OPTIMIZING HIV/TB MANAGEMENT IN THE HAART ERA

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DESCRIPTION (provided by applicant): Approximately 93% of the global HIV infections occur in the developing world, with Latin America accounting for 1.5 million cases and the Caribbean, which has the highest HIV prevalence rate outside of sub-Saharan Africa, for 440,000 more, indicating the critical need for an international effort to control HIV spread in these countries. Through the auspices of the Miami Fogarty AITRP and Pediatric programs, 175 government endorsed scholars have received instruction in AIDS/TB prevention and treatment, returning home (92+% return rate) to guide their countries with initiatives and strategies to reduce the burden of disease. With the advent of highly active antiretroviral therapy (HAART), possibilities of HIV-1 suppression and control have emerged. In response to increasing access to HAART in Latin America and the Caribbean our objectives for the next five years are designed to promote independent and sustainable scientific capacity that will enable Fogarty scholars to assist their countries in conducting wide-scale programs to: 1) Promote optimal treatment and care of children and adults living with HIV/AIDS and those co-infected with HIV/TB; 2) Enhance adherence for HIV/TB treatment, and reduce the potential for drug resistance; 3) Determine obstacles in access to care, including the impact of stigma on utilization of health services; 4) Identify continued high-risk behaviors and establish appropriate interventions to reduce risk of transmission, and improve quality of life in the era of HAART; and 5) Evaluate the economic and social impact of prevention and treatment interventions. The establishment of effective scientific infrastructures, and long-standing partnerships between Miami and host country institutions will permit the challenges facing our target countries (Brazil, Colombia, Dominican Republic, Guyana, Jamaica, Peru) to be addressed. These objectives will be implemented in the context of ethical procedures and will include attention to the economic and social impact of research operations. We propose to integrate the research expertise of our in-country Fogarty scholars with biomedical and behavioral research training, according to the specific needs of the host countries. Research training will be conducted in Miami and the host countries, to facilitate independent research capacity and sustainable interventions, to ultimately quell the tide of the epidemic.