HIV infection is a devastating epidemic in the Dominican Republic and in particular the region of Puerto Plata. It has one of the highest HIV seroprevalence rates in the country and is a top-priority area for HIV prevention and treatment efforts. The goals of the present application are: I. Establish a comprehensive HIV clinical research program in the region of Puerto Plata. This program will evaluate strategies for the treatment and further prevention of HIV that are practical, affordable, and durable for the local region and that can ultimately be applied to other developing regions of the world that have limited health and monetary resources. II. Identify research priorities of the Dominican Republic. The host country has identified several key areas of HIV research that will constitute part of a future U01 proposal. These include: 1) Maternal-fetal transmission. Evaluation of a better, more cost-effective antiretroviral regimen that can prevent vertical HIV transmission and the development of viral resistance at the same time. 2) Antiretroviral therapy. Evaluation of different methods to deliver antiretroviral therapy in resource poor settings. 3) Opportunistic infection prophylaxis. Evaluation of different methods to deliver prophylaxis in poor resource settings including initiation and cessation of prophylaxis based on clinical criteria rather than laboratory criteria. 4) Education programs for health care providers. 5) Development of an infrastructure that will support future HIV vaccine trials. III. Develop the necessary expertise to conduct clinical trials and research in HIV therapeutics and prevention.
