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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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The PEPI-Malawi study is a randomized, open-label, controlled phase III trial of extended post-exposure prophylactic antiretrovirals to prevent breastmilk-associated HIV transmission.
The study population consists of women and their babies attending antenatal clinics and/ or admitted to labor rooms at the Queen Elizabeth Central Hospital in Blantyre and 5-6 township health centers in southern Malawi. Women attending antenatal clinics in their second or early third trimesters of pregnancy and those who present for delivery at the labor ward will be targeted for recruitment into the study. Women interested in participation will receive one-on-one counseling on breastfeeding, risk of HIV/AIDS transmission and infant feeding options, in addition to HIV testing and counseling. Counseling includes details of the study such as HIV virus found in breastmilk, and the potential to transmit the virus to their infants. Participants are educated on ways to minimize transmission risk by ceasing to breastfeed or how the risk can also be reduced by exclusively breastfeeding versus mixed feeding. Comprehensive counseling is also conducted to educate the mothers on infant feeding including all breastfeeding options and replacement feeding options.
Newton Kumwenda, PhD, Principal Investigator
Taha E. Taha, MD, PhD, Co-Investigator
Researchers
Newton Kumwenda
Taha E. Taha
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HPTN 052 is a Phase III, two-arm, multi-site, randomized trial to determine the effectiveness of two treatment strategies in preventing the sexual transmission of HIV in HIV-serodiscordant couples.
Based on data collected in Africa and Thailand, there is a correlation between HIV viral load (blood levels) and HIV transmission. Specifically, the higher the viral load in the blood, the more likely the chance for transmission. Antiretroviral therapy (ART) reduces the viral load in the blood, as well as in genital secretions (for both men and women), and the drugs can be detected in semen and vaginal and cervical secretions. All of this information strongly suggests that ART may make HIV-infected people less contagious. HPTN 052 compares the HIV-infection rates of two groups of HIV-serodiscordant couples. The index case of the first group starts taking ART as soon as the couple is enrolled in the study, while the index case of the second group starts taking ART when his or her CD4+ cell count drops to 200 cells/mm3 or when he or she develops an AIDS-defining illness. Both groups will receive HIV primary care and couples counseling sessions to teach them how to reduce their risk of transmission.
Researchers
Robert Bollinger Jr.
David Celentano
Joel Gallant
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To provide overall project leadership and technical expertise in behavior change communication (BCC) in support of the Malawi BRIDGE HIV/AIDS prevention program. CCP will work closely with Save the Children (SC). SC will provide expertise in grants management and community mobilization.
Researchers
Susan Krenn
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Chris Beyrer, MD, MPH, Principal Investigator
Taha E. Taha, MD, PhD, Country Director for Malawi
The JHU Fogarty International Training and Research Program (JHU-AITRP) provides greatly needed opportunities for the training of Malawians in the fields of HIV, STDs, epidemiology, vaccinology, laboratory sciences, and informatics. This endeavor has been vital for the continuing success of research endeavors to control HIV and STDs in the country for the past 16 years. Both degree (Masters and Doctoral) and non-degree programs (short and long term training courses such as Summer Epidemiology, postdoctoral advanced training, and workshops) are supported by the JHU-AITRP It is noteworthy that most trainees have returned to Malawi, and several are in prominent policy positions. For example, Mr. Yusef Mwawa (MHS 1996) is the Minister of Health and Population; Dr. Richard Pendame (MPH 1998) was the Principal Secretary of the Ministry of Health (MOH); Dr. Biswick Mwale (MPH 1999) is the Manager National AIDS Commission (NAC); Dr. Habib Somanje (MPH 1998) is the MOH Controller for Preventive Services; Dr. Thomas Ndovi (PhD 2005) was the Vaccine Coordinator for the JHU-MOH-COM Research Project; and Dr. Newton Kumwenda (PhD 1996) is the Field Director of the JHU-MOH-COM Research Project in Malawi.
Researchers
Chris Beyrer
Taha E. Taha
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CHAVI 001 studies the HIV-1 virus specifically to determine the prevalence of acute HIV infection, characteristics of the transmitted virus in acute HIV-1 infection, host acquired and innate immune responses that contribute to virus control and/or protection against infection with HIV-1, genetic factors that contribute to early virus control and/or protection from infection and examination of the clinical, laboratory, and behavioral characteristics of individuals with acute HIV infection, their sexual partners and appropriate controls.
Researchers
Newton Kumwenda
Taha E. Taha
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Since 1998, Jhpiego has collaborated with the Reproductive Health Unit of the Ministry of Health and the U.S. Agency for International Development/Malawi to improve reproductive health services that meet the country’s needs. Jhpiego’s work has focused on the following key strategies and approaches:
-- Strengthening of provider skills through pre-service education and in-service training
-- Improvements to supervisory skills and systems
-- Development of improved information systems for reproductive health
-- Performance and quality improvement for infection prevention and control and reproductive health
-- Expansion of postabortion care services
-- Strengthening of family planning services, including emergency contraception and reintroduction of the IUD
-- Strengthening of cervical cancer prevention services through the introduction of visual inspection of the cervix using acetic acid, a low-cost approach to cervical cancer prevention
-- Development and provision of information, education and communication materials for family planning
Strong collaborative partnerships with the Ministry of Health and other local partners are the cornerstone of Jhpiego’s approach. By partnering with the Ministry and supporting national programs, Jhpiego’s work is responsive to the government’s needs and is likely to be sustained long term. Jhpiego’s approaches to improving supervision and building the skills of health care providers incorporate a systems approach that is more sustainable than simply training providers. A wide-ranging portfolio of activities reflects a dynamic partnership between the Ministry and Jhpiego.
About Jhpiego:
For nearly 40 years, Jhpiego, (pronounced "ja-pie-go"), has empowered front-line health workers by designing and implementing simple, low-cost, hands-on solutions that strengthen the delivery of health care services, following the household-to-hospital continuum of care. We partner with community- to national-level organizations to build sustainable, local capacity through advocacy, policy and guidelines development, and quality and performance improvement approaches.
Researchers
Alain Damiba
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This project proposes to examine the reliability of HIV Treatment adherence measurement methods in Malawi, determine the impact of fixed-dose therapy and identify barriers and facilitators of excellent adherence. The results of the study can be used to develop culturally appropriate methods of increasing adherence in Malawi, a low income country.
Researchers
Jean B. Nachega
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HIV prevention project in Malawi. Project uses community mobilization activities and mass media.
Researchers
Rajiv N. Rimal
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Impact evaluation component of Partnership for Maternal, Newborn and Child Health rapid scale-up in Africa
Researchers
Abdullah Baqui
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In Malawi, ACCESS is improving the availability of and access to sustainable maternal and newborn health services at the facility and community levels. Specifically, ACCESS is supporting Ministry of Health and USAID efforts to increase utilization of these services and the practice of healthy behaviors to reduce maternal and neonatal morbidity and mortality.
To meet these objectives, ACCESS is implementing an integrated community and facility-based essential maternal and newborn care program focusing on antenatal care and basic emergency obstetric care and postpartum care along the Household-to-Hospital Continuum of Care (HHCC). ACCESS is working with its partners using President’s Malaria Initiative (PMI) funds to build the capacity of District Health Management Teams (DHMT) to increase IPTp uptake and provide support to selected hospitals and health centers. This technical assistance will improve national capacity to prevent malaria in pregnancy in line with the goals of the President’s Malaria Initiative (PMI).
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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Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality in HIV-infected persons worldwide. However, early treatment failure (i.e. WHO stage 3 or 4 illnesses or death during the first 12 months of HAART) is >3-fold higher in resource limited settings (RLS) than in resource-rich settings. Early treatment failure is associated with low CD4 count, low body mass index, and anemia, but these markers are nonspecific and could reflect advanced HIV, co-infections, and/or malnutrition. The relative contribution of malnutrition to early treatment failure in RLS is unknown. Up to 40% of adults in RLS are malnourished due to protein-energy, iron or iron-deficiency anemia, or other micronutrient deficiencies, which are associated with immune dysfunction and increased morbidity and mortality. However, the significance of this malnutrition in HIV-infected persons initiating HAART in RLS is unclear. In addition to immune dysfunction, this malnutrition has been associated with impaired gut integrity, increased microbial translocation and immune activation. Recently, chronic HIV infection
has also been associated with a “leaky gut” and systemic immune activation. High levels of immune activation result in impaired immune restoration with HAART and HIV disease progression. Therefore, we hypothesize that baseline malnutrition is predictive of early treatment failure among HIV-infected adults in RLS and that early treatment failure is related to the synergistic deleterious effects of HIV and malnutrition on gut mucosal integrity leading to increased systemic immune activation. To address our hypotheses, we will utilize data and cryopreserved samples collected as part of an ongoing trial conducted by the Adults AIDS Clinical Trial Group (ACTG 5175). This NIH-funded study is evaluating the efficacy of HAART among 1571 HIV-infected adults in 8
RLS countries (Africa-3, Asia-2, Americas-3) and the United States. We propose three specific aims:1) To characterize baseline micronutrient status and assess its relationship to baseline disease stage, demographics and simple-to-measure nutritional indices among treatment-naïve HIV-infected adults initiating HAART; 2) To assess whether specific measures of baseline malnutrition are independent predictors of early treatment failure. 3) To determine whether malnutrition and treatment failure are associated with microbial translocation, immune activation, and reduced immune restoration. Our study has a high likelihood of success because our international
team includes leaders in HIV, immunology, statistics and nutrition research. Data and specimens for our study come from a NIH-funded trial that is ongoing but has completed enrolment. This will reduce the time needed to complete the planned studies and optimize cost-efficiency. Importantly, data generated from our study will fill a
critical knowledge gap in the understanding the role of malnutrition on early HAART outcomes in RLS. Such data are needed to 1) provide necessary evidence to guide the design of new trials that will optimize the benefits of HAART in RLS, where HIV, early treatment failure, food insecurity, and malnutrition are all common, and 2) further our insights on the relationship between malnutrition, immunity and infectious disease pathogenesis.
Researchers
Adriana Andrade
Robert Bollinger Jr.
Parul Christian
Amita Gupta
David Thomas
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The overall goal is to reduce maternal, newborn and child mortality in high-mortality countries in Africa and lay the foundation for concerted, coordinated actions to reduce maternal, newborn and child mortality in Asia.
Researchers
Robert Black
Jennifer Bryce
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The Malawi Clinical Trials Unit (CTU) - in collaboration with the College of Medicine-University of Malawi and the University of North Carolina - Chapel Hill - conducts prevention, microbicide, perinatal and antiretroviral trials as well as develops educational and scientific infrastructure in Blantyre and Lilongwe, Malawi.
Researchers
Taha E. Taha
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Abstract not available
Researchers
Susan Krenn
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The Family Health and Wealth Study is carried out in collaboration with eight partner programs of the Gates Institute. Over a three year period, it will study the relationship between family building/reproductive patterns and health and wealth consequences for a sample of households in peri-urban areas of Addis Ababa (Ethiopia), Kampala (Uganda), Blantyre (Malawi), Assiut (Egypt), Kumasi (Ghana), Ife and Ibadan (Nigeria).
Researchers
Saifuddin Ahmed
Stan Becker
David Bishai
Vladimir Canudas-Romo
Michelle Hindin
Amy Tsui
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The Malawi Couples Study tests the feasibility and acceptability of delivering home-based HIV counseling and testing and family planning services to couples. By delivering the intervention at the household level to couples, stigma is mitigated and both partners of the couple are reached in terms of the individual and combined information and service benefits of the intervention. The qualitative and quantitative components showed potential acceptability of the intervention in peri-urban areas. A subsequent phase of the project seeks to test the intervention in rural areas.
Researchers
Stan Becker
Michelle Hindin
Amy Tsui
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