Proposed is a K24 Mid-Career Investigator Award for Dr. Gregory Kirk, Associate Professor at Johns Hopkins University entitled "Patient-Oriented Research and Mentorship in HIV and Non-Communicable Diseases (NCDs)." To address the dual epidemics of HIV and NCDs, this proposal aims to enhance both investigator and research capacity in the US and in sub-Saharan Africa. Dr. Kirk is an infectious disease specialist with an MPH and PHD in epidemiology jointly appointed in the Department of Epidemiology and the Division of Infectious Diseases in the Schools of Public Health and Medicine, respectively. He has been actively engaged in research, clinical, mentoring and teaching activities at Hopkins for more than a decade with an established track record of research productivity, sustained NIH funding, and effective mentorship leading to mentees' successful transition to academic faculty positions. Dr. Kirk's current research program is directed toward two compelling and complementary primary research objectives: First, to characterize the epidemiology, mechanisms and consequences of non-AIDS outcomes among aging HIV-infected persons, and Second, to improve treatment outcomes among marginalized HIV-infected populations. These research activities are centered in three well-developed and highly-characterized study populations, including the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, the Study of HIV Infection in the Etiology of Lung Disease (SHIELD) cohort, and in studies supported by the newly-initiated HIV and Hepatocellular Carcinoma in Uganda (H2U) Consortium. For each cohort, Dr. Kirk serves as the principal investigator with separate NIH grant support in collaboration with a multidisciplinary team of expert investigators. Each of these study populations support focused, hypothesis-driven investigation of NCDs in the setting of HIV while also providing excellent opportunities for mentees in patient-oriented research. With K24 support, Dr. Kirk proposes expanding his HIV and aging research from a US focus to address the double burden of HIV and NCDs in sub-Saharan Africa. Nested within the substantive clinical research infrastructure of the Infectious Disease Institute (IDI) and Makerere University in Kampala, Uganda, Dr. Kirk and colleagues will characterize the prevalence of seven NCDs among 1000 older HIV-infected Ugandans recruited into the H2U cohort to determine the prevalence and correlates of age-related phenotypes including multimorbidity, frailty, and reduced physical performance. During 2-year follow-up, consequences of these phenotypes will be assessed including HIV care outcomes, disability and mortality. In parallel, Dr. Kirk's successful mentoring approaches employed at Hopkins will be expanded globally to provide intensive mentoring and training in essential academic skills (e.g., grant and scientific writing, study design, presentation skills) to advance the careers of early-stage African investigators.