South Africa is currently experiencing one of the worst H IV epidemics in the world and tuberculosis is the most common opportunistic infection associated with advancing HIV disease and AIDS. The recent, substantial increase in numbers of people co-infected with HIV and tuberculosis is exacerbating the existing tuberculosis crisis in South Africa. Building on the longstanding collaborative relationships between the University of Natal and Columbia University with respect to research and training in HIV and tuberculosis through the existing Fogarty AITRP, HVTN and HPTN, we propose to develop a collaborative program in clinical, operational and health services research and training to fill an important training gap in the local response to the HIV and tuberculosis epidemics in South Africa. In order to expand the existing collaboration between the two institutions and the South African Medical Research Council we propose to: i. develop a common vision and understanding of the training program between the US and South African partners; ii. identify the specific research training opportunities and required infectious diseases resources in both the US and South Africa; iii. establish the structure, policies and procedures for the comprehensive ICOHRTA-AIDS/TB co-operative agreement; iv. develop integrated links with other training programs such as the CU-SA Fogarty AITRP; and v. prepare an institutional development plan for the next 10 years demonstrating how ICOHRTA resources will enable the University of Natal to achieve its long-term goals in infectious diseases. The continuum of training concept that has evolved through the CU-SA Fogarty AITRP for HIV and tuberculosis basic science, public health, behavioral and ethics research training where Fellows do coursework in the US and conduct their research in South Africa will be applied to this proposed training program for building clinical, operational and health services research capacity. Training opportunities at Columbia University through the Division of Infectious Diseases in the context of providing clinical care include: consultation rounds for patients on the HIV/TB inpatient care, a unit dedicated to the management of HIV infection and the diagnosis and management of tuberculosis, and augmented by a core conference schedule. The following collaborative projects will provide research opportunities for Fellows in South Africa: HPTN 046, HPTN 035, HPTN 043, HVTN 040, numerous operational tuberculosis projects and new initiatives such as the proposed CIPRA which includes an acute infection and natural history study in a clade C population and strategies to integrate antiretroviral therapy with the tuberculosis directly observed short course therapy program. This planning grant will facilitate the development of an ICOHRTA training program which addresses South Africa's priority needs and the institutional development plan of the University of Natal. It optimally utilizes the Columbia University training resources and strong linkages with existing NIH funded clinical research and other Fogarty training programs through building on a well-established, vibrant collaboration involving Columbia University, the University of Natal, the South African Medical Research Council and potentially the NIH Clinical Center.
