PROJECT SUMMARY/ABSTRACT Candidate: Dr. Attia’s long-term goal is to improve lung health globally, conducting clinical research and trials in chronic lung diseases, with a focus on the role of HIV and other risk factors in influencing the pathophysiology and clinical course of lung disease. Research proposed in this funded extension of her K23 Career Development Award builds on her previous and ongoing work, which demonstrates a substantial burden of chronic lung disease among adolescents living with HIV in a resource-limited setting. This extension will provide Dr. Attia with essential protected time to complete longitudinal analyses for Aim 2 and 3 of her K23 research, submit R01 applications, and continue training to support her goal of becoming an independent investigator at the intersection of pulmonary disease, HIV and global health. During the extension, Dr. Attia will continue to solidify her expertise in: 1) training in analysis of lung growth in adolescents; 2) advanced biostatistical methods to analyze complex correlated and missing data. These objectives will be achieved through a career development plan that incorporates coursework and continued mentoring by an advisory committee with expertise in lung disease and lung growth, HIV, epidemiology, biostatistics, and the use of biospecimens in clinical research. Environment: The rich academic environment at the University of Washington (UW) is an ideal place for Dr. Attia’s continued research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Division of Pulmonary and Critical Care Medicine is widely recognized for its Clinical Research Training Track and offers an intellectual environment that supports development of the skills necessary to achieve academic success. As co-director of the UW Department of Global Health Teaching, Research and Expert Education program, Dr. Attia will have full access to resources that support the administrative, clinical, laboratory and database management infrastructure for clinical research at the UW-affiliated Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. She will also have access to biostatistical support through the UW CTSA and School of Public Health. Research: During this extension, Dr. Attia will examine differences in subtypes, risk factors and mechanisms of chronic lung disease, based on repeat pre- and post-bronchodilator spirometry obtained over 3-4 years in 161 adolescents living with HIV from the Hope Center compared to 174 HIV-uninfected adolescents. She will: 1) determine the role of HIV on change in lung function over time, considering the complex interplay with other risk factors including malnutrition and indoor biofuel burning; 2) evaluate whether HIV severity, and biomarkers of immune activation and inflammation are associated with diminished lung function growth over time. Findings will provide novel insights into...