Research training to improve ART adherence among HIV-infected adolescents in Haiti

描述（由申请人提供）：该提案建立在福格蒂和NIAID三十年来在海地建立的基础上，该基础为康奈尔大学和海地研究和培训组织（GHESKIO）提供了支持。该培训方案的重点是预防与艾滋病有关的子宫颈癌。一个多学科研究小组将接受培训，进行HPV临床和疫苗试验，研究HIV-HPV合并感染的发病机制，并检查与这些感染相关的复杂行为，社会和伦理问题。福格蒂学者（医学博士，注册护士）骨干（n= 12）将接受两年的培训，包括海地康奈尔- gheskio - quisqueya项目的公共卫生硕士学位，以及海地卫生部确定的5个相互关联的优先研究领域之一的重点培训：1)为感染艾滋病毒的妇女制定子宫颈筛查和治疗战略；2)开展少女HPV疫苗接种规划的业务研究；3)检查与青少年HPV感染和疫苗接种相关的行为和伦理问题；4)开展新的预防策略的实施和成本效益分析；5)开展宫颈中HIV、HPV和宿主免疫相互作用的转化研究。该计划还将包括对护士（n= 8）、实验室技术人员（n=6）、数据管理人员（n=3）、社会工作者（n=3）和药剂师（n=1）的中期培训（6-12个月），他们也将在上述五个领域进行培训。培训方案的初始阶段将在GHESKIO在太子港的诊所和实验室进行，在GHESKIO附近社区的青少年妇女中引入疫苗。到赠款的第五年，我们预计将把宫颈癌预防（筛查、治疗、教育、疫苗接种）纳入由GHESKIO和卫生部监督并得到PEPFAR支持的全国诊所网络。海地是西半球艾滋病毒感染率最高的国家（2.7%），也是世界上宫颈癌发病率最高的国家（94例/10万）。在海地，接受抗逆转录病毒治疗的艾滋病毒感染妇女中，60%有高危HPV感染，11%有宫颈癌前病变。通过抗逆转录病毒治疗，感染艾滋病毒的妇女的寿命延长了，这使得宫颈癌有了发展的时间，发病率和死亡率都在增加。宫颈癌现在是感染艾滋病毒的妇女死亡的第三大原因。这个研究培训计划响应了宫颈癌预防的迫切需要，加上新技术的承诺，包括HPV疫苗和分子诊断。我们在GHESKIO启动了宫颈癌筛查的试点研究培训计划。这项提议将增加这项研究培训的深度和广度，培养一批关键的海地调查人员，他们将进行协同研究并领导一项国家宫颈癌预防计划。

DESCRIPTION (provided by applicant): This proposal builds on the foundation established in Haiti during three decades of Fogarty and NIAID research and training support to Cornell and the Groupe Haitien d'Etude du Sarcome et des Infections Opportunistes (GHESKIO). The focus of this training program is the prevention of AIDS related cervical cancer. A multidisciplinary group of investigators will be trained to conduct HPV clinical and vaccine trials, study the pathogenesis of HIV-HPV co-infection, and examine the complex behavioral, social, and ethical issues associated with these infections. A cadre of Fogarty Scholars (MDs, RNs) (n= 12) will receive 2 years of training including an MPH from the Cornell-GHESKIO-Quisqueya program in Haiti and focused training in one of 5 interrelated priority research areas identified with the Haitian Ministry of Health: 1) Develop cervical screening and treatment strategies for HIV infected women; 2) Conduct operational studies of HPV vaccination programs for adolescent girls; 3) Examine behavioral and ethical issues related to HPV infection and vaccination in adolescents; 4) Conduct implementation and cost effectiveness analysis of new prevention strategies, and 5) Conduct translational research on interactions between HIV, HPV, and host immunity in the cervix. The program will also include medium term training (6-12 months) of nurses (n= 8), laboratory technicians (n=6), data managers (n=3), social workers (n=3), and a pharmacist (n=1) who will also train in the five aforementioned areas. The initial phase of the training program will be conducted in GHESKIO's clinics and laboratories in Port au Prince, with vaccine introduction in adolescent women in the communities adjacent to GHESKIO. By year 5 of the grant, we expect to have introduced cervical cancer prevention (screening, treatment, education, vaccinations) into the national network of clinics supervised by GHESKIO and the Ministry of Health and supported by PEPFAR. Haiti has the highest prevalence of HIV infection in the Western Hemisphere (2.7%) and the highest incidence of cervical cancer in the world (94 cases/100,000). In Haiti, 60% of HIV infected women initiating antiretroviral therapy (ART) have a high risk HPV infection and 11% have pre-cancerous cervical lesions. With ART, HIV infected women are living longer, permitting cervical cancer time to progress with increasing morbidity and mortality. Cervical cancer is now the third leading cause of death in HIV infected women. This research training program responds to the urgent need for cervical cancer prevention, coupled with the promise of new technologies, including the HPV vaccine and molecular diagnostics. We initiated a pilot research training program in cervical cancer screening at GHESKIO. This proposal will increase the depth and breadth of this research training and develop a critical mass of Haitian investigators who will conduct synergistic research and lead a national cervical cancer prevention program.