Fulbright-Fogarty Program Sites by Region and Country

Location: Gaborone, Botswana

Affiliation: The Botswana Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education

U.S. partner: Harvard University

Contact: Dr. Max Essex MESSEX@hsph.harvard.edu or Dr. Vladimir Novitsky vnovi@hsph.harvard.edu

Eligibility: Ph.D. students in biomedical areas, especially virology/immunology; MD, or DVM levels. All fellows should be interested in doing lab work projects in molecular epidemiology related to prevention, treatment, transmission, and drug resistance for HIV/AIDS.

Not eligible: Applicants only interested in behavioral research.

Project descriptions: Fellows will work with ongoing research to:

1. Analyze the HIV reverse transcriptase or protease genes from newly transmitted viruses in people with acute or early infections. The mutations seen would be correlated with time of infection or disease progression, the degree of use of the drugs in the region, and the fitness of the mutant viruses in competition with the wild-type revertant parental virus as determined by competition assays. Viruses from acutely infected individuals would also be characterized for envelope signatures that suggest which class of transmission partner they may have originated from.
2. Identify human AIDS risk genes or single nucleotide polymorphisms that alter risk for HIV infection and/or rate of disease progression (or immune cell loss) after infection. This is based on gene scans for single nucleotide differences. Once genes are identified that are associated with different risks for infection or progression, the gene products will be analyzed to see how they may alter the infection process.

Location: Kumasi, Ghana

Affiliation: Kwame Nkrumah University of Science and Technology (KNUST)

U.S. partner: University of Washington

Contact: Dr. Beth Ebel bebel@u.washington.edu , Dr. Charles Mock cmock@uw.edu , or Dr. Peter Donkor petadonkor@yahoo.com .

Eligibility: Post-third year medical school; Post graduation from medical school, veterinary or dental school; Ph.D. candidate in later years of program, post Ph.D., post-Master's level degree candidates must have completed their basic science courses and one year of clinical clerkship prior to the start of the fellowship year.

Background:

In stark contrast to the reduction in injury deaths among industrial nations, low and middle-income countries (LMIC) have experienced growing rates of fatal injury, most notably in sub-Saharan Africa. Longstanding collaborations developed through the UW-KNUST Fogarty program have developed a cadre of trained injury research leaders, and engaged junior researchers in innovative, mentored injury-related health research. The program plans to develop, expand and consolidate existing collaborative research and training networks by integrating researchers from Ghana, other West African nations, the UW and other institutions with a shared commitment to preventing and treating injury.

Project descriptions:

Research Scope: Death and disability from injury has increased hand-in-hand with growth of vehicle traffic and evolving socio-economic environments in low and middle-income countries, often displacing infectious disease as a leading cause of death and disability. A cadre of trained experts in global injury research is needed to avert epidemic levels of injury in poorer countries.

Examples of long-term projects:

• Road traffic safety. Road traffic injury has grown rapidly in Ghana, and is the leading cause of injury death. The majority of road traffic injuries impact pedestrians, and many of them are children. There is a growing proportion of occupant injuries along with the rise in vehicle traffic. There are many beneficial practices (use of public transportation, heavy pedestrian traffic, favorable legislative environment, developing traffic injury surveillance systems) to which many US cities aspire. Ghana has built an impressive network of data systems for analyzing road traffic injuries and is working with partners such as the BRRI and the National Road Safety Commission to identify and implement strategies to reduce road injury. Research areas include speed control, measures to reduce pedestrian injury, commercial driving risk, and measures to improve the safety of public transportation.
• Epidemiology and surveillance systems for injury control. Reliable estimates of injury incidence and disability are critical for identifying and implementing policies for national safety. Population based injury surveillance systems are largely absent in developing countries. Research areas include the creative use of existing population-based surveillance measures which include injury-related data elements, and development of analytical tools to derive estimates of injury burden from pre-hospital data, hospital records, morgue data, police reports and health surveys.
• Development and enforcement of standards for trauma care. Developing standards for levels of trauma care (e.g. trauma center verification) has been a foundation of trauma system development in high income countries. The World Health Organization has developed similar standards, oriented for the circumstances of low and middle income countries. These standards have been used in several countries to identify opportunities for low-cost and sustainable improvements in resources for trauma care. Research areas include the identification of deficiencies in critically important resources that could be sustainably improved through better organization and planning, at minimal cost.
• Improving pre-hospital care for injured patients. The Ghana National Ambulance Service currently covers only a small percent of the need in Ghana, with many areas without access to ambulance service. This has major policy implications globally, as most of the world’s population does not currently have access to systematic pre-hospital care. As the National Ambulance Service expands, there are opportunities to compare areas with new access to formal prehospital care (e.g. ambulances) with the current models of pre-hospital care (e.g. wherein bystanders or relatives bring injured persons to hospitals). Research questions include analysis of the impact of pre-hospital care on outcomes, study of specific injury care where there is heavy use of traditional healers (e.g. bone-setters for fracture care), and application of systems approaches to identifying areas of heavy need and efficient resource utilization.
• Reducing alcohol-related injury. Alcohol use is a pervasive risk factor for risk of all trauma, including motor vehicle crashes, pedestrian injury, violence and falls. Ghana has a progressive drunk driving laws but more research is needed to consider the prevalence of alcohol use and risk for injury, as well as research which identifies intervention strategies.

Location: Eldoret, Kenya

Affiliation: USAID AMPATH Partnership, Moi University School of Medicine, Moi Teaching and Referral Hospital

U.S. partner: Brown University

Contact: Dr. E. Jane Carter e_jane_carter@brown.edu

Eligibility: Post-third year medical school; Post graduation from medical school; Ph.D. candidate in later years of program, post PhD, post-Master’s level, Dental School or Veterinary School doctoral degree candidates must have completed their basic science courses and one year of clinical clerkship prior to the start of the fellowship year, Post-graduation from Dental or Veterinary School

Project descriptions:

USAID AMPATH has five research working groups: Pediatrics, Adult, Public Health, Tuberculosis and Reproductive Health. At any time there are between 20-30 projects ongoing in each working group. Please contact site PI for more specific details.

Examples of long-term projects that the fellow could be involved in:

1. USAID PEPFAR funded, Intensified Case Finding for Tuberculosis- Intensifies Case Finding Program (Cough Monitor Program) has been funded and in continuous existence over the last 4 years. Ongoing evaluations in this program include best screening question s for predicting TB disease, modeling of continuous versus intermittent ICF in decreasing incidence of TB disease, and incorporation of screening algorithms for children in ICF programs.
2. USAID PEPFAR funded, Community based DOTS for MultiDrug Resistant TB – A community based MDR treatment program has been in effect for the last three years. Evaluation of home infection control as well as pharmacovigilance programs are under development.
3. Lifespan and USAID funded, Fluoroquinolone Use and Tuberculosis Drug Resistance in the Developing World- Fluoroquinolones are the backbone of MDR Treatment and represent the only hope presently on the horizon for shortening therapy. However, due to their broad spectrum of antibiotic action they are used for many indications. Mono-Treatment with a Fluoroquinolone in unsuspected TB for as little as 10 days can lead to Fluoroquinolone resistant TB. Study ongoing to evaluate the link between broad use of Fluoroquinolone in the developing world and Fluoroquinolone resistance.
4. USAID PEPFAR funded, Diabetes Care in the Developing World- Diabetes in the developing world was formerly a death sentence. AMPTH has developed diabetes care clinics at multiple sites and now work with over 3000 diabetic patients. Studies are ongoing for evaluation of risk factors for diabetes as well as best management programs for diabetic care in the developing world.
5. OSCAR (Orphans and Separated Children Assessment Research) Health and Well Being Project- Oscar is an NIH R0-1funded 5 year longitudinal observational study of a cohort of 4000 children who are either actually or virtually orphaned or separated. This longitudinal study is stratified by care site (extended family, Street youth, orphanage) to evaluate outcomes – medical and social. The aim is to determine best care setting to promote child development.
6. USAID PEPFAR supplement funded, HIV biodiversity- Long-term studies continue at our site to track both incidence and risk factors for HIV drug resistance.

Location: Nairobi, Kenya

Affiliation: University of Nairobi http://www.uonbi.ac.ke/
Kenya Medical Research Institute (KEMRI) http://www.kemri.org/

U.S. partner: University of Washington

Contact: Dr. Carey Farquhar cfarq@u.washington.edu or International AIDS Research and Training Program iartp@uw.edu

Eligibility: Candidates must be medical students or graduate students in Ph.D. programs in health sciences

Project descriptions:

Research and training activities available for fellow participation focus on HIV/AIDS and include the projects listed below.

• HIV-1 and Protective Immunity against Common Childhood Pathogens
• Cervical Dysplasia in HIV-Positive Women on Antiretroviral Therapy in Kenya
• Building Capacity of Infant HIV-1 Vaccine Clinical Trial Centres in Nairobi, Kenya and Fajara, The Gambia
• Effect of Long-lasting Insecticide-treated Bed Nets and a Point-of-use Water Purification Device on HIV Disease Progression in Kenya
• Molecular Basis of Nontyphoidal Salmonella Emergence
• Mechanisms and Cofactors of HIV Transmission to Women
• Optimizing Pediatric HIV Therapy
• Parallel Comparison of Tenofovir and Emtricitabine/Tenofovir Pre-Exposure Prophylaxis to Prevent HIV-1 Acquisition within HIV-1 Discordant Couples
• Protective Cellular Immune Responses in HIV-1 Discordant Couples
• Empiric Therapy of Helminth Co-infection to Reduce HIV-1 Disease Progression
• STI Etiologic Surveillance Among HIV-infected Adults in Care Programs

For project descriptions, see the University of Washington-Kenya Research Program website.

Location: Lilongwe, Malawi

Affiliation: UNC Project - Malawi, Lilongwe

U.S. partner: University of North Carolina, Chapel Hill

Contact: Dr. Charles van Der Horst charles_vanderhorst@med.unc.edu or Dr. Mina Hosseinipour mina_hosseinipour@med.unc.edu

Eligibility: Medical students who will have completed 3 years of medical school at the time the fellowship starts or students in epidemiology programs with preference given to those who have at least an MPH. We also accept current residents (medicine, pediatrics, surgery, OB-GYN), post-doctoral students or fellows.

Project descriptions:

Fellows would work in one or more of the following areas:

1. Sexually transmitted infections; prevention of mother to child transmission of HIV (PMTCT); antiretroviral treatment (ART); tuberculosis diagnosis; family planning, obstetric fistula repair, cancer registry and hospital admissions (medicine, surgery and obstetrics). Through these activities and their existing databases, a wide variety of research questions can be supported. Additionally, UNC Project will be responsible for the roll-out of laboratory services for the country for the next 5 years.
2. Rolling out universal ART for pregnant and breastfeeding women and evaluation of the impact on HIV transmission to the infant. The proposed position will work closely with the existing monitoring and evaluation team to answer operational issues related to the rollout of PMTCT and ART activities and best practices for the integration of additional services, including tuberculosis screening, family planning and laboratory services. Research activities will include cost effectiveness evaluation of novel programs including point of care testing, modification of ART eligibility guidelines, couple recruitment and retention strategies such as cell phone reminders and evaluation of the impact of such programs if expanded nationally.
3. Development of optimal screening algorithms using new technologies. Drug resistance to common tuberculosis treatment is increasing but the extent of resistance in Malawi is under investigation. UNC Project has developed more sensitive diagnostic testing capacity but it is unclear how these tests should be integrated into the TB program. Research activities will include development of optimal screening algorithms using technologies
4. The Malawi ART program, initiated in 2004, has now evolved to provide more comprehensive integrated services including family planning, cervical cancer screening, pre-ART care including Isoniazid prophylaxis, and other prevention health programs including mosquito bednet distribution. Previous projects have included evaluation of uptake of family planning services including IUCD, evaluation of criteria for treatment failure and reasons for loss to follow-up in both pre-ART and post-ART care. Fellows may develop projects focused on program evaluation of existing services or models of integration within the program.
5. The UNC Project is a part of the ACTG , IMPAACT , MTN , HPTN , CHAVI , IPM and Malaria Vaccine Initiative networks and has participated in many network studies. Under some circumstances, trainees may become involved with site specific projects related to a network study.

Location: Durban, South Africa

Affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA)

U.S. partner: Columbia University

Contact: Dr. Quarraisha Abdool Karim abdoolq2@ukzn.ac.za and Dr. Nesri Padayatchi padayatchin@ukzn.ac.za

Eligibility: Post-third year medical school; Post graduation from medical school; Ph.D., post-Master’s level

Project descriptions:

Fellows would participate in one or more of the following projects:

1. The TRAPS Program (Tenofovir gel Research for Advancing Prevention Science) studies are designed to offer fundamentally new insights into how tenofovir gel works to prevent HIV in vivo, and the biology of HIV acquisition and control. It’s principal goal is to provide the information necessary to design an improved gel with substantially higher efficacy. The TRAPS Program provides an opportunity to study the impact of topical antiretroviral pre-exposure prophylaxis in humans on four important aspects of HIV infection viz. innate and adaptive immune responses, viral dynamics, pharmacokinetics of tenofovir and the role of genital inflammation in HIV acquisition. At the completion of the TRAPS Program studies we expect to have an enhanced understanding of whether tenofovir gel has an impact on genital cytokines and CD4+ cell distribution, genital CD4+ cell trafficking, viral diversity, viral drug resistance and mucosal immunity. Additionally, multiple compartment tenofovir drug levels will be explored as potential correlates of protection.
2. The Reducing HIV in Adolescents study, which is currently a matched pair, cluster randomized controlled trial to assess the impact of a school-based intervention of cash incentivized behaviour change on HIV incidence in grade 9 and 10 children in 14 schools in rural KwaZulu-Natal. The RHIVA essential package includes a seven-module life skills program delivered to all intervention and control schools. Learners will be encouraged to achieve three milestones: annual HIV testing, good academic performance and participation in an extra-mural AIDS prevention (a component of sustainable livelihoods) program. However, only learners in the intervention schools will receive a cash incentive for achieving these milestones. The RHIVA trial sets out to demonstrate that cash incentives can increase desired behaviors to the level where their high uptake reduces HIV risk and thereby HIV incidence.
3. The TB Recurrence upon Treatment with HAART study, which opened enrolment in 2009, will assess whether TB recurrence in treated TB-HIV co-infected patients is due to reactivation or reinfection. Inthis prospective cohort study, the mycobacterial strain from new episodes of TB in ex-SAPIT and ex-START trial participants will be compared to baseline stored mycobacterial to assess whether the recurrent TB episode is due to reactivation or reinfection. Innate and T-cell immunity will be assessed to identify potential immunological grounds which predispose to reactivation and reinfection
4. The CAPRISA 008 tenofovir gel implementation trial, which is a phase IIIb open-label randomized controlled trial to assess the effectiveness and safety of tenofovir gel provision through family planning services in KwaZulu-Natal, South Africa. The implementation of tenofovir gel through the health services is the next biggest challenge once tenofovir gel is registered as a medicine and can be legally dispensed in each country. A major gap exists between the prevention effectiveness achieved in clinical trials and subsequent performance of the health system in real-life clinical settings.
5. The CAPRISA 009 study aims to determine whether prophylactic exposure to tenofovir gel alters the therapeutic response to a tenofovir containing antiretroviral regimen. Women who become infected with HIV while participating in the CAPRISA 004 and CAPRISA 008 trials will be randomised to either receive Tenofovir, lamivudine and efavirenz or Zidovudine, lamivudine and efavirenz as their first line treatment regimen and antiretroviral treatment failure rate at 12 months will be compared.

Location: Kampala, Uganda

Affiliation: Joint Clinical Research Center (JCRC), Kampala

U.S. partner: Case Western University

Contact: Dr. Peter Mugyenyi, pmugyenyi@jcrc.co.ug

Eligibility: Applicants must be professionals in Medicine, Clinical investigation, Epidemiology; behavioral and social science research clinicians; and who are holders of a: McBCHB; M.D.; Master’s degree and/or Ph.D. degree. RNs with specific training or experience with HIV/AIDS. Candidates who will have just completed their Ph.D. are preferred. Training and research experience in public health, epidemiology or health economics is an added advantage. Highly motivated students can submit proposals addressing areas such as: Operations research with a goal to improve the care and treatment of AIDS or TB patients in resource-limited settings; inform antiretroviral therapy practice and policy; HIV/TB prevention, care and management; comprehensive HIV or TB patient care; enhancing adherence to ARVs and to improving outcomes of the roll-out and scale-up of antiretroviral therapy in Africa.

Project descriptions:

AIDS Clinical Trials Group Studies include:

• “Optimal Combination Therapy After Nevirapine Exposure”; “Maintaining Options for Mothers Study” ;A Strategy Study of Immediate vs. Deferred Initiation of ART for HIV-Infected Persons Treated for TB with CD4<200 Cells/mm3”; ”International Trial of Directly Observed Therapy versus Standard of Care for Patients with First Virologic Failure on a Non-Nucleoside Reverse Transcriptase Inhibitor- Containing Antiretroviral Regimen.
• Assessment of the role of routine laboratory monitoring for patients receiving antiretroviral therapy in Uganda: Evaluation Program for the Presidents Emergency Plan for AIDS Relief will evaluate the role of routine lab monitoring in improving the outcomes of antiretroviral therapy among 600 HIV infected Uganda patients above 18 years of age.
• International Clinical Operational and Health Services Research Training Award for AIDS and TB is a collaboration between Uganda institutions including Makerere University Faculty of Medicine, Mbarara University of Science and Technology (MUST), National TB/Leprosy Program (NTLP) and Kampala City Council (KCC) and the Case Western Reserve University. The goal of the program is to expand national capacity to address the public health and scientific challenges of the evolving HIV and TB epidemic in Uganda through clinical and field research.
• Development of AntiRetroviral Therapy in Africa is an open randomized trial evaluating strategic approaches for the management of ART in previously untreated symptomatic HIV infected adults with CD4 cell counts <200 cells/mm3 initiating ART in Africa.
• A randomised trial to evaluate the efficacy of maintenance monotherapy with ritonavir-boosted lopinavir (Aluvia tablets) following initiation with 24 weeks of combination therapy in second-line ART in Africa. Second-line Anti-Retroviral Therapy in Africa Study
• Anti-Retroviral Research for Watoto is a randomized trial evaluating two strategic approaches for management of antiretroviral therapy (ART) in 1200 symptomatic HIV infected infants and children in Uganda and Zimbabwe. The first approach compares clinically driven monitoring with laboratory plus clinical monitoring. The second approach compares a continuous first line ART three drug two class regimen, comprising two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) plus one Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), with induction with four drugs (two classes) followed by maintenance with three drugs.

Other research and training activities available include:

• Protocol to Evaluate the Safety and Immunogenicity of LFn-P24 as a Therapeutic Vaccine in HIV-infected Adult.
• TIME Table for Regional Expansion of Antiretroviral Therapy Program is an ART access program of the JCRC that is supported by USAID from the PEPFAR funds.
• “A randomized, controlled trial of short cycle intermittent versus continuous HAART for the treatment of chronic HIV infection in Uganda" Structured Treatment Interruption (STI) Project
• PharmAccess African Studies to Evaluate Resistance (PASER) Program
• The PASER program is a multi site project in collaboration with PharmAccess Foundation, a Dutch multi-service, not-for-profit organization.
• Expanding the Availability of Fixed Dose Combination Antiretroviral Formulations for First-line Treatment of HIV-infected Children - the Children with HIV in Africa Pharmacokinetics and Acceptability/Adherence of Simple Antiretroviral Regimens CHAPAS-3 Trial
• The Eastern and southern Africa Research Network for Evaluation of Second Line Therapy in HIV infection: The EARNEST Trial

Location: Kampala, Uganda

Affiliation: Infectious Disease Institute, Makerere University
U.S. partner: Johns Hopkins University
Contact: Dr. Yukari C Manabe, ymanabe@mu-jhu.idi.co.ug

Eligibility: Post-third year medical school; Post graduation from medical school; Ph.D. students in health sciences (post-Master’s-level)

Project descriptions:

Fellows would work in one or more of the following areas:

1. Testing new TB diagnostics and investigating their role in diagnostic algorithms especially in the context of HIV.
2. Operational research on new models of care in TB-HIV co-infection, sexual and reproductive health, discordant couples and in young adults who are HIV infected and evaluation of health systems.
3. HIV longitudinal cohort research using over 43,000 unique patients’ data to answer operational questions related to HIV prevention care and treatment in both urban and rural settings.
4. Prevention of early mortality after antiretroviral therapy with empiric TB therapy or through TB and cryptococcal antigen screening and treatment of positives.
5. Evaluation of point-of-care technologies for HIV and related infections