Multidisciplinary Research Training to Understand and Reduce HIV Incidence in Uganda

虽然在全球艾滋病毒应对方面取得了实质性进展，但影响并不均衡。乌干达 提供了一个最佳案例研究。乌干达是埃博拉疫情的早期震中，第一个报告是“苗条”。 我们小组于1985年出版了《东非的疾病》。在接下来的20年里，乌干达在 努力控制疫情。最近，新的艾滋病毒感染人数仍然很多，特别是在难以控制的 到达亚群，现代乌干达对艾滋病毒流行病的反应呈现出改善的趋势，但 情况喜忧参半。尽管艾滋病毒服务规模适度扩大，但据估计，仍有大约 在次优抗逆转录病毒治疗的背景下，每年有28,000人死于艾滋病，83,000人新感染 和男性包皮环切术。高机动性、次优连接和护理保留、持续高风险 性行为和对艾滋病毒传播动力学的不完全理解继续损害着 最佳响应。使这些挑战雪上加霜的是，越来越多的人发现乌干达的艾滋病毒“热点”， 艾滋病毒负担高的地理区域，那里的艾滋病毒服务往往有限。乌干达，像大多数PEPFAR一样 国家采取了更积极的方法，包括检测和治疗所有人，并在 暴露预防(PrEP)。然而，这些方法的影响尚不清楚，需要密切关注。 监测以了解其实施和影响。艾滋病毒传播动力学的这种复杂性 回应提出了许多关键的研究问题，影响了乌干达和撒哈拉以南非洲地区 政策和计划。为了处理这些研究领域，至关重要的是地方能力 得到了加强。特别是，我们认为，必须以多学科的方式建设能力，以更好地 了解并减少乌干达及其他地区的艾滋病毒发病率，这是美国国立卫生研究院高度重视的研究领域。我们的团队 在培训艾滋病毒研究领域的领导者方面有着长期而成功的遗产，并处于强有力的地位，以期在此基础上 这个基金会。我们建议采用多学科方法来发展乌干达的科学能力，这将 强调3个协同领域：(1)实施科学；(2)地理空间分析/传染病 动力学和(3)病毒学/免疫学/艾滋病毒治疗。这些学科横跨诊所、社区、建模、 和实验室科学，并将确保我们达到该计划的长期目标和目的，这 乌干达机构将拥有所需的研究能力，以理解、回应并最终 控制艾滋病疫情。我们将涉及22名多学科的学士、硕士、博士和博士后- 研究生级别的培训，主要是在乌干达。这项培训的主要受益者将是Rakai Health 约翰·霍普金斯大学科学计划和乌干达Makerere大学公共卫生学院 大学作为申请机构，30年来一直保持着非常成功的合作关系。我们的 预期结果是培养出一支世界级的乌干达研究干部队伍，能够 带领乌干达结束了艾滋病毒的流行。

While substantial progress have been made in the global HIV response, impact have been uneven. Uganda provides a prime case study. Uganda was an early epicenter of the epidemic, with the first report of “slim disease” in East Africa published by our group in 1985. Over the next two decades, Uganda was a leader in efforts to control the epidemic. More recently, new HIV infections remain substantial, particularly in hard-to- reach subpopulations, and the modern Ugandan response to the HIV epidemic presents an improving but mixed picture. Despite moderate scale-up of HIV services, it is estimated that there are still approximately 28,000 yearly AIDS-related deaths and 83,000 new infections in the setting of suboptimal antiretroviral therapy and male circumcision coverage. High mobility, suboptimal linkage and retention in care, persistent high risky sexual behaviors, and an incomplete understanding of HIV transmission dynamics continue to compromise an optimal response. Adding to these challenges are the increasing identification of HIV “hotspots” in Uganda, geographic areas of high HIV burden, where HIV services are often limited. Uganda, like most PEPFAR countries, has adopted more aggressive approaches, including Test and Treat All and introducing Pre- Exposure Prophylaxis (PrEP). However, the impact of these approaches is unclear and will need close monitoring to understand their implementation and impact. This complexities of HIV transmission dynamics and responses raise many critical research questions which impact both Ugandan and Sub-Saharan African policies and programs. In order to address these research areas, it is essential that local capacity be strengthened. In particular, we believe capacity must be built in a multidisciplinary fashion to better understand and reduce HIV incidence in Uganda and beyond, a high priority NIH research area. Our group has a long and successful legacy of training leaders in HIV research and are strongly positioned to build upon this foundation. We propose a multidisciplinary approach to developing scientific capacity in Uganda which will emphasize 3 synergistic areas: (1) Implementation Science, (2) Geospatial Analysis/Infectious Disease Dynamics and (3) Virology/Immunology/HIV Cure. These disciplines span the clinic, community, modeling, and the lab sciences and will ensure that we reach the long-term goals and objectives of the program, which are that Ugandan institutions will have the research capacity needed to understand, respond to, and eventually control the HIV epidemic. We will involve 22 trainees in multidisciplinary bachelor, master's, PhD, and post- graduate level training, mostly in Uganda. The primary beneficiaries of this training will be the Rakai Health Sciences Program and the Makerere University School of Public Health in Uganda with whom Johns Hopkins University, the applicant institution, has had a highly successful collaborative relationship for 30 years. Our anticipated outcome is to have developed a world-class cadre of Ugandan research capacity capable of leading Uganda to the end of its HIV epidemic.