Evaluation of the immunologic and genital tract changes among Malawian women

描述（由申请人提供）：这是一份申请福格蒂国际中心K 01国际研究科学家发展奖的申请，该奖项授予查佩尔山的北卡罗来纳州大学专门从事计划生育和全球妇女健康的妇产科医生詹妮弗·唐博士。唐博士正在建立自己作为一个年轻的研究人员在激素避孕和艾滋病毒预防领域。该K 01奖将为唐博士提供必要的支持，以实现以下目标：（1）学习与艾滋病毒感染相关的免疫学和生殖道标志物的基础知识;（2）获得先进的研究设计和生物统计分析经验;（3）成为在资源有限的环境中设计和实施随机对照试验的专家;（4）在艾滋病毒感染的基础上进行研究。（4）培养与临床和基础科学家进行多学科、远程合作的技能。为了实现这些目标，Tang博士组建了一个指导小组，成员包括：一位美国的主要指导员，Jeffrey Stringer博士，他是艾滋病全球妇女健康部主任，也是国际公认的艾滋病预防和治疗研究专家;一位马拉维的主要指导员，Mina Hosseinipour博士，他是艾滋病项目-马拉维的临床主任，也是撒哈拉以南非洲艾滋病和传染病研究专家; Gretchen Stuart博士，联合国计划生育方案主任，激素避孕与艾滋病毒感染和治疗之间相互作用的专家; William米勒博士，联合国卫生保健流行病学和临床研究方案主任，分析方法专家，指导年轻研究人员实现研究独立; Kristina Abel博士，艾滋病研究免疫学核心中心副主任，粘膜免疫和艾滋病毒感染发病机制专家。了解孕激素（如甲羟孕酮或左炔诺孕酮）和艾滋病毒感染之间的潜在联系是目前妇女健康研究人员和政策制定者的一个重要研究优先事项。唐博士的研究将集中在阐明这种关系，通过随机分配艾滋病毒阴性妇女接受长效醋酸甲羟孕酮（DMPA）注射或Jadelle（R）左炔诺孕酮植入剂，并比较这些避孕药开始后发生的免疫学变化（目标1）和生殖道变化（目标2）。此外，她的研究将评估在撒哈拉以南非洲艾滋病毒感染风险人群中进行DMPA与Jadelle（R）长期随机对照试验的可行性和可接受性（目标3）。唐博士将30名妇女随机分为DMPA或Jadelle（R），并在避孕开始前后的多个时间点评估血清和生殖道抗菌素，炎性细胞因子和抗炎细胞因子的水平，长达2年的避孕使用。这项研究将为一项更大规模的多中心临床试验奠定基础，该试验将评估使用DMPA、Jadelle（R）和其他激素避孕药的妇女感染艾滋病毒的风险。这项试验将由唐博士在4年职业发展奖励期结束前作为R 01申请提交。

DESCRIPTION (provided by applicant): This is an application for a Fogarty International Center K01 International Research Scientist Development Award for Dr. Jennifer Tang, an obstetrician gynecologist specializing in family planning and global women's health at the University of North Carolina (UNC) at Chapel Hill. Dr. Tang is establishing herself as a young investigator in the areas of hormonal contraception and HIV prevention. This K01 award will provide Dr. Tang with the support necessary to accomplish the following goals: (1) to learn the fundamentals of immunological and genital tract markers related to HIV acquisition; (2) to gain experience in advanced study design and biostatistical analysis; (3) to become an expert in the design and implementation of randomized controlled trials in resource-limited settings; and (4) to develop skills in multidisciplinary, long-distance collaboration with clinical and basic scientits. To achieve these goals, Dr. Tang has assembled a mentoring team comprised of a U.S primary mentor, Dr. Jeffrey Stringer, Director of the UNC Global Women's Health Division and an internationally-recognized research expert in HIV prevention and treatment; a Malawi primary mentor, Dr. Mina Hosseinipour, Clinical Director of UNC Project-Malawi and an expert in HIV and infectious disease research in sub-Saharan Africa; Dr. Gretchen Stuart, Director of the UNC Family Planning Program and expert in interactions between hormonal contraception and HIV infection and treatment; Dr. William Miller, Director of the UNC Program in Health Care Epidemiology and Clinical Research and an expert in analytic methods and mentoring young investigators toward research independence; and Dr. Kristina Abel, Associate Director of the UNC Center for AIDS Research Immunology Core and an expert in mucosal immunity and the pathogenesis of HIV infection. Understanding the potential association between progestins (such as medroxyprogesterone or levonorgestrel) and HIV acquisition is currently a critical research priority for women's health researchers and policymakers. Dr. Tang's research will focus on elucidating this relationship by randomizing HIV-negative women to receive the depot medroxyprogesterone acetate (DMPA) injection or the Jadelle(R) levonorgestrel implant and comparing the immunologic changes (Aim 1) and genital tract changes (Aim 2) that occur after initiation of these contraceptives. In addition, her research will evaluate the feasibility and acceptability of conducting a long-term randomized controlled trial of DMPA versus Jadelle(R) in a sub-Saharan African population at-risk for HIV acquisition (Aim 3). Dr. Tang will randomize 30 women to DMPA or Jadelle(R) and evaluate serum and genital tract levels of antimicrobials, inflammatory cytokines, and anti-inflammatory cytokines at multiple time points before and after contraceptive initiation, for up to 2 years of contraceptive use. This study will form the basis fo a larger, multicenter clinical trial that will evaluate the risk for HIV acquisition among women usin DMPA , Jadelle(R), and other hormonal contraceptives. This trial will be submitted by Dr. Tang as an R01 application before the end of the 4-year career development award period.