This is a supplement to the parent AITRP of the Division of International Medicine & Infectious Diseases, Weill Medical College of Cornell University. This request for additional funding is to continue an over 10 year-partnership of training in Tb/AIDS research between Cornell University, University of California (UC) at Berkeley and the Tb Program at the Federal University of Rio de Janeiro (UFRJ), Brazil. Brazil is one of the 22 countries in the world with the largest Tb burden and has a high rate of multi-drug resistance (MDR). Tb in Brazil is concentrated in urban centers, and Rio de Janeiro with a high prevalence of HIV/AIDS has become the city with the highest incidence cases of Tb from 80/100,000 in 1985 to 120/100,000 in 1988. The objective of this program is to train Brazilian investigators in the conduct of epidemiologic, clinical, and applied laboratory research to control the epidemic of Tb and HIV/Tb. The emphasis is on mid and long-term training in 1) epidemiology and clinical trials, 2) pathogenesis and immunobiology and 3) diagnostics with a focus on Tb/HIV. Depending on the training area, candidates will acquire skills in epidemiology, clinical trials design, bio-statistics, molecular and cell biology, genetics, and immunology. The Tb Program at UFRJ has set a research agenda in its effort to combat the HIV and Tb co-epidemic, and to fill gaps in the national research priorities. The Tb program's research agenda are as follows: 1) Improve the diagnosis of Tb; 2) Delineate the immunopathologic factors in Tb/HIV; 3) Identify microbial factors in Tb persistence/latency and reactivation Tb; 4) Identify host factors in susceptibility to Tb and HIV/Tb interactions and 5) Evaluate MDR Tb transmission and interventions against HIV/Tb. Training is conducted in US (Cornell and UC Berkeley: 1 long-term and 1 short-term fellow) and in Brazil at UFRJ where through the prior Fogarty training, a cadre of Mentors is now available for more cost-effective in-country training (7 predoctoral candidates per year). Moreover, through the integration of trainees upon completion of their training into the Tb Program at the UFRJ, which cares for 5% of the annual Tb cases (>10,000) in the Rio will enhance the program's impact in the control of Tb and AIDS and ensure retention of talent. ? ?
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