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

描述(由申请人提供)：撒哈拉以南非洲(SSA)抗逆转录病毒疗法(ART)的可获得性增加，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，其中大部分是由合并感染病原体造成的。根据联合国艾滋病规划署的数据，尽管乌干达最初对艾滋病毒疫情做出了强有力的反应，但在15至49岁的成年人中，乌干达的流行率仍为7.2%。许多患者仍然出现在感染后期，并经常与结核病和隐球菌性脑膜炎等机会性感染合并感染。病毒性肝炎(B&C)合并感染发生在2%-10%的艾滋病毒感染者中，这对最佳抗病毒治疗、诊断和预防提出了挑战。随着HIV感染患者接受抗逆转录病毒治疗的寿命延长，由HIV感染加速的病毒性肝炎相关性肝硬变和肝细胞癌将成为病毒抑制者的主要死亡原因。乌干达传染病研究所(IDI)是一个卓越的研究中心，在前研究部主任(Y.Manabe，项目主任)的领导下，已经建立了艾滋病毒合并感染的研究项目。现任研究负责人(乌干达项目主任A.Kambugu)在担任临床服务负责人的过去5年里一直与Manabe博士密切合作。IDI的这些重点领域的基本描述流行病学已经由经过严格培训的博士生发表，这些博士生已经成功地获得了博士学位，并有能力进行原创科学研究。该计划的主要目标是培训乌干达人在艾滋病毒混合感染领域进行当地相关研究，包括结核病、隐球菌性脑膜炎和病毒性肝炎。IDI的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；能够撰写赠款，并将研究兴趣扩大到预防、改进的护理模式、新的诊断评估、用于分析纵向队列的先进生物统计学方法，以及通过海外轮换在乌干达进行的翻译基础科学研究。四名硕士学生将在约翰霍普金斯大学彭博公共卫生学院接受有关马凯雷尔卫生学院没有开设课程的专题领域的培训，如卫生经济学、卫生系统，以及上面列出的合并感染的翻译基础研究。每年还将支持三名乌干达硕士学生用新的研究人员填补这条管道。在这项为期5年的培训计划结束时，我们的总体目标是巩固一批富有成效的独立科学家的核心团队，他们可以获得外部资金，继续指导其他人，并被公认为艾滋病毒共同感染领域的国际和地区领导者。

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.