Research Training Program in Adolescent HIV in Haiti

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This proposal builds on the foundation established in Haiti during three decades of NIH research and training support to Groupe Haitien d’Etude du Sarcome et des Infections Opportunistes (GHESKIO) and Weill Cornell Medicine (WCM) to address the burgeoning adolescent HIV epidemic in Haiti. The focus of this training program is to improve HIV-related health outcomes of adolescents (10 to 19 years) and youth (20 to 24 years) in Haiti. A major emphasis is research-training to extend adolescent HIV services from the clinic to the community. Evidence demonstrates that providing services in the community improves access, social acceptability, cost-effectiveness, and ultimately large-scale impact. This program extends graduate level training in Haiti by establishing Haiti’s first PhD program in Public Health. We build upon an MPH program established in Haiti with prior Fogarty support. A cadre of 8 Haitian long-term trainees will receive research training – 4 will receive an MPH and 4 will receive a PhD – the first cohort with doctoral level public health training in Haiti. The research training will focus on adolescent health in the areas of 1) HIV prevention, 2) HIV treatment, 3) HIV and TB co-infection, and 4) HIV and NCDs. Trainees will be groomed to be the future leaders of adolescent health research at GHESKIO and the Haitian Ministry of Health. The program will also include medium-term training (6-12 months) of research staff including psychologists (4), data managers (4), and community health workers (4) to establish community-based research teams. In Haiti, 50% of all new HIV infections are in adolescents and youth, and 80% of these are impoverished and stigmatized females. UNICEF has declared adolescents the ‘center of the HIV epidemic’. HIV-infected adolescents and youth have poor antiretroviral treatment outcomes with only 50% remaining in care after 1 year, compared to 90% retention among adults. The period between 10 and 24 years is the peak incidence of TB infection and disease. Furthermore, only 40% of HIV-infected adolescents with culture-positive TB successfully complete therapy. Finally the rate of early onset hypertension in adolescents and youth in Haiti is 12% - 3-fold greater than in similarly aged Black Americans. The development and validation of community-based approaches to identify, engage, and retain adolescents and youth in care will lead to sustainable improvements in health outcomes in Haiti. This program responds to the priorities of the Haitian Ministry of Health and will train the next generation of Haitian leaders in the conduct of community-based adolescent HIV research.