Modified Project Summary/Abstract Section The RUSTBELT CFAR Uganda Core C achieved several notable milestones: (i) In 2017, the core was chosen as one of two leading national HIV drug resistance testing laboratories for genotyping second-line ART treatment failures. (ii) We incorporated next-generation sequencing (NGS) alongside traditional Sanger sequencing for HIV drug resistance testing. (iii) We received College of American Pathologists’ (CAP) accreditation in 2017, which was recertified in 2019, for HIV drug resistance testing. (iv) The EDITS assay for measuring the HIV RNA reservoir was transferred from CWRU. (v) Core C advanced research projects on HIV Cure, HIV-TB, HIV-associated malignancies, and cardiovascular complications. (vi) Core C became a training and research site for graduate students from Makerere University (MU). The collaboration between MU and CWRU celebrated its 30th year in 2018 and is recognized as a successful model of international cooperation and progress. Currently, more than 200 Ugandan scientists and healthcare professionals participate in CFAR programs at the Joint Clinical Research Centre (JCRC), MU, and Mulago Hospital in Kampala. Thanks to CFAR investments, Uganda has advanced in molecular HIV virology and clinical immunology research. The integration of the University of Pittsburgh (Pitt) with CWRU/UHMC to establish RUSTBELT CFAR has significantly broadened Core C’s research and training opportunities for Ugandan, CWRU, and Pitt trainees and researchers, encompassing a wider range of translational, clinical, and implementation research. Building on these milestones, Core C aims to (1) support virologic and immunologic research into HIV complications and the influence of sex on HIV infection in Uganda. It will incorporate innovative techniques and assays to examine how hormonal status and contraception affect the HIV reservoir, the role sex plays in HIV co-infection, cardiovascular complications, HIV-associated malignancies, and the microbiome in HIV patients. (2) Expand research on how HIV drug resistance impacts HIV prevention efforts in Uganda. The collaboration with Pitt brings extensive expertise that will enhance Core C’s focus on HIV drug resistance and prevention research. (3) Support new translational HIV research in Uganda led by RUSTBELT CFAR investigators. This will build on Uganda’s clinical research experience through CWRU’s TB Research Unit and AIDS Clinical Trials Unit. (4) Continue providing biomedical training in the US for Ugandan Master’s and PhD students. Core C, through Fogarty’s "Microbiology and Immunology Training for HIV and HIV-Related Research in Uganda” (MITHU, Co-PI: Boom, Karn, & Joloba), will help expand research opportunities. The integration of Pitt with CWRU/UHMC CFAR to create RUSTBELT CFAR greatly enhances Core C’s research and training collaborations in Uganda. Dr. Urvi Parikh, Director of Core C from Pitt, will collaborate with Dr. Immaculate Nankya, Director of Core C fr...