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）的日益普及导致死亡率下降。世卫组织估计，2011年有170万人死于艾滋病毒，其中大多数是由病原体共同感染造成的。尽管对艾滋病毒流行病采取了强有力的初步应对措施，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，并经常合并机会性感染，如结核病和隐球菌性脑膜炎。病毒性肝炎（乙型和丙型）合并感染发生在2-10%的艾滋病毒感染者中，在最佳抗病毒治疗、诊断和预防方面存在挑战。由于艾滋病毒感染患者接受抗逆转录病毒治疗后寿命延长，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患者的主要死亡原因。乌干达传染病研究所（IDI）是一个卓越的研究中心，已经在前任研究主任（Y. Manabe，项目主任）的领导下建立了艾滋病毒合并感染的研究项目。现任研究主任（A. Kambugu，乌干达项目主任）在过去5年担任临床服务主任期间与Manabe博士密切合作。在IDI的这些重点领域，已经由经过严格训练的博士生发表了基本的描述性流行病学，这些博士生已经成功地获得了博士学位，并且能够进行原创性的科学调查。该方案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。IDI的研究背景和指导模式将支持IDI的博士后研究人员完全独立；能够申请资助并将研究兴趣扩展到预防、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方法，以及通过海外轮转在乌干达进行的转化性基础科学研究。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培训，学习在Makerere健康科学学院没有开设的主题领域课程，如卫生经济学、卫生系统和上述合并感染的转化基础研究。每年还将支持三名乌干达硕士研究生，以填补新的研究人员的空缺。在这个为期5年的培训项目结束时，我们的总体目标是巩固一个由富有成效的独立科学家组成的核心小组，他们可以获得外部资金，继续指导他人，并被公认为艾滋病毒合并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.