Collaborative Program Aims To Improve Study of HIV and Rheumatic and Musculoskeletal Diseases in Uganda

A new collaborative program, the Ugandan Registry of RMDs in HIV (GEMINI), aims to improve the study of HIV and rheumatic and musculoskeletal diseases (RMDs) in Uganda.

Evelyn Hsieh, MD, PhD, associate professor of medicine (rheumatology, allergy and immunology) and chronic diseases epidemiology, recently received an R21 grant from the Fogarty International Center at the U.S. National Institutes of Health to establish a novel registry of patients with co-existing HIV and RMD and two comparator groups of patients with HIV alone and RMD alone. The award will also support her work to build a collaborative research network to support innovative research in this area. Mark Kaddumukasa, MD, PhD, senior lecturer and deputy dean at Makerere University College of Health Sciences (MakCHS) and head of the rheumatology clinic at Mulago Hospital in Uganda, is the co-principal investigator of the project.

GEMINI is set to begin enrollment of patients in August 2025. To demonstrate the ability of GEMINI to support research studies, the team will concurrently carry out a pilot study focused on the impact of HIV and rheumatoid arthritis on skeletal outcomes among a subgroup of patients in the registry.

In addition to strengthening clinical and research capacity, the team is focused on training early-career faculty. They identified GEMINI Scholar Edward Mpoza, MBChB, MMed, an internal medicine physician at Makerere, who is visiting Yale for six weeks this summer to receive training in research methods and clinical rheumatology. Mpoza will return to Yale in 2026 to gain hands-on experience analyzing registry data and to pursue additional clinical training.

GEMINI’s activities are supported by an advisory committee of faculty from Yale and MakCHS, including Heather Allore, PhD; Richard Bucala, MD, PhD; Amy Justice, MD, PhD; Harriet Mayanja-Kizza, MBChB; and Fred Semitala, MBChB, as well as collaborating faculty, Levi Mugenyi and Karl Insogna, MD.

For Hsieh and Kaddumukasa, the work is deeper than a research interest – it has a direct impact on the patients they see each day as rheumatologists.

“It’s important to look at cross-cutting questions that are both impactful for low-resource country settings as well as the United States, and this is definitely one of those topics at that intersection,” Hsieh says. “As providers, we have many unanswered questions about how to optimize care for patients who have both HIV and rheumatic disease, and that’s one of the gaps in the science that we are trying to address here,” she adds. “Whether it’s understanding more about biology, treatment-related outcomes, or long-term comorbidities, we want to provide our patients with the best care and information about what to expect.”

Ongoing Work To Improve Study and Care of Patients With Non-Communicable Diseases

GEMINI grew out of ongoing efforts among researchers at Yale and MakCHS focused on improving the study and care of patients with non-communicable diseases, including HIV and RMDs.

In 2015, Hsieh co-founded the Yale Network for Global Non-Communicable Diseases (Yale NGN, pronounced “engine”) with colleagues from Yale School of Medicine and Yale School of Public Health: Nicola Hawley, PhD, associate professor of epidemiology (chronic disease); Tracy Rabin, MD, SM, associate professor of medicine (general internal medicine) and clinical professor of nursing; and Jeremy Schwartz, MD, associate professor of medicine (general internal medicine) and epidemiology (chronic disease).

In 2018, the Yale NGN received a Hecht Global Health Faculty Network Award to work with partners in Uganda on the self-care of chronic conditions among patients with non-communicable diseases in rural Uganda. Through this project, Hsieh and Kaddumukasa, who had previously crossed paths when Kaddumukasa was a Makerere University/Yale University (MUYU) Scholar at Yale, reconnected.

Hsieh and Kaddumukasa began to collaborate on a new project examining the intersection between HIV and RMDs, a topic that both strongly felt was important but understudied.

They co-mentored a team of trainees and early-career faculty from Yale and MakCHS and partnered with The Arthritis Association of Uganda, a patient-led advocacy group, to implement a patient-education project focused on strengthening rheumatic disease self-management skills.

The pair also implemented a training curriculum together with Joshua Bilsborrow, MD, MHS, Lillian Tugume, and Anthony Makhoba, MD, for Ugandan general physicians and residents on basic rheumatology concepts and established a rheumatology patient registry supported by a seed grant from the International League of Associations for Rheumatology.

The research reported in this news article was supported in part by the National Institutes of Health (award R21TW012889-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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