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

项目总结/摘要 医疗男性包皮环切术（MMC）减少了男性感染艾滋病毒的机会，也减少了男性和女性感染病毒性性传播感染的机会。 然而，MMC在许多非洲国家的使用率低于预期， 在年轻的低风险男性中迫切需要实施科学， 定性/定量混合方法的研究，以增加对MMC的需求，特别是在较高的 风险管理人员;使用MC设备、任务转移/共享和移动的MMC来提高MMC服务的效率 难民营;并对覆盖面和影响进行人口一级的监测。在基础科学层面， 在MC过程中收集的包皮为研究生殖器粘膜的病毒学、免疫学 和与易感染艾滋病毒或保护免受艾滋病毒有关的宿主遗传因素，以及对艾滋病毒的影响 预防Rakai健康科学计划（RHSP）和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 两项MMC试验、试验后监测、MMC服务评价和MMC程序评估， 包括新的MMC设备。我们还合作进行包皮的免疫学和病毒学研究 组织和生殖器微生物组。该合作已培训了50多名学位和非学位学生， 福格蒂国际中心（FIC）奖。我们建议继续进行这些培训工作， 为乌干达科学家提供研究机会和职业发展，重点是MMC相关研究， 这既是因为MMC对艾滋病预防至关重要，也是因为MMC相关研究为以下方面提供了机会： 广泛的协同和跨学科研究。具体来说，在JHU，我们建议培养一名博士 候选人在生殖器免疫学，病毒学和分子微生物学，和5 MPH/MHS候选人在 执行科学、流行病学和生物统计学、项目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， 学员来JHU高级课程和指导。在乌干达，我们将支持5名大师和3名 在MakSPH和乌干达其他大学获得学士学位的学员和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和乌干达的关键 国外合作者是MakSPH教授大卫Serwadda博士。培训将由培训部监督 乌干达和美国的咨询委员会。RHSP/MakSPH将提供进入Rakai研究领域的机会 体验式培训的网站，培训相关研究的数据和样本，以及丰富稳定的 职业发展。该计划建立在先前的培训和研究，以确保长期的可持续性 作为世界级的艾滋病毒研究机构，生殖健康卫生项目和MakSPH发挥了领导作用。

Project Summary/ Abstract 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.