Increasing availability of antiretroviral therapy (ART) in sub-Saharan Africa (SSA) has led to decreases in mortality rates. The WHO estimates that 1.7 million deaths were attributable to HIV in 2011 with the majority caused by co-infecting pathogens. Despite a strong initial response to the HIV epidemic, Uganda still has a prevalence rate of 7.2% among adults aged 15-49 according to UNAIDS. Many patients still present late in infection and often co-infected with opportunistic infections such as tuberculosis (TB) and cryptococcal meningitis. Viral hepatitis (B &C) co-infection occurs in 2-10% of HIV-infected individuals and present challenges in terms of best anti-viral treatment, diagnosis, and prevention. As HIV-infected patients live longer on ART, viral hepatitis related cirrhosis and hepatocellular carcinoma which are accelerated by HIV infection will dominate as causes of death in the virally suppressed. The Infectious Diseases Institute (IDI) in Uganda is a Research Center of Excellence and has already established research programs in HIV co-infections under the previous Head of Research (Y. Manabe, Program Director). The current Head of Research (A. Kambugu, Ugandan Program Director) has worked closely with Dr. Manabe for the last 5 years when he was Head of Clinical Services. Basic descriptive epidemiology has already been published in these focal areas at the IDI by rigorously trained PhD students who have been successfully awarded doctoral degrees and who are capable of original scientific investigation. The overarching objective of the program is to train Ugandans to perform locally relevant research in the area of HIV co-infections including tuberculosis, cryptococcal meningitis, and viral hepatitis. This IDI research context and mentorship model will support post-doctoral researchers at the IDI to become fully independent;capable of writing grants and expanding research interests to prevention, improved models of care, new diagnostics evaluations, advanced biostatistical methodology to analyze longitudinal cohorts, and translational basic science research in Uganda through overseas rotations. Four Masters students will be trained at Johns Hopkins Bloomberg School of Public Health in topical areas for which courses are not available at Makerere College of Health Sciences such as health economics, health systems, and translational, basic research in the co-infections listed above. Three Ugandan Masters'students per year will also be supported to fill the pipeline with new researchers. At the end of this 5-year training program, our overarching objective is to solidify a core group of productive, independent scientists who can garner outside funding, continue to mentor others, and be recognized as international, regional leaders in the area of HIV co-infections.

Public Health Relevance

The proposed partnership training program for the Johns Hopkins University Bloomberg School of Public Health in Baltimore and the Infectious Diseases Institute (IDI) in Uganda will train Post-Doctoral Fellows, PhD, and Masters Students who will be mentored by a deep pool of dedicated local and international faculty who have previously engaged in funded, published research in HIV co-infections (tuberculosis, cryptococcal meningitis, and viral hepatitis), regionally relevant research areas for Uganda. At the end of this 5-year training program, our overarching objective is to solidify a core group of productive, independent scientists who can garner outside funding, continue to mentor others, and be recognized as international, regional leaders who are able to influence policy and practice in the area of HIV co-infections.

National Institute of Health (NIH)
Fogarty International Center (FIC)
International Research Training Grants (D43)
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Special Emphasis Panel (ZRG1-AARR-H (57))
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Mcdermott, Jeanne
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Johns Hopkins University
Internal Medicine/Medicine
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United States
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Wekesa, Clara; Asiki, Gershim; Kasamba, Ivan et al. (2016) Atherogenic Risk Assessment among Persons Living in Rural Uganda. J Trop Med 2016:7073894
Meya, David B; Manabe, Yukari C; Boulware, David R et al. (2016) The immunopathogenesis of cryptococcal immune reconstitution inflammatory syndrome: understanding a conundrum. Curr Opin Infect Dis 29:10-22
Manabe, Yukari C; Worodria, William; van Leth, Frank et al. (2016) Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial. Am J Trop Med Hyg 95:1265-1271
Nakiyingi, Lydia; Nonyane, Bareng A S; Ssengooba, Willy et al. (2015) Predictors for MTB Culture-Positivity among HIV-Infected Smear-Negative Presumptive Tuberculosis Patients in Uganda: Application of New Tuberculosis Diagnostic Technology. PLoS One 10:e0133756
Nakiyingi, Lydia; Ssengooba, Willy; Nakanjako, Damalie et al. (2015) Predictors and outcomes of mycobacteremia among HIV-infected smear- negative presumptive tuberculosis patients in Uganda. BMC Infect Dis 15:62
Cox, Janneke A; Lukande, Robert L; Kalungi, Sam et al. (2015) Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults. PLoS One 10:e0123323
Pac, Lincoln; Horwitz, Mara Murray; Namutebi, Anne Marion et al. (2015) Implementation and operational research: Integrated pre-antiretroviral therapy screening and treatment for tuberculosis and cryptococcal antigenemia. J Acquir Immune Defic Syndr 68:e69-76
Manabe, Yukari C; Moore, Richard D (2015) Cryptococcal Antigen Screening and Preemptive Treatment in a US Cohort of Patients With AIDS. Clin Infect Dis 61:1632-4
Cox, Janneke A; Lukande, Robert L; Kalungi, Sam et al. (2015) Accuracy of Lipoarabinomannan and Xpert MTB/RIF Testing in Cerebrospinal Fluid To Diagnose Tuberculous Meningitis in an Autopsy Cohort of HIV-Infected Adults. J Clin Microbiol 53:2667-73
Manabe, Yukari C; Zawedde-Muyanja, Stella; Burnett, Sarah M et al. (2015) Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers. Open Forum Infect Dis 2:ofv030

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