Research Training Program in the Diagnosis, Treatment, and Prevention of AIDS-related MDR-TB in Haiti

 描述(由申请人提供)：本提案建立在海地国立卫生研究院为威尔·康奈尔医学院和海天感染机会主义者组织(GHESKIO)提供研究和培训支持的三十年期间建立的基础上。该培训计划的重点是改进艾滋病相关结核病的诊断、治疗和预防，重点是耐多药结核病(MDR-TB)。一个由10名海地临床医生组成的干部将接受为期两年的研究培训，其中包括在海地的康奈尔-GHESKIO-基斯奎亚项目的公共卫生硕士学位。我们还将响应海地卫生部表示的对熟练实验室领导的迫切需求，并为8名海地实验室实习生建立为期两年的实验室科学硕士课程。这18名临床和实验室受训人员将在以下优先研究领域进行公共卫生硕士和理科硕士指导论文：1)关于结核分枝杆菌潜伏期、持久性和药物发现的转化研究；2)治疗耐多药结核病的新药临床试验，包括艾滋病毒患者；3)母婴结核病诊断、艾滋病毒/结核病治疗和预防；4)艾滋病毒/结核病和耐多药结核病分子流行病学的社区病例检测；5)扩大新的结核病诊断和艾滋病毒/多药耐药结核病治疗的实施科学。该计划还将培训研究人员，包括护士(6名)、数据管理员(2名)、社会工作者(2名)和药剂师(2名)，以参与上述研究领域。海地的艾滋病毒(2.2%)和结核病(296/10万)的流行率是西半球最高的。海地估计有1540例耐多药结核病流行病例，但目前只有约150名患者得到治疗，这在很大程度上是由于缺乏熟练的临床和实验室人员。因此，90%以上的耐多药结核病患者在社区得不到治疗。三分之一的患者也是艾滋病毒阳性，这一事实加剧了这一公共卫生风险。新诊断和抗结核疗法的开发和验证，加上有针对性的研究培训计划，将满足这一迫切需求。该项目不仅响应海地卫生部的优先事项，还将培训海地在艾滋病毒和结核病研究领域的下一代领导人。他们的成就将对海地的国家艾滋病毒/结核病规划产生直接影响，并有可能对全球产生重大影响。

 DESCRIPTION (provided by applicant): This proposal builds on the foundation established in Haiti during three decades of NIH research and training support to Weill Cornell Medical College and the Groupe Haitien d'Etude du Sarcome et des Infections Opportunistes (GHESKIO). The focus of this training program is improving the diagnosis, treatment, and prevention of AIDS related tuberculosis, with an emphasis on multi-drug resistant tuberculosis (MDR-TB). A cadre of 10 Haitian clinicians will receive 2 years of research training which will include an MPH from the Cornell-GHESKIO- Quisqueya program in Haiti. We will also respond to an urgent need expressed by the Haitian Ministry of Health for skilled laboratory leaders and establish a 2 year MS in Laboratory Science program for 8 Haitian laboratory trainees. These 18 clinical and laboratory trainees will conduct their mentored MPH and MS theses in the following priority research areas: 1) translational research on M. tuberculosis latency, persistence, and drug discovery; 2) clinical trials of new drugs for the treatment of MDR-TB, including patients with HIV; 3) maternal- child tuberculosis diagnosis, HIV/TB treatment, and prevention; 4) community-based case detection of HIV/TB and MDR-TB molecular epidemiology; 5) implementation science to scale-up new TB diagnostics and HIV/MDR-TB treatment. The program will also train research staff including nurses (6), data managers (2), social workers (2), and pharmacists (2) to participate in the aforementioned research areas. Haiti has the highest prevalence of HIV (2.2%) and tuberculosis (296/100,000) in the Western Hemisphere. There are an estimated 1,540 prevalent MDR-TB cases in Haiti, but only ~150 patients are currently treated, in large part due to the lack of skilled clinical and laboratory personnel. Therefore over 90% of MDR-TB patients are left untreated in the community. This public health risk is compounded by the fact that 1/3 of patients are also HIV-positive. The development and validation of new diagnostics and anti-tuberculous therapies, coupled with a targeted research training program will address this urgent need. This program not only responds to the priorities of the Haitian Ministry of Health but will also train the next generation of Haitian leaders in the field of HIV and tuberculosis research. Their accomplishments will have a direct effect on the national HIV/TB program in Haiti and have the potential for a major global impact.