Training

STD/AIDS Research Training Fellowship Program

International STD/HIV Research

Connie Celum, MD, MPH, Grace John-Stewart, MD, PhD, and King Holmes, MD, PhD Co-Directors

Overview: The International Research Track attracts fellows committed to an academic career in international STD/AIDS research. Most have received MD or PhD degrees, and have previous experience in developing countries. Most MDs in this track obtain an MPH degree in the Department of Epidemiology and have close linkage with the Public Health Epidemiology Track.

This track includes field research experience in Africa, Asia, Latin America, or the Caribbean.

Through many formal institutional affiliation agreements, UW faculty and fellows have access to STD/AIDS research opportunities at several international sites, involving long-term, sustainable partnerships and interdisciplinary approaches to epidemiology studies, clinical trials, or prevention trials. The UW Center for AIDS and STD provides laboratory support for a wide range of STD/AIDS research at these sites.

This program is closely integrated with the UW CFAR International Research Core, and with our AITRP, initiated in 1988 with grants from the Fogarty International Center to foster international collaborative AIDS research through bilateral scientist exchange. To date, 148 investigators from 23 developing countries have come to the University of Washington for research training, most from Kenya, Peru, Senegal, Thailand, Mozambique, and Russia. International track scientists supported by AITRP and CFAR provide a rich peer network of investigators for collaboration. The Fogarty-funded Health Informatics Training Program in Peru, led by Ann-Marie Kimball includes training for HIV/STD applications. Our new HRSA-funded I-TECH (International Training and Education Center on HIV), involving the Regional AIDS Training Network in Africa and the India-Canada HIV/AIDS Project, will give trainees and faculty in the International Track opportunities to serve as I-TECH educators.

Through productive research collaborations, comprehensive STD and HIV research programs have developed in Kenya and Peru with annual research funding coordinated by the UW investigators of approximately $12 million per year. The NIH HIV Vaccine Trials Network also has 15 well-supported field sites in developing countries offering additional training opportunities.

Didactic Curriculum and Additional Seminar Training and Mentoring for Pre-doctoral and Post-doctoral Trainees: All trainees participate in the STD and AIDS Core Curriculum. In addition, all take didactic coursework in areas pertinent to their planned research (i.e., biostatistics, pathobiology, or epidemiology). Coursework is often integrated as part of a degree program (MPH or PhD).

In addition to MPH degree requirements, individuals pursuing the MPH degree with an emphasis on international AIDS/STD research select from the following international health courses taught by faculty in this track: Problems in International Health; Epidemiology of Infectious Diseases of Third World Importance; Emerging Infectious Diseases of International Public Health Importance; and Research Methods for Developing Countries.

Faculty: Over the past decade, the list of faculty participating in international studies has expanded substantially, to 12 training faculty and many resource faculty at the UW and at affiliated institutions overseas. Other UW training faculty in other tracks have substantial research in developing countries (e.g., Drs. Overbaugh, Coombs, Collier, McElrath, Richardson, Mullins, Frenkel, Morris, Corey, Morrow, and Hughes) represent resource faculty for this track, as do 14 investigators from other countries.

Research Opportunities: In addition to existing NIH- or foundation-funded international research programs on AIDS & STD in Peru or Kenya led by UW faculty are:

Kenya: The UW has been active in the Kenya HIV/STD Research Project since 1984. In conjunction with the WHO Collaborating Center for Research and Training in STDs in the Department of Medical Microbiology, University of Nairobi, this international collaborative project also includes as participants the University of Manitoba, University of Ghent, Oxford University and others. This project has trained international HIV/STD scientists who have continued in academic careers (e.g., Drs. Marie Laga, Francis Plummer, and Joan Kreiss under the direction of Drs. Peter Piot, Allan Ronald, and King Holmes, respectively). The AITRP supports an active research scientist exchange program between the Univ. of Nairobi, Kenya Medical Research Institute (KEMRI), and the University of Washington. Several former trainees have remained affiliated with the collaborative research program in Kenya (Ruth Nduati, Dorothy Mbori-Ngacha, Elizabeth Bukusi, J. Ndinya Achola, Grace John-Stewart, Scott McClelland, Carey Farquhar).

Peru: Over the past decade sixteen Peruvian and 14 UW faculty scientists have been involved in collaborative research as part of the CFAR International Track. Recently, the UW-Peru collaborations have led to several major new research initiatives, including a 20-city community-randomized trial funded by the Wellcome-Trust, and NIH-funding for establishment of clinical trials sites through the HVTN, HPTN, and ACTG. These new research programs under the direction of Drs. Holmes, Celum, Sanchez, and Garcia, will provide ample opportunities for trainees during the next 5-year cycle.

Other: In addition to Kenya and Peru, there are opportunities for research in Senegal with Dr. Nancy Kiviat; and in Mozambique with Dr. Stephen Gloyd. Several new multi-country initiatives may provide rich opportunities for future International Track trainees, including the HIV Prevention Trials Network (HPTN) and the HIV Vaccine Trials Network (HVTN). The Leadership and Basic Science Cores of the HVTN support HIV vaccine trials in 15 countries. SCHARP (Statistical Center for HIV AIDS Research Program), based at the Fred Hutchinson Cancer Research Center is affiliated with the UW CFAR and provides statistical support for international HIV/AIDS research.

The research of 7 senior and 5 new training faculty is summarized below.

• Celum, Connie MD, MPH Co-Director: Dr. Celum’s research on HIV and STD clinical epidemiologic and prevention research focuses on men who have sex with men (MSM). Specifically, behavioral and biologic risk factors for HIV acquisition among MSM in Seattle and Peru; the effect of bacterial STDs on mucosal shedding of HIV; HSV-2 and bacterial STDs as risk factors for HIV infection; HIV vaccine efficacy trials; clinical trials of microbicides; and natural history and pathogenesis of early HIV infection. 
  
  
• John-Stewart, Grace MD, PhD Co-Director: Dr. John-Stewart's major research interest is the epidemiology and transmission of HIV-1 infection in Africa. Particular research interests include determinants of mother-to-child transmission of HIV-1, breast milk transmission of HIV-1, cervicovaginal shedding of HIV-1 during pregnancy, and HIV-1 specific immune responses in exposed uninfected children.
  
  
• Holmes, King MD, PhD, Co-Director: Dr. Holmes heads a Wellcome Trust-funded 20-city community-randomized trial of STD/HIV prevention in Peru in collaboration with Drs. Geoff Garnett, Patricia Garcia, Martina Morris; oversees NIH-funded studies of use of microbicides and newer treatment regimens in prevention and treatment of bacterial vaginosis in Kenya; serves as PI on a study of the natural history of HHV8 shedding in Mombassa; and is PI of the UW Fogarty AITRP training grant.
  
  
• Gloyd, Steve MD: As Director of the International Health Program at UW, Dr. Gloyd has expertise in operations research and is funded by USAID as well as by a recent grant from Columbia University to implement MTCT-plus regimens in Mozambique.
  
  
• Kiviat, Nancy MD: Dr. Kiviat has extensive experience in conducting epidemiologic studies of HIV, both in the United States and in Africa, including studies among both HIV-seronegative and HIV-seropositive subjects. Dr. Kiviat has expertise in HIV and laboratory PCR-based technologies for the detection of HIV in blood and mucosal secretions, and for the diagnosis of HPV and other genital pathogens.
  
  
• Kreiss, Joan MD, MSPH: Dr. Kreiss' research has focused on the epidemiology of sexual and mother-to-child transmission of HIV-1 in Kenya. Other studies currently focus on the role of vitamin supplementation and STD treatment in decreasing infectivity, as well as studies on HHV8.
  
  
• Richardson, Barbra PhD: Research focuses on statistical methods for incomplete data, statistical methodology for clinical trials data, longitudinal data analysis, and for AIDS and STD data.
  
  
• Self, Steve PhD: Dr. Self Co-directs SCHARP (described above), and has had extensive experience in the design and operation of large disease prevention and epidemiologic studies. He is also actively involved in statistical methodologic research.
  
  
• Joseph Zunt, MD, MPH: Dr. Zunt’s research is defining the course of acute and early sexually acquired HTLV-I infection in female sex workers, including the natural history of subclinical neurologic manifestations, the determinants of genital shedding of HTLV-I-infected cells, and the immunologic manifestations in early infection and with tropical spastic paraparesis/HTLV-I-associated myelopathy.

Additional opportunities in this track: The Fogarty Center AITRP Program generally funds (on a competitive basis) trainees in this track for 1-2 years of international research field work (e.g., Drs. Zunt, Farquhar, John-Stewart, McClelland, in the past, and several current trainees)..


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