Male Circumcision and Use of Foreskin Tissues for HIV Prevention in Uganda

描述（由申请人提供）：医学男性包皮环切术（MMC）减少男性艾滋病毒感染，以及男性和女性的病毒性性传播感染。然而，MMC在许多非洲国家的使用率低于预期，并且在年轻，风险较低的男性中不成比例。迫切需要将定性/定量混合方法研究纳入实施科学，以增加对MMC的需求，特别是在高风险男性中;使用MC设备，任务转移/共享和移动的MMC营地来提高MMC服务的效率;并对覆盖范围和影响进行人口水平的监测。在基础科学水平上，在MC期间收集的包皮提供了独特的生殖器粘膜，用于研究与艾滋病毒易感性或保护相关的病毒学，免疫学和宿主遗传因素，对艾滋病毒预防有影响。Rakai健康科学计划（RHSP）和乌干达Makerere大学公共卫生学院（MakSPH）与约翰霍普金斯大学（JHU）合作了20多年。我们进行了两项MMC试验、试验后监测、MMC服务评价和MMC手术评估，包括新MMC器械。我们还合作进行包皮组织和生殖器微生物组的免疫学和病毒学研究。该合作通过Fogarty国际中心（FIC）奖项培训了50多名学位和非学位学生。我们建议继续这些培训工作，并提供研究机会和职业发展的乌干达科学家专注于MMC相关的研究，因为MMC是至关重要的艾滋病毒预防，因为MMC相关的研究提供了一个机会，范围广泛的协同和跨学科的研究。具体而言，在JHU，我们建议培养一名生殖器免疫学，病毒学和分子微生物学博士候选人，以及5名MPH/MHS候选人，包括实施科学，流行病学和生物统计学，计划评估和混合方法研究。我们将在MakSPH培养2名博士生，使用既定的“三明治”博士学位，允许短期学员来JHU接受高级课程和指导。在乌干达，我们将支持MakSPH和其他乌干达大学的5名硕士和3名学士学位学员，以及18名文凭/证书学员。美国项目主任（PD）罗纳德格雷博士，流行病学教授在JHU和乌干达的主要外国合作者是大卫Serwadda博士，教授，在MakSPH。培训将由乌干达和美国的培训咨询委员会监督。RHSP/MakSPH将提供进入Rakai研究现场的体验式培训，培训相关研究的数据和样本，以及丰富稳定的职业发展环境。该方案以先前的培训和研究为基础，以确保生殖健康卫生方案和MakSPH作为世界级艾滋病毒研究机构的长期可持续性和领导地位。

DESCRIPTION (provided by applicant): Medical male circumcision (MMC) reduces HIV acquisition in men, and viral STIs in men and women. However, uptake of MMC in many African countries is less than expected and has disproportionately been among younger, lower risk men. There is an urgent need for implementation science incorporating qualitative/quantitative mixed methods research to increase the demand for MMC, particularly among higher risk men; to increase the efficiency of MMC services using MC devices, task shifting/sharing and mobile MMC camps; and to conduct population-level monitoring of coverage and impact. At the basic science level, foreskins collected during MC provide unique access to genital mucosa for study of the virologic, immunologic and host genetic factors associated with vulnerability to or protection from HIV, with implications for HIV prevention. The Rakai Health Sciences Program (RHSP) and Makerere University School of Public Health (MakSPH) in Uganda have collaborated with Johns Hopkins University (JHU) for over 20 years. We conducted two trials of MMC, post-trial surveillance, evaluation of MMC services, and assessment of MMC procedures, including new MMC devices. We have also collaborated on immunologic and virologic studies of foreskin tissues and the genital microbiome. The collaboration has trained over 50 degree and non-degree students via Fogarty International Center (FIC) awards. We propose to continue these training efforts and to provide research opportunities and career development for Ugandan scientists focusing on MMC related research, both because MMC is vital to HIV prevention, and because MMC-related research provides an opportunity for a wide range of synergistic and interdisciplinary studies. Specifically, at JHU we propose to train one PhD candidate in genital immunology, virology and molecular microbiology, and 5 MPH/MHS candidates in implementation science, epidemiology and biostatistics, program evaluation and mixed methods research. We will train 2 doctoral students at MakSPH, using an established "sandwich" PhD which allows short-term trainees to come to JHU for advanced courses and mentoring. In Uganda, we will support 5 Masters and 3 Bachelors degree trainees, and 18 diploma/certificate trainees at MakSPH and other Ugandan universities. The U.S. Program Director (PD) Dr. Ronald Gray, Professor of Epidemiology at the JHU and the Ugandan Key Foreign Collaborator is Dr. David Serwadda, Professor, at MakSPH. Training will be overseen by Training Advisory Committees in Uganda and the US. RHSP/MakSPH will provide access to the Rakai research field site for experiential training, data and samples for training-related research, and a rich stable environment for career development. The program builds on prior training and research to ensure the long-term sustainability and leadership of RHSP and MakSPH as world class HIV research institutions.