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

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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.