Multidisciplinary Research Training to Understand and Reduce HIV Incidence in Uganda

多学科研究培训以了解和减少乌干达的艾滋病毒发病率

• 批准号: 10462080
• 负责人: Larry William Chang
• 金额: $ 7.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-10 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462080
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adopted; Africa; African; Area; Caring; Case Study; Cessation of life; Clinic; Communicable Diseases; Communities; Country; Discipline; Doctor of Philosophy; Educational Status; Ensure; Epidemic; Foundations; Geographic Locations; Goals; HIV; HIV Infections; HIV Wasting Syndrome; Health Sciences; Immunology; Incidence; Infection; Institution; Interdisciplinary Study; Male Circumcision; Modeling; Modernization; Monitor; Outcome; Policies; Positioning Attribute; Public Health Schools; Publishing; Reporting; Research; Research Training; Science; Services; Testing; Training; Uganda; United States National Institutes of Health; Universities; antiretroviral therapy; beneficiary; high risk sexual behavior; implementation science; improved; interdisciplinary approach; multidisciplinary; pre-exposure prophylaxis; programs; response; scale up; transmission process; virology

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.

虽然全球艾滋病毒防治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。乌干达是这一流行病的早期中心， 1985年我们小组发表的《东非的疾病》。在接下来的20年里，乌干达是一个领导者， 努力控制疫情。最近，新的艾滋病毒感染仍然很大，特别是在难以感染的地区。 达到亚人群，现代乌干达对艾滋病毒流行病的反应呈现出改善，但 好坏参半。尽管艾滋病毒服务略有扩大，但据估计， 每年有28 000例艾滋病相关死亡和83 000例新感染病例是在抗逆转录病毒治疗欠佳的情况下发生的 和男性包皮环切术的覆盖率。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力学的不完全理解，继续损害着 最佳反应除了这些挑战之外，乌干达越来越多地发现艾滋病毒“热点”， 艾滋病毒负担重的地理区域，那里的艾滋病毒服务往往有限。乌干达，像大多数PEPFAR一样， 国家，采取了更积极的方法，包括测试和治疗所有和引进前- 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，以了解其执行情况和影响。艾滋病毒传播动力学的复杂性 和反应提出了许多关键的研究问题，影响乌干达和撒哈拉以南非洲 政策和方案。为了解决这些研究领域的问题，必须加强当地能力， 增强广大特别是，我们认为，必须以多学科方式建设能力， 了解和减少艾滋病毒的发病率在乌干达和超越，一个高度优先的NIH研究领域。我们集团 在培训艾滋病毒研究领导者方面拥有长期而成功的传统，并有能力在此基础上再接再厉 这个基金会。我们建议采取多学科方法来发展乌干达的科学能力， 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/艾滋病毒治疗。这些学科跨越诊所，社区，建模， 和实验室科学，并将确保我们达到该计划的长期目标和目的， 乌干达的机构将拥有必要的研究能力来理解，回应，并最终 控制艾滋病的流行。我们将涉及22名多学科学士，硕士，博士和博士后培训生， 研究生水平的培训，主要是在乌干达。这项培训的主要受益者将是Rakai保健 科学计划和乌干达马凯雷雷大学公共卫生学院，约翰霍普金斯大学和他们一起 大学，申请机构，有一个非常成功的合作关系为30年。我们 预期的结果是发展了一个世界级的乌干达研究能力骨干，能够 使乌干达结束了艾滋病的流行。