HIV Co-infections in Uganda: TB, Crypotococcus, and Viral Hepatitis.

描述（由申请人提供）：在撒哈拉以南非洲（SSA），抗逆转录病毒疗法（ART）的可用性不断增加，导致死亡率下降。世卫组织估计，2011年有170万人死于艾滋病毒，其中大多数是由共同感染的病原体引起的。尽管对艾滋病毒流行病作出了强有力的初步反应，但根据联合国艾滋病规划署的数据，乌干达15-49岁成年人的流行率仍为7.2%。许多患者在感染后期仍然存在，并且经常合并感染机会性感染，如结核病（TB）和隐球菌脑膜炎。病毒性肝炎（B & C）合并感染发生在2-10%的HIV感染者中，并在最佳抗病毒治疗，诊断和预防方面提出了挑战。随着艾滋病毒感染者接受抗逆转录病毒治疗的寿命延长，由艾滋病毒感染加速的病毒性肝炎相关肝硬化和肝细胞癌将成为病毒抑制者的主要死亡原因。乌干达的传染病研究所（IDI）是一个卓越的研究中心，已经在前任研究负责人（Y。Manabe，Program Director）.现任研究主任（A。Kambugu，乌干达项目主任）在过去的5年里与Manabe博士密切合作，当时他是临床服务负责人。在IDI，经过严格培训的博士生已经成功地获得了博士学位，并且能够进行原始的科学调查，他们已经在这些重点领域发表了基本的描述性流行病学。该计划的总体目标是培训乌干达人在艾滋病毒合并感染领域进行当地相关研究，包括结核病，隐球菌脑膜炎和病毒性肝炎。这种IDI研究背景和导师模式将支持IDI的博士后研究人员完全独立;能够编写赠款并将研究兴趣扩展到预防，改进护理模式，新的诊断评估，先进的生物统计方法来分析纵向队列，并通过海外轮换在乌干达进行转化基础科学研究。四名硕士生将在约翰霍普金斯布隆伯格公共卫生学院接受培训，课程在Makerere健康科学学院不可用，如卫生经济学，卫生系统和翻译，基础研究在上面列出的合并感染。每年还将支持三名乌干达硕士生，以填补新研究人员的渠道。在这个为期5年的培训计划结束时，我们的总体目标是巩固一个核心小组的生产力，独立的科学家谁可以获得外部资金，继续指导他人，并被公认为国际，区域领导人在艾滋病毒合并感染领域。

DESCRIPTION (provided by applicant): Increasing availability of antiretroviral therapy (ART) in sub-Saharan Africa (SSA) has led to decreases in mortality rates. The WHO estimates that 1.7 million deaths were attributable to HIV in 2011 with the majority caused by co-infecting pathogens. Despite a strong initial response to the HIV epidemic, Uganda still has a prevalence rate of 7.2% among adults aged 15-49 according to UNAIDS. Many patients still present late in infection and often co-infected with opportunistic infections such as tuberculosis (TB) and cryptococcal meningitis. Viral hepatitis (B & C) co-infection occurs in 2-10% of HIV-infected individuals and present challenges in terms of best anti-viral treatment, diagnosis, and prevention. As HIV-infected patients live longer on ART, viral hepatitis related cirrhosis and hepatocellular carcinoma which are accelerated by HIV infection will dominate as causes of death in the virally suppressed. The Infectious Diseases Institute (IDI) in Uganda is a Research Center of Excellence and has already established research programs in HIV co-infections under the previous Head of Research (Y. Manabe, Program Director). The current Head of Research (A. Kambugu, Ugandan Program Director) has worked closely with Dr. Manabe for the last 5 years when he was Head of Clinical Services. Basic descriptive epidemiology has already been published in these focal areas at the IDI by rigorously trained PhD students who have been successfully awarded doctoral degrees and who are capable of original scientific investigation. The overarching objective of the program is to train Ugandans to perform locally relevant research in the area of HIV co-infections including tuberculosis, cryptococcal meningitis, and viral hepatitis. This IDI research context and mentorship model will support post-doctoral researchers at the IDI to become fully independent; capable of writing grants and expanding research interests to prevention, improved models of care, new diagnostics evaluations, advanced biostatistical methodology to analyze longitudinal cohorts, and translational basic science research in Uganda through overseas rotations. Four Masters students will be trained at Johns Hopkins Bloomberg School of Public Health in topical areas for which courses are not available at Makerere College of Health Sciences such as health economics, health systems, and translational, basic research in the co-infections listed above. Three Ugandan Masters' students per year will also be supported to fill the pipeline with new researchers. At the end of this 5-year training program, our overarching objective is to solidify a core group of productive, independent scientists who can garner outside funding, continue to mentor others, and be recognized as international, regional leaders in the area of HIV co-infections.