An important part of my research program is training and mentoring the next generation of HIV scientists. As the principal investigator of 2 large international data management and statistical support cores (one for a NICHD supported program project, and one for a NIAID funded International Center for Excellence in Malaria Research, ICEMR) – I am able to organize and support the cores as a resource for training and mentoring post-doctoral researchers and medical students in international HIV and clinical research. Through individual level research mentorship, a weekly international investigators seminar held in the US, the UCSF CAPS Traineeship in AIDS Prevention Studies (TAPS) program, and affiliated NIH K training grants, I supervise and assist between 3-5 trainees annually in the development of individual research projects, and epidemiologic and biostatistical training.
Publications
  1. Factors predictive of successful retention in care among HIV-infected men in a universal test-and-treat setting in Uganda and Kenya: A mixed methods analysis.
  2. A patient-centered multi-component strategy for accelerated linkage to care following community-wide HIV testing in rural Uganda and Kenya.
  3. Mobile, Population-wide, Hybrid HIV Testing Strategy Increases Number of Children Tested in Rural Kenya and Uganda.
  4. Early Adopters of Human Immunodeficiency Virus Preexposure Prophylaxis in a Population-based Combination Prevention Study in Rural Kenya and Uganda.
  5. Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the search study.
  6. "Hurdles on the path to 90-90-90 and beyond": Qualitative analysis of barriers to engagement in HIV care among individuals in rural East Africa in the context of test-and-treat.
  7. Dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria during pregnancy and risk of malaria in early childhood: A randomized controlled trial.
  8. Population mobility associated with higher risk sexual behaviour in eastern African communities participating in a Universal Testing and Treatment trial.
  9. Effect of a Patient-Centered Phone Call by a Clinical Officer at Time of HIV Testing on Linkage to Care in Rural Kenya.
  10. Isoniazid Preventive Therapy Completion in the Era of Differentiated HIV Care.
  11. Gaps in the Child Tuberculosis Care Cascade in 32 Rural Communities in Uganda and Kenya.
  12. Redemption of the "spoiled identity:" the role of HIV-positive individuals in HIV care cascade interventions.
  13. Understanding uptake of an intervention to accelerate antiretroviral therapy initiation in Uganda via qualitative inquiry.
  14. Correction to: Impact of a Structural Intervention to Address Alcohol Use Among Gay Bar Patrons in San Francisco: The PACE Study.
  15. Impact of a Structural Intervention to Address Alcohol Use Among Gay Bar Patrons in San Francisco: The PACE Study.
  16. Predictors of Retention in HIV Care Among Youth (15-24) in a Universal Test-and-Treat Setting in Rural Kenya.
  17. High rates of viral suppression in adults and children with high CD4+ counts using a streamlined ART delivery model in the SEARCH trial in rural Uganda and Kenya.
  18. Intermittent Preventive Treatment With Dihydroartemisinin-Piperaquine for the Prevention of Malaria Among HIV-Infected Pregnant Women.
  19. Association of Implementation of a Universal Testing and Treatment Intervention With HIV Diagnosis, Receipt of Antiretroviral Therapy, and Viral Suppression in East Africa.
  20. Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda.
  21. Population levels and geographical distribution of HIV RNA in rural Ugandan and Kenyan communities, including serodiscordant couples: a cross-sectional analysis.
  22. Growth Recovery Among HIV-infected Children Randomized to Lopinavir/Ritonavir or NNRTI-based Antiretroviral Therapy.
  23. High levels of retention in care with streamlined care and universal test and treat in East Africa.
  24. Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa.
  25. Implementation and Operational Research: Population-Based Active Tuberculosis Case Finding During Large-Scale Mobile HIV Testing Campaigns in Rural Uganda.
  26. Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya.
  27. Effects of a multicomponent intervention to streamline initiation of antiretroviral therapy in Africa: a stepped-wedge cluster-randomised trial.
  28. Tuberculosis Infection in Early Childhood and the Association with HIV-exposure in HIV-uninfected Children in Rural Uganda.
  29. Strengthening universal HIV 'test-and-treat' approaches with social science research.
  30. Dihydroartemisinin-Piperaquine for the Prevention of Malaria in Pregnancy.
  31. Brief Report: Food Insufficiency Is Associated With Lack of Sustained Viral Suppression Among HIV-Infected Pregnant and Breastfeeding Ugandan Women.
  32. A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study.
  33. "How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial.
  34. Expectations about future health and longevity in Kenyan and Ugandan communities receiving a universal test-and-treat intervention in the SEARCH trial.
  35. Men "missing" from population-based HIV testing: insights from qualitative research.
  36. A Framework for Global Collaborative Data Management for Malaria Research.
  37. "I Have Remained Strong Because of That Food": Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy.
  38. Acceptance of the use of HIV surveillance data for care engagement: national and local community perspectives.
  39. Examining clinic-based and public health approaches to ascertainment of HIV care status.
  40. Hair concentrations of antiretrovirals predict viral suppression in HIV-infected pregnant and breastfeeding Ugandan women.
  41. Authors' response.
  42. The effect of malnutrition on the pharmacokinetics and virologic outcomes of lopinavir, efavirenz and nevirapine in food insecure HIV-infected children in Tororo, Uganda.
  43. Efficacy and safety of lopinavir/ritonavir versus efavirenz-based antiretroviral therapy in HIV-infected pregnant Ugandan women.
  44. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy.
  45. Risk factors for preterm birth among HIV-infected pregnant Ugandan women randomized to lopinavir/ritonavir- or efavirenz-based antiretroviral therapy.
  46. Successful antiretroviral therapy delivery and retention in care among asymptomatic individuals with high CD4+ T-cell counts above 350 cells/µl in rural Uganda.
  47. Assessing the quality of tuberculosis evaluation for children with prolonged cough presenting to routine community health care settings in rural Uganda.
  48. Increased morbidity in early childhood among HIV-exposed uninfected children in Uganda is associated with breastfeeding duration.
  49. Lopinavir/ritonavir-based antiretroviral treatment (ART) versus efavirenz-based ART for the prevention of malaria among HIV-infected pregnant women.
  50. Artemisinin-based combination therapies are efficacious and safe for treatment of uncomplicated malaria in HIV-infected Ugandan children.
  51. Virologic and immunologic outcomes of HIV-infected Ugandan children randomized to lopinavir/ritonavir or nonnucleoside reverse transcriptase inhibitor therapy.
  52. Changes in population HIV RNA levels in Mbarara, Uganda, during scale-up of HIV antiretroviral therapy access.
  53. Evaluating linkage to care for hypertension after community-based screening in rural Uganda.
  54. Uptake of community-based HIV testing during a multi-disease health campaign in rural Uganda.
  55. Epidemiology and awareness of hypertension in a rural Ugandan community: a cross-sectional study.
  56. Does effective depression treatment alone reduce secondary HIV transmission risk? Equivocal findings from a randomized controlled trial.
  57. Pharmacokinetics of lopinavir/ritonavir and efavirenz in food insecure HIV-infected pregnant and breastfeeding women in Tororo, Uganda.
  58. Hair and plasma data show that lopinavir, ritonavir, and efavirenz all transfer from mother to infant in utero, but only efavirenz transfers via breastfeeding.
  59. Acceptability and feasibility of serial HIV antibody testing during pregnancy/postpartum and male partner testing in Tororo, Uganda.
  60. High retention in care among HIV-infected patients entering care with CD4 levels >350 cells/µL under routine program conditions in Uganda.
  61. Neonatal mortality in HIV-exposed infants born to women receiving combination antiretroviral therapy in Rural Uganda.
  62. Improved employment and education outcomes in households of HIV-infected adults with high CD4 cell counts: evidence from a community health campaign in Uganda.
  63. Prevalence of asymptomatic parasitemia and gametocytemia among HIV-infected Ugandan children randomized to receive different antiretroviral therapies.
  64. Assessment of population-based HIV RNA levels in a rural east African setting using a fingerprick-based blood collection method.
  65. Antiretroviral agents and prevention of malaria in HIV-infected Ugandan children.
  66. Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda.
  67. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.
  68. Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial.
  69. Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts.
  70. Resistance patterns and response to entecavir intensification among HIV-HBV-coinfected adults with persistent HBV viremia.
  71. Sex differences in HIV RNA level and CD4 cell percentage during childhood.
  72. Responding to the National HIV/AIDS Strategy-setting the research agenda.
  73. The effect of expanded antiretroviral treatment strategies on the HIV epidemic among men who have sex with men in San Francisco.
  74. Effects of antiretroviral therapy on immune function of HIV-infected adults with pulmonary tuberculosis and CD4+ >350 cells/mm3.
  75. Early virologic failure and the development of antiretroviral drug resistance mutations in HIV-infected Ugandan children.
  76. Short-term risk of HIV disease progression and death in Ugandan children not eligible for antiretroviral therapy.
  77. "A bird in the hand...": a commentary on the test and treat approach for HIV.
  78. Mycobacterium tuberculosis microbiologic and clinical treatment outcomes in a randomized trial of immediate versus CD4(+)-initiated antiretroviral therapy in HIV-infected adults with a high CD4(+) cell count.
  79. Acute HIV-1 infection is highly prevalent in Ugandan adults with suspected malaria.
  80. Effect of trimethoprim-sulphamethoxazole on the risk of malaria in HIV-infected Ugandan children living in an area of widespread antifolate resistance.
  81. HIV-subtype A is associated with poorer neuropsychological performance compared with subtype D in antiretroviral therapy-naive Ugandan children.
  82. Tuberculosis as part of the natural history of HIV infection in developing countries.
  83. Tuberculosis treatment in HIV infected Ugandans with CD4 counts>350 cells/mm reduces immune activation with no effect on HIV load or CD4 count.
  84. Lopinavir/ritonavir affects pharmacokinetic exposure of artemether/lumefantrine in HIV-uninfected healthy volunteers.
  85. Patient perspectives with abbreviated versus standard pre-test HIV counseling in the prenatal setting: a randomized-controlled, non-inferiority trial.
  86. Dynamics of T cell activation accompanying CD4 recovery in antiretroviral treated HIV-infected Ugandan children.
  87. Polymerase chain reaction of secA1 on sputum or oral wash samples for the diagnosis of pulmonary tuberculosis.
  88. The Distribution and Immune Profile of T Cell Subsets in HIV-Infected Children from Uganda.
  89. Project Accept (HPTN 043): a community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand.
  90. Unexpected low-level viremia among HIV-infected Ugandan adults with untreated active tuberculosis.
  91. HIV RNA suppression among HIV-infected Ugandan children with measles.
  92. Receipt of prevention services among HIV-infected men who have sex with men.
  93. High risk of neutropenia in HIV-infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda.
  94. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: the healthy living project randomized controlled study.
  95. HIV-1 infection in patients referred for malaria blood smears at government health clinics in Uganda.
  96. Profile of T cell immune responses in HIV-infected children from Uganda.
  97. Effects of trimethoprim-sulfamethoxazole and insecticide-treated bednets on malaria among HIV-infected Ugandan children.
  98. Early virological response of zidovudine/lamivudine/abacavir for patients co-infected with HIV and tuberculosis in Uganda.
  99. Correlates of suicidal ideation among HIV-positive persons.
  100. Hepatotoxicity due to a drug interaction between amodiaquine plus artesunate and efavirenz.
  101. Comparison of an interferon-gamma release assay with tuberculin skin testing in HIV-infected individuals.
  102. Inappropriate antibiotic use in soft tissue infections.
  103. False-positive results of enzyme immunoassays for human immunodeficiency virus in patients with uncomplicated malaria.
  104. Antiretroviral therapy and TB.
  105. Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV-infected adults: A mediation model.
  106. Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe.
  107. HIV surveillance in theory and practice: assessing the acceptability of California's non-name HIV surveillance regulations.
  108. Population dynamics of nasal strains of methicillin-resistant Staphylococcus aureus--and their relation to community-associated disease activity.
  109. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections.
  110. HIV seroconversion among the homeless and marginally housed in San Francisco: a ten-year study.
  111. Rapid increase in tuberculosis incidence soon after infection with HIV--a new twist in the twin epidemics.
  112. Impact of a formulary switch from ticarcillin-clavulanate to piperacillin-tazobactam on colonization with vancomycin-resistant enterococci.
  113. Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA.
  114. Written clinic procedures enhance delivery of HIV "prevention with positives" counseling in primary health care settings.
  115. Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study.
  116. An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients.
  117. Multiple validated measures of adherence indicate high levels of adherence to generic HIV antiretroviral therapy in a resource-limited setting.
  118. HIV seroprevalence among homeless and marginally housed adults in San Francisco.
  119. Modeling the HIV protease inhibitor adherence-resistance curve by use of empirically derived estimates.
  120. Origins of community strains of methicillin-resistant Staphylococcus aureus.
  121. Hepatitis C virus infection in San Francisco's HIV-infected urban poor.
  122. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale.
  123. Are untimed antiretroviral drug levels useful predictors of adherence behavior?
  124. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy.
  125. Increasing prevalence of methicillin-resistant Staphylococcus aureus infection in California jails.
  126. High levels of adherence do not prevent accumulation of HIV drug resistance mutations.
  127. Epidemiology of vancomycin-resistant Enterococcus faecium under a selective isolation policy at an urban county hospital.
  128. Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco.