STD/AIDS Research Training Fellowship Program
International STD/AIDS Research
(Connie Celum, MD, MPH, Grace John-Stewart, MD, PhD, Co-Directors)
Overview: The International Research Track attracts trainees committed to an academic career in international STD/AIDS research. Many, but not all, have previous experience in developing countries. Most MDs in this track obtain (or already have) an MPH degree in the Department of Epidemiology during fellowship and they have close linkage with the Epidemiology & Public Health Track. This track includes field research experience in Africa, Asia, Latin America, or the Caribbean. Stipend funding during periods abroad is usually provided by the Fogarty International AITRP grant, awarded on a competitive basis to trainees in this track for 1-2 years of international research field work (e.g., Drs. Zunt, Farquhar, Cohen, John-Stewart, McClelland). A representative program for a typical International Track trainee follows: Year 1: 3-4 academic quarters of courses in the School of Public Health and Community Medicine, including the MPH and the Center for AIDS and STD core curriculum. A protocol is developed for the MPH thesis. Concurrent clinical training for physicians is limited to a once weekly STD or AIDS clinic, and 2 months of infectious disease consultation; Year 2: Conduct of research in a developing country; Year 3: 2 academic quarters of formal courses in the School of Public Health to complete MPH degree requirement. Completion of MPH thesis and of clinical ID training for physicians in specialty training; Year 4: Completion of manuscripts, grant applications for new research protocols, transition toward research independence.
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 & 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, 180 investigators from 23 developing countries have come to the University of Washington for research training, most from Kenya, Peru, Thailand, and Mozambique, and more recently India and Uganda. 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 Dr. Ann-Marie Kimball, includes training for HIV/STD applications. The UW-affiliated International Training and Education Center on HIV (I-TECH) a global HIV and AIDS training program with 350 employees working in 10 field offices, supports programs in more than a dozen countries hardest hit by the AIDS epidemic. I-TECH, which has grown rapidly since it was founded in 2002, is a $40 million a year program that offers opportunities to share training, clinical mentoring and other expertise.
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 28 field sites in 15 developing countries offering additional training opportunities.
Didactic Curriculum and Additional Seminar Training for Predoctoral and Postdoctoral 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 or PhD degree requirements, individuals in the International Track select from the following international health courses taught by faculty in this track: Problems in International Health; Epidemiology of Infectious Diseases in Resource-Limited Countries; Emerging Infections of International Public Health Importance; and Research Methods in Developing Countries, HIV and STIs in Women and Children, AIDS: A Multidisciplinary Approach, and Responsible Conduct of International Research (described above).
Research Opportunities: Existing NIH- or foundation-funded international research programs on AIDS & STD in Peru or Kenya led by UW faculty are described below. Many of the international collaborators mentioned below are members of our training resource faculty.
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. The AITRP supports an active research scientist exchange program between the University of Nairobi, Kenya Medical Research Institute (KEMRI), and the University of Washington.
Peru: Over the past decade 9 Peruvian and 9 UW faculty scientists have been involved in collaborative research as part of the CFAR International Core. Specifically, the UW-Peru collaborations have led to several major 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 AACTG under Dr. Jorge Sanchez. The Peru site has been recognized as one of the most productive international DAIDS clinical trial units, as recognized by their significant contributions in terms of recruitment, retention, and quality of data in recent trials in the HVTN, and AACTG trials. In addition, Peruvian graduates of the UW IATRP have assumed leadership roles in critical new research initiatives. These new research programs and ongoing collaborations outside of the DAIDS networks will provide ample opportunities for trainees.
Other sites:In addition to Kenya and Peru, there are opportunities for research in Senegal, in Mozambique, and in India. 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 28 sites 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.
Department of Global Health Training Opportunities: A new UW resource for training of pre- and post-doctoral candidates in clinical epidemiology and clinical trials is the newly formed Department of Global Health, which houses the International Clinical Research Center (ICRC) in Infectious Diseases. The goal of the ICRC is to build upon existing international clinical trial infrastructure in Africa in the multi-center Partners in Prevention HSV-HIV Transmission and Pre-Exposure Prophylaxis trials, which are enrolling large cohorts of HIV-discordant couples into HIV prevention clinical trials. The ICRC will expand clinical trials capacity through training junior investigators in the design, conduct, and analysis of multicenter infectious diseases prevention trials as well as opportunities to develop ancillary studies in our ongoing clinical trial sites in Kenya and Uganda. In addition, the ICRC includes an invaluable biological specimen repository of whole blood, PBMCs, plasma, serum, and genital tract samples from HIV-discordant couples, which can provide research opportunities for pre- and postdoctoral candidates with interests in immunologic, genetic, and virologic correlates of HIV transmission and disease progression.
Over the past 15 years, the list of faculty participating in international studies has expanded substantially. Mentors in this track include 12 training faculty and 11 resource faculty at the UW and at affiliated institutions overseas. Additional UW training faculty in other tracks also have substantial research in developing countries (e.g., Drs. Overbaugh, Coombs, Collier, McElrath, Richardson, Mullins, Frenkel, Morris, Corey, and Hughes) and represent additional resources for trainees. The research of 9 senior and 3 new training faculty is given below.
Celum, Connie MD, PhD Track Co-Director, Training Faculty Dr. Celum's primary research focus is HIV prevention clinical trials, including HSV-2 interventions, microbicides, pre-exposure prophylaxis, and HIV vaccine trials, as well as HIV and STD epidemiology. She is Principal Investigator of the UW HIV Prevention Trials Unit since 1996, is Co-investigator of the FHCRC HIV Vaccine Trials Unit and is Co-PI of the Microbicides Trial Network Leadership Group. She is the Principal Investigator of two multi-center international randomized, double-blind efficacy trials to assess whether suppression of genital herpes can reduce HIV susceptibility (HPTN 039, NIH) and infectiousness (Partners in Prevention, Bill and Melinda Gates Foundation).
John-Stewart, Grace MD, MPH, PhD D Track Co-Director, Training Faculty Dr. John-Stewart's major research interest is the epidemiology and transmission of HIV infection in Africa. She directs several large cohort studies aimed at defining mechanisms of HIV transmission between sexual partners and from mother to infants in Nairobi, Kenya. In addition, her group is conducting studies to evaluate HIV-1 progression, with studies targeted to evaluate the role of lactation, contraception, and co-infections on HIV-1 pathogenesis. Particular research interests include determinants of mother-to-child transmission of HIV-1, breast milk transmission of HIV-1, correlates of immune protection from HIV-1, HIV-1 treatment and resistance following HAART in resource-poor settings, and pediatric HIV-1 pathogenesis. Molecular epidemiology studies and clinical trials are the focus of her research group.
Chung, Michael MD, MPH Training Faculty Dr. Chung's research has focused on breast milk shedding of HIV-1 in mother-to-child transmission of HIV-1 and adherence to antiretroviral medications in Nairobi, Kenya, with Dr. John-Stewart. In the perinatal research project, we assess HIV-1 shedding in breast milk and test infants to determine transmission rates. A NIH K23 grant is supporting a randomized clinical trial at a large-scale treatment clinic in Nairobi that is examining whether alarm and/or counseling interventions improves adherence to antiretroviral medications and suppression of HIV-1 over an 18-month time period. Adherence is measured by pill count; secondary outcomes include CD4 count and HIV-1 RNA viral load.
Farquhar, Carey MD, MPH Training Faculty Training Faculty As Director of IARTP at the University of Washington, Dr. Farquhar currently spends approximately 3-4 months each year in Nairobi mentoring US and Kenyan trainees and conducting research on mother-to-child HIV transmission and correlates of immunity against HIV among HIV-sero-discordant couples. Specific research topics include cellular, innate and humoral immune responses associated with protection against vertical and heterosexual transmission; couple counseling and partner notification in the antenatal setting; HSV-2 and vertical and heterosexual transmission; HIV immune factors in breast milk; childhood immunization responses among HIV-infected children; optimizing pediatric HIV treatment; and maternal HIV disease progression post-partum.
Gloyd, Stephen MD Training Faculty Dr Gloyd is a pioneer in the area of health systems (HSR) or operations research (OR), focusing on access quality of primary health care, reproductive health, and STI/AIDS prevention, care, and treatment. He has lead an HSR team in Mozambique since 1988 and has also conducted HSR in Mexico, Zimbabwe, and Côte d'Ivoire. His work has been critical in the development of antenatal care and AIDS/STD policy, especially in Mozambique and Africa. He is the PI on several OR grants in Mozambique, funded by USAID, CDC, the Gates and Doris Duke Foundations, and the World Bank. He was awarded a Fulbright Research Fellowship in 1996-97 to implement his work on prenatal care in Côte d'Ivoire.
Holmes, King K. MD, PhD Program Co-Director, Training Faculty Dr. Holmes is Wm. H. Foege Chair, Department of Global Health and directs the UW Center for AIDS and STDs, which involves over 321 UW-affiliated faculty and research scientists and 85 pre- and post-doctoral trainees. He is the PI for the NIH-funded UW Center for AIDS Research and the UW STI Cooperative Research Center, and a Fogarty International Center International AIDS Research Training Program. Dr. Holmes participates in WHO Expert Advisory Panels on STI including HIV. He is past chair of the AIDS Research Advisory Committee for the NIAID Division of AIDS, the Scientific Advisory Board for the Academic Alliance/Institute for Infectious Diseases at Makerere University in Kampala, Uganda, and the STI Working Group for the NIH HIV Prevention Trials Network. He currently leads an NIH-funded randomized trial of topical microbicide use by Kenyan men in fishing communities on Lake Victoria for prevention of STI/HIV acquisition and a Wellcome Trust/NIH-funded 20-city randomized trial of STD/HIV prevention in Peru.
Lingappa, Jairam MD, PhD Junior Training Faculty Dr. Lingappa is Medical Director for a large clinical trial in of Africa to test the efficacy of genital herpes suppression to reduce HIV-1 transmission, and is developing a research program to evaluate host immunogenetic, pathogen and epidemiologic factors that contribute to HIV-1 transmission and disease progression. Dr. Lingappa conducts these studies in collaboration with Dr. Celum.
McClelland, Scott MD, MPH Junior Training Faculty Training Faculty Dr. McClelland is the Site Leader for the Mombasa HIV/STD Research Site and the PI for the Mombasa Female Sex Workers Cohort, which was established in 1993. His research focuses on HIV-1 prevention in both seropositive and seronegative women, including the effect of antiretroviral therapy infectivity; identification of risk factors for genital HIV-1 shedding among women receiving antiretrovirals; changes in sexual risk behavior among women on antiretroviral therapy; and reduction of vaginal infections in a randomized, double-blind, placebo controlled trial.
Richardson, Barbra PhD Training Faculty Dr. Richardson has been involved in clinical trials and HIV/AIDS and microbicide research since 1994, contributing significantly to the design of several HIV microbicide research trials, including preparedness studies, safety studies (Phase I and II), and efficacy trials (Phase IIB and III). Dr. Richardson served as a member of the HPTN Microbicide Working Group and is the SDMC PI for the recently completed NICHD-funded Hormonal Contraception and Risk of HIV-1 Acquisition (HC-HIV) study. Dr. Richardson has served on several national and international review committees, and has advised various entities (including WHO) and the IAS Ghent Group) on statistical issues in infectious disease.
Self, Steven PhD Training Faculty Dr. Self is currently Full Member and Head (since 1994) of the Program in Biostatistics and Biomathematics at the Fred Hutchinson Cancer Research Center. He is Executive Director of the Statistical Center for HIV/AIDS Research and Prevention (SCHARP) and Co-Director of the Vaccine and Infectious Disease Institute (VIDI).
Stergachis, Andrew PhD Training Faculty Dr. Stergachis' research is in the area of pharmacoepidemiology, including studies on the safety and effectiveness of marketed drugs. We are presently assessing the opportunities and barriers in implementing sustainable pharmacovigilance programs in sub-Saharan African countries, involving diseases of global health importance, including HIV/AIDS. We conduct clinical epidemiology studies and have contributed to the evidence base for risk factors for Chlamydia trachomatis infections in young women as well as to the prevention of pelvic inflammatory disease.
Zunt, Joseph MD, MPH Training Faculty Dr. Zunt has built a collaborative research network involving the University of Washington and numerous medical centers, NGOs and universities throughout Peru. His interests include 1) Clinical, neurologic and virologic manifestations of HIV, HTLV-I, and HTLV-II infections in the general population and in marginalized populations, including commercial sex workers (CSW), men who have sex with men, and people with neurologic disabilities; 2) Sexually transmitted infections in CSW; 3) Viral and "tropical" infections of the nervous system in Peru; and 4) Assessment and education of CSW and adolescents regarding STI, violence and reproductive health.
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