This proposal builds on the foundation established in Haiti during three decades of NIH research and training support to Weill Cornell Medical College and the Groupe Haitien d'Etude du Sarcome et des Infections Opportunistes (GHESKIO). The focus of this training program is improving the diagnosis, treatment, and prevention of AIDS related tuberculosis, with an emphasis on multi-drug resistant tuberculosis (MDR-TB). A cadre of 10 Haitian clinicians will receive 2 years of research training which will include an MPH from the Cornell-GHESKIO- Quisqueya program in Haiti. We will also respond to an urgent need expressed by the Haitian Ministry of Health for skilled laboratory leaders and establish a 2 year MS in Laboratory Science program for 8 Haitian laboratory trainees. These 18 clinical and laboratory trainees will conduct their mentored MPH and MS theses in the following priority research areas: 1) translational research on M. tuberculosis latency, persistence, and drug discovery; 2) clinical trials of new drugs for the treatment of MDR-TB, including patients with HIV; 3) maternal- child tuberculosis diagnosis, HIV/TB treatment, and prevention; 4) community-based case detection of HIV/TB and MDR-TB molecular epidemiology; 5) implementation science to scale-up new TB diagnostics and HIV/MDR-TB treatment. The program will also train research staff including nurses (6), data managers (2), social workers (2), and pharmacists (2) to participate in the aforementioned research areas. Haiti has the highest prevalence of HIV (2.2%) and tuberculosis (296/100,000) in the Western Hemisphere. There are an estimated 1,540 prevalent MDR-TB cases in Haiti, but only ~150 patients are currently treated, in large part due to the lack of skilled clinical and laboratory personnel. Therefore over 90% of MDR-TB patients are left untreated in the community. This public health risk is compounded by the fact that 1/3 of patients are also HIV-positive. The development and validation of new diagnostics and anti-tuberculous therapies, coupled with a targeted research training program will address this urgent need. This program not only responds to the priorities of the Haitian Ministry of Health but will also train the next generation of Haitian leaders in the field of HIV and tuberculosis research. Their accomplishments will have a direct effect on the national HIV/TB program in Haiti and have the potential for a major global impact.
The focus of this training program is to build research capacity at the GHESKIO Center in Haiti in the diagnosis, treatment, and prevention of HIV/TB and MDR-TB. A multidisciplinary group of investigators will be trained in five priority research areas including translational studies on M. tuberculosis, clinical trials of new drugs for the treatment of MDR-TB, maternal-child tuberculosis, MDR-TB epidemiology, and implementation science to scale-up MDR-TB treatment. The goal is to train the next generation of Haitian leaders who will conduct synergistic research and direct a national HIV/TB and MDR-TB program with the ultimate goal of eliminating MDR-TB in Haiti.
