OPTIMIZING HIV/TB MANAGEMENT IN THE HAART ERA

描述（由申请人提供）：全球约93%的艾滋病毒感染发生在发展中国家，拉丁美洲占150万例，加勒比地区是撒哈拉以南非洲以外艾滋病毒感染率最高的地区，另有44万例，表明迫切需要国际努力控制艾滋病毒在这些国家的传播。通过迈阿密福格蒂AITRP和儿科项目的赞助，175名政府认可的学者接受了艾滋病/结核病预防和治疗方面的指导，回国后（回国率92%以上）指导他们的国家采取减少疾病负担的举措和战略。随着高效抗逆转录病毒疗法（HAART）的出现，抑制和控制HIV-1的可能性已经出现。为了应对拉丁美洲和加勒比地区越来越多地获得HAART，我们未来五年的目标是促进独立和可持续的科学能力，使福格蒂学者能够协助他们的国家开展大规模的方案，以便：1)促进对感染艾滋病毒/艾滋病的儿童和成人以及合并感染艾滋病毒/结核病的儿童和成人的最佳治疗和护理；2)加强对艾滋病毒/结核病治疗的坚持，减少耐药性的可能性；3)确定获得保健的障碍，包括污名化对利用保健服务的影响；4)识别持续的高危行为，制定适当的干预措施，以降低传播风险，提高HAART时代的生活质量；5)评估预防和治疗干预措施的经济和社会影响。建立有效的科学基础设施，以及迈阿密与东道国机构之间的长期伙伴关系，将使我们的目标国家（巴西、哥伦比亚、多米尼加共和国、圭亚那、牙买加、秘鲁）面临的挑战得以解决。这些目标将在伦理程序的范围内实施，并将包括注意研究业务的经济和社会影响。我们建议根据东道国的具体需要，将我国国内福格蒂学者的研究专长与生物医学和行为研究培训结合起来。将在迈阿密和东道国进行研究培训，以促进独立研究能力和可持续干预措施，最终遏制这一流行病的蔓延。

DESCRIPTION (provided by applicant): Approximately 93% of the global HIV infections occur in the developing world, with Latin America accounting for 1.5 million cases and the Caribbean, which has the highest HIV prevalence rate outside of sub-Saharan Africa, for 440,000 more, indicating the critical need for an international effort to control HIV spread in these countries. Through the auspices of the Miami Fogarty AITRP and Pediatric programs, 175 government endorsed scholars have received instruction in AIDS/TB prevention and treatment, returning home (92+% return rate) to guide their countries with initiatives and strategies to reduce the burden of disease. With the advent of highly active antiretroviral therapy (HAART), possibilities of HIV-1 suppression and control have emerged. In response to increasing access to HAART in Latin America and the Caribbean our objectives for the next five years are designed to promote independent and sustainable scientific capacity that will enable Fogarty scholars to assist their countries in conducting wide-scale programs to: 1) Promote optimal treatment and care of children and adults living with HIV/AIDS and those co-infected with HIV/TB; 2) Enhance adherence for HIV/TB treatment, and reduce the potential for drug resistance; 3) Determine obstacles in access to care, including the impact of stigma on utilization of health services; 4) Identify continued high-risk behaviors and establish appropriate interventions to reduce risk of transmission, and improve quality of life in the era of HAART; and 5) Evaluate the economic and social impact of prevention and treatment interventions. The establishment of effective scientific infrastructures, and long-standing partnerships between Miami and host country institutions will permit the challenges facing our target countries (Brazil, Colombia, Dominican Republic, Guyana, Jamaica, Peru) to be addressed. These objectives will be implemented in the context of ethical procedures and will include attention to the economic and social impact of research operations. We propose to integrate the research expertise of our in-country Fogarty scholars with biomedical and behavioral research training, according to the specific needs of the host countries. Research training will be conducted in Miami and the host countries, to facilitate independent research capacity and sustainable interventions, to ultimately quell the tide of the epidemic.