HIV associated tuberculosis training program

描述(申请人提供)：艾滋病毒相关结核病是南非和非洲许多其他国家面临的最大公共卫生挑战。南非有600多万人感染了艾滋病毒。艾滋病毒使结核病死灰复燃，每年的发病率接近1%。超过50%的结核病病例中存在艾滋病毒混合感染，这给预防、诊断和治疗带来了具体挑战。艾滋病毒相关结核病是南非最常见的死亡原因。开普敦大学(UCT)是艾滋病毒相关结核病领域的全球领导者，拥有20多年的研究和培训经验。在以下领域有特别的优势：临床试验(包括结核病-IRIS的治疗；异烟肼预防疗法在接受抗逆转录病毒治疗的患者中的作用，以及新型结核病疫苗在艾滋病毒感染者中的试验)；抗逆转录病毒药物和结核病药物的药代动力学，以及结核病药物的药代动力学-药效关系；艾滋病毒合并感染患者的结核病诊断；艾滋病毒感染患者对结核病的免疫反应；结核病-IRIS的发病机制；艾滋病毒感染患者中潜伏结核病的免疫学和诊断；以及抗逆转录病毒药物对艾滋病毒相关结核病流行病学的影响。在艾滋病毒相关结核病研究和培训方面，与这一应用方面的合作机构(约翰霍普金斯大学、北卡罗来纳大学和范德比尔特大学)存在着牢固和富有成效的关系。随着病原体耐药性的增加和治疗方案的演变，在艾滋病毒相关结核病领域有许多尚未回答和正在出现的研究问题。UCT的下一代研究人员需要培养。此外，我们已经在我们的艾滋病毒相关结核病研究平台中确定了几个不发达的领域，如果得到解决，将把我们的研究提升到一个更高的水平。这些领域包括数学建模、侧重于艾滋病毒相关结核病的先进生物统计能力、用于分析全基因组序列和药物基因组数据的生物信息学技能以及业务研究。拟议的两年规划过程将使联合技术与3个伙伴机构能够系统地记录联合技术当前与艾滋病毒相关的结核病研究和培训，定义培训需求，确定满足这些需求的培训计划和机会，以及与现有培训计划的协同效应。将编写一份关于这一进程的报告，并将举行包括合作机构在内的两个研讨会。将提交D43 Fogarty培训计划拨款申请。设想的培训计划将侧重于通过竞争性申请程序授予成就卓著的早期职业研究人员的博士/博士后奖学金。这些奖学金将由UCT的教职员工共同监督，并在专门解决UCT研究差距的领域与美国机构合作。研究员将在美国接受技能和方法方面的培训，这是不可能的 在密歇根大学。还将包括补助金/手稿写作、业务研究和远程学习方案方面的培训课程。我们将在非洲确定2到3所结成伙伴关系的大学，目标是通过与UCT和本国机构联合培训的形式，满足它们与艾滋病毒相关的结核病培训需求。1

DESCRIPTION (provided by applicant): HIV-associated tuberculosis is the greatest public health challenge facing South Africa and many other countries in Africa. Over 6 million people are HIV infected in SA. HIV has driven a resurgence of TB and incidence rates approach 1% per annum. HIV co-infection is present in over 50% of TB cases giving rise to specific challenges in prevention, diagnosis and treatment. HIV-associated TB is the most common cause of death in SA. The University of Cape Town (UCT) is a global leader in HIV-associated TB with over 20 years experience of research and training. Particular strengths in the following areas exist: clinical trials (including treatment of TB-IRIS, the role of isoniazid preventive therpy in patients on ART, and trials of novel TB vaccines in HIV-infected individuals); the pharmacokinetics of ART and TB drugs, and pharmacokinetic- pharmacodynamic relationships of TB drugs; TB diagnostics in patients with HIV co-infection; the immune response to TB in HIV-infected patients; the pathogenesis of TB-IRIS; the immunology and diagnosis of latent TB in HIV-infected patients; and the impact of ART on the epidemiology of HIV-associated TB. Strong and productive relationships exist with the partnering institutions on this application (Johns Hopkins, University of North Carolina and Vanderbilt) in HIV-associated TB research and training. There are many unanswered and emerging research questions in the HIV-associated TB field, as drug resistance in both pathogens increases and treatment programs evolve. The next generation of researchers at UCT needs to be developed. In addition, we have identified several under-developed areas in our HIV-associated TB research platform that if addressed will lift our research to a higher level. Areas include mathematical modelling, advanced biostatistical capacity focussed on HIV-associated TB, bioinformatics skills for analysis of whole genome sequence and pharmacogenomics data and operational research. A 2 year planning process is proposed that will allow UCT with the 3 partner institutions to systematically document current HIV-associated TB research and training at UCT, define training needs and identify training programs and opportunities to meet these needs as well as synergies with existing training programs. A report of this process will be written and 2 symposia will be held that include partnering institutions. A D43 Fogarty Training Program grant application will be submitted. The envisaged training program will be focussed on PhD/post-doctoral fellowships awarded to high achieving early career researchers through competitive application processes. These fellowships will be co-supervised by faculty members at UCT and partnering US institutions in areas that specifically address UCT's research gaps. Fellows will spend defined periods of time in the US receiving training in skills and methodologies where this is not possible at UCT. Training courses in grant/manuscript writing and operational research and distance learning programs will also be included. We will identify 2 or 3 partnering universities in Africa with the goal of addressing their HIV-associated TB training needs in the form of joint training with UCT and home institutions. 1