Multidisciplinary Research Training to Understand and Reduce HIV Incidence in Uganda

尽管全球艾滋病毒应对工作取得了实质性进展，但影响并不均衡。乌干达 提供了一个主要的案例研究。乌干达是疫情早期的震中，首次报告“苗条” 我们小组于 1985 年发表了《东非疾病》。在接下来的二十年里，乌干达在这方面处于领先地位。 努力控制疫情。最近，新增艾滋病毒感染人数仍然较多，特别是在难以控制的地区 现代乌干达对艾滋病毒流行的应对措施虽有所改善，但仍 混合图片。尽管艾滋病毒服务规模有所扩大，但估计仍有大约 在抗逆转录病毒治疗效果不佳的情况下，每年有 28,000 例与艾滋病相关的死亡和 83,000 例新感染病例 和男性包皮环切术的覆盖范围。高流动性、次优联系和护理保留、持续高风险 性行为以及对艾滋病毒传播动态的不完全了解继续损害 最佳响应。乌干达越来越多地发现艾滋病毒“热点”，这加剧了这些挑战， 艾滋病毒负担高的地理区域，这些地区的艾滋病毒服务往往很有限。乌干达，像大多数总统紧急救援计划一样 国家采取了更积极的方法，包括测试和治疗所有并引入预治疗 暴露预防 (PrEP)。然而，这些方法的影响尚不清楚，需要密切关注 监测以了解其实施情况和影响。 HIV 传播动态的复杂性 和回应提出了许多影响乌干达和撒哈拉以南非洲地区的关键研究问题 政策和计划。为了解决这些研究领域的问题，当地能力至关重要 加强了。特别是，我们认为必须以多学科的方式建设能力，以便更好地 了解并减少乌干达及其他地区的艾滋病毒发病率，这是美国国立卫生研究院的一个高度优先的研究领域。我们组 在培训艾滋病毒研究领域的领导者方面拥有悠久而成功的遗产，并且有能力在此基础上继续发展 这个基础。我们提出了一种多学科方法来发展乌干达的科学能力，这将 强调 3 个协同领域：(1) 实施科学，(2) 地理空间分析/传染病 动力学和 (3) 病毒学/免疫学/HIV 治疗。这些学科跨越诊所、社区、模特、 和实验室科学，并将确保我们实现该计划的长期目标和目的， 乌干达机构将具备理解、应对并最终解决问题所需的研究能力 控制艾滋病毒流行。我们将邀请22名多学科学士、硕士、博士和博士后学员参加 研究生水平的培训，主要在乌干达。此次培训的主要受益者将是Rakai Health 约翰·霍普金斯大学与乌干达科学项目和麦克雷雷大学公共卫生学院合作 申请机构大学与该大学有着长达 30 年的非常成功的合作关系。我们的 预期成果是培养乌干达世界一流的研究能力骨干队伍，能够 带领乌干达结束艾滋病毒流行。

While substantial progress have been made in the global HIV response, impact have been uneven. Uganda provides a prime case study. Uganda was an early epicenter of the epidemic, with the first report of “slim disease” in East Africa published by our group in 1985. Over the next two decades, Uganda was a leader in efforts to control the epidemic. More recently, new HIV infections remain substantial, particularly in hard-to- reach subpopulations, and the modern Ugandan response to the HIV epidemic presents an improving but mixed picture. Despite moderate scale-up of HIV services, it is estimated that there are still approximately 28,000 yearly AIDS-related deaths and 83,000 new infections in the setting of suboptimal antiretroviral therapy and male circumcision coverage. High mobility, suboptimal linkage and retention in care, persistent high risky sexual behaviors, and an incomplete understanding of HIV transmission dynamics continue to compromise an optimal response. Adding to these challenges are the increasing identification of HIV “hotspots” in Uganda, geographic areas of high HIV burden, where HIV services are often limited. Uganda, like most PEPFAR countries, has adopted more aggressive approaches, including Test and Treat All and introducing Pre- Exposure Prophylaxis (PrEP). However, the impact of these approaches is unclear and will need close monitoring to understand their implementation and impact. This complexities of HIV transmission dynamics and responses raise many critical research questions which impact both Ugandan and Sub-Saharan African policies and programs. In order to address these research areas, it is essential that local capacity be strengthened. In particular, we believe capacity must be built in a multidisciplinary fashion to better understand and reduce HIV incidence in Uganda and beyond, a high priority NIH research area. Our group has a long and successful legacy of training leaders in HIV research and are strongly positioned to build upon this foundation. We propose a multidisciplinary approach to developing scientific capacity in Uganda which will emphasize 3 synergistic areas: (1) Implementation Science, (2) Geospatial Analysis/Infectious Disease Dynamics and (3) Virology/Immunology/HIV Cure. These disciplines span the clinic, community, modeling, and the lab sciences and will ensure that we reach the long-term goals and objectives of the program, which are that Ugandan institutions will have the research capacity needed to understand, respond to, and eventually control the HIV epidemic. We will involve 22 trainees in multidisciplinary bachelor, master's, PhD, and post- graduate level training, mostly in Uganda. The primary beneficiaries of this training will be the Rakai Health Sciences Program and the Makerere University School of Public Health in Uganda with whom Johns Hopkins University, the applicant institution, has had a highly successful collaborative relationship for 30 years. Our anticipated outcome is to have developed a world-class cadre of Ugandan research capacity capable of leading Uganda to the end of its HIV epidemic.