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Research into new prevention technologies, including vaccines, effective treatment regimens, and improved deployment of existing approaches, remains of central importance to eventual control of AIDS. However, the scientific and public health questions which require the most urgent answers are increasingly difficult to investigate in developed world settings. International collaborative HIV/AIDS research, and the training needed for developing country scientists to lead that research, remains an urgent global priority and a public health necessity.
From its inception the Hopkins AITRP has endeavored to provide training and research support to developing country partners in training relevant to the growing global HIV/AIDS research agenda. Our model has been to provide training in support of collaborative research between faculty of the Johns Hopkins Schools of Public Health and Medicine and their developing country partners, to foster lasting research partnerships, and to assist developing country scientists in establishing their own, and their countries’, capacity in independent HIV/AIDS research. We have measured our success through scientific contributions, competitive funding awards, the impact on country responses of returning fellows, and leadership in international HIV/AIDS research on the part of our trainees.
The Hopkins AITRP is located in the Department of Epidemiology in the Bloomberg School of Public Health; the Principal Investigator is Dr. Chris Beyrer. However, it is a campus-wide program involving faculty and trainees in departments in both the Bloomberg School of Public Health and the School of Medicine. Our international partners include institutions and investigators in Uganda, Malawi, Ethiopia, South Africa, Cameroon, Thailand, India, China, Laos, Russia, The Dominican Republic and Brazil. Primary departments participating in the program are: Biostatistics, Epidemiology, Health Policy & Management, International Health, Molecular Microbiology & Immunology and Population & Family Health Sciences in the Bloomberg School of Public Health and the Departments of Clinical Investigation, Medicine, Pathology, Pediatrics and OB/GYN in the School of Medicine. Campus-wide centers such as the Center for Immunization Research (CIR), the Center for Clinical Trials (CCT), the Center for Clinical Global Health Education (CCGHE), the Center for Public Health and Human Rights, the Center for TB Research, The Bioethics Institute, and the Center for Communications Programs (CCP) serve as resources for faculty and training programs. The Johns Hopkins University Fogarty AITRP is now in its fourth five-year funding cycle, Years 16-20. Year 19 began June 1, 2006.
For more information, visit the program''''''''s web site.
Researchers
Chris Beyrer
Robert Bollinger Jr.
Donald Burke
David Celentano
Karen Charron
Jacqueline Coberly
Vivian Go
Ronald Gray
Laura Guay
Clayton Harro
Deanna L. Kerrigan
Andrea Ruff
Hua Shan
Susan Sherman
Nicole Simmons
Michael Sweat
Taha E. Taha
Nathan Wolfe
Xiao-Fang Yu
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With finding from USAID, ACCESS has been working in West Africa with AWARE-RH, Mwangaza Action, United Nations Children’s Fund (UNICEF) and partner governments. ACCESS/Cameroon works to build the capacity of skilled birth attendants in the areas of prevention of postpartum hemorrhage, use of the partograph (a tool for tracking progress of labor and care of the newborn), and developing regional and national training capacity in maternal and neonatal health care.
In Cameroon’s Ngaoundéré and Tibati districts, ACCESS has taken the lead in building clinical training capacity in essential health services for mothers and newborns. To help ensure that trained providers apply their new skills on the job, ACCESS is supporting Cameroonian trainers to perform post-training follow-up visits. ACCESS is also implementing a quality improvement methodology to motivate clinical sites to regularly assess, improve and monitor their quality of services against evidence-based standards.
In the Ngaoundéré district, ACCESS is spearheading social mobilization efforts around improved maternal and neonatal health. Collaborating with Mwangaza Action, ACCESS has assisted community leaders in developing a pool of trainers to carry out community-level social mobilization workshops. The workshops utilize an ACCESS-developed “auto-diagnostic” tool, which is designed to help communities prepare an action plan for social mobilization that fits their individual needs and is linked to the health facility that serves that community. ACCESS will then help the communities implement those plans.
About ACCESS:
The ACCESS Program is the U.S. Agency for International Development''s global program to improve maternal and newborn health. The ACCESS Program works to expand coverage, access and use of key maternal and newborn health services across a continuum of care from the household to the hospital—with the aim of making quality health services accessible for women and newborns. Jhpiego implements the program in partnership with Save the Children, Constella Futures, the Academy for Educational Development, the American College of Nurse-Midwives and Interchurch Medical Assistance.
Researchers
Koki Agarwal
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In sub-Saharan Africa, malaria infection is estimated to cause 400,000 cases of severe maternal anemia and 75,000-200,000 infant deaths annually. Maternal anemia contributes significantly to maternal mortality and causes an estimated 10,000 deaths per year. In areas of stable transmission, the WHO promotes a three-prong strategy to address MIP prevention and control: 1) intermittent preventive treatment during pregnancy (IPTp); 2) insecticide treated nets (ITNs) for prevention; and 3) case management for treatment.
ACCESS supports the prevention and treatment of malaria in Africa, with an emphasis on malaria in pregnancy (MIP). From 2004-2006, ACCESS was one of four partners—with the Centers for Disease Control and Prevention, World Health Organization (WHO) and Rational Pharmaceutical Management Plus—of the USAID-funded Malaria Action Coalition (MAC). The MAC collectively provided technical support to countries to address the burden of malaria for both prevention and treatment.
Most notably during this partnership, ACCESS served as Secretariat to the Roll Back Malaria, Malaria in Pregnancy Working Group, which included contributing to the development of global consensus statements to support MIP program implementation. At the regional level, ACCESS supported regional MIP coalitions and the sub-regional RBM networks to promote the exchange of information and best practices, development of regional capacity, and revision of national MIP policies. At the country level, ACCESS supported program implementation in six African countries—Burkina Faso, Kenya, Madagascar, Mali, Rwanda, Uganda—with the goal of improving malaria prevention and treatment services provided to pregnant women during antenatal care.
ACCESS continues to provide technical guidance on malaria through the development of clinical and programmatic materials, revising its MIP clinical training materials to reflect the most up-to-date information and current guidance from the WHO. ACCESS has also collaborated with the Centers for Disease Control and Prevention, the Rational Pharmaceutical Management Plus Program/MSH and WHO to develop a MIP program implementation guide for the African region.
To further apply its MIP clinical and programmatic expertise, ACCESS assists African countries develop proposals for funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). GFATM grants provide an important support to allow countries to sustain and grow their malaria prevention and control programs. Moreover, for those countries with existing GFATM grants that have experienced problems implementing their programs, ACCESS helps to identify bottlenecks and devise solutions to overcome them.
About ACCESS:
The ACCESS Program is the U.S. Agency for International Development''s global program to improve maternal and newborn health. The ACCESS Program works to expand coverage, access and use of key maternal and newborn health services across a continuum of care from the household to the hospital—with the aim of making quality health services accessible for women and newborns. Jhpiego implements the program in partnership with Save the Children, Constella Futures, the Academy for Educational Development, the American College of Nurse-Midwives and Interchurch Medical Assistance.
Researchers
Koki Agarwal
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Malaria transmission entails development of the Plasmodium parasite in the mosquito. We have identified a critical interaction between an unknown ookinete lectin-like protein and a chondroitin sulfate glycosaminoglycan ligand on the mosquito midgut lumenal surface. We hypothesize that by disrupting this interaction through the use of small molecule inhibitors we can prevent parasite establishment in the mosquito and, subsequently, completely abrogate malaria transmission. This is a translational research grant proposal with the goal of taking our basic research understanding of Plasmodium-mosquito host interactions toward the development of novel highly potent malaria transmission-blocking therapeutics. Our first aim, the Complete molecular characterization of Plasmodium ookinete protein-midgut glycosaminoglycan interactions involves (1) identifying novel lectin-like ookinete molecules by glycan-affinity chromatography and mass spectrometry, (2) characterizing their functional role in vivo through the production of gene knockout parasites, (3) assessing their binding affinity for mosquito chondroitin glycosaminoglycans by protein array-surface plasmon resonance, and (3) gaining insight into the structure-function of the molecule(s) in complex with chondroitin glycosaminoglycan fragments and structural analogues by molecular modeling and x-ray crystallography. The second aim of the project, the Development of lead Plasmodium transmission-blocking glycan-mimetic compounds and assessment of their transmission-blocking potential involves identification of novel derivatives and analogues of our lead transmission-blocking compound, VS1 (a non-peptidyl polyvinylsulfonated polymer), which is a structural mimic of midgut chondroitin glycosaminoglycans and inhibits >95% of parasite development in the
mosquito. To develop more potent structural analogs, we propose a four-tiered approach: (1) isolation of varying chain-lengths of the VS1 polymer, (2) derivitization of VS1 to enhance inhibitory activity and bioavailability, (3) derivitization of (+)-usnic acid, a polyphenolic compound from lichens, and (4) assessment of the utility of peptide mimotopes of mosquito chondroitin sulfate glycosaminoglycans as transmission-blocking vaccine targets. To
help progress toward preclinical studies, the top candidate compounds from each approach will be analyzed for their pharmacokinetic and pharmacodynamic properties in animal and human serum models.
Researchers
Rhoel Dinglasan
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