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    Center for AIDS Research

    From Providence to Chennai

    When it comes to immunology research, the borders of The Miriam Hospital extend far beyond the East Side of Providence. More than 7,000 miles away, researchers from the Samuel and Esther Chester Immunology Center at The Miriam Hospital are leading global health projects to help stem the tide of HIV/AIDS and associated diseases, like tuberculosis (TB), in the developing world.

    Shah and Connell
    Kinjai Shah, Md and Nate Connell, MD, on a home visit in Eldoret, Kenya on their rotation in the fall of 2009.

    Overall, there are currently more than 20 Miriam researchers collaborating on clinical, behavioral and basic science research initiatives in nearly a dozen countries throughout Asia and Africa. Many of the group's research projects are funded through the Lifespan/Tufts/Brown Center for AIDS Research (CFAR), a program launched by the National Institutes of Health (NIH) to fund basic science and clinical research. The Lifespan CFAR—one of only 20 CFAR sites nationwide—is a joint research effort between Tufts and Brown universities and their affiliated hospitals and centers, including The Miriam Hospital, which serves as the primary contracting institution. Charles Carpenter, MD, founder of the Immunology Center at The Miriam Hospital and a global leader in HIV/ AIDS research, serves as principal investigator for the Lifespan CFAR.

    “The Miriam Hospital has a longstanding commitment to bring HIV awareness and knowledge to countries that are disproportionately affected by this disease and lack the resources to effectively cope with it. Our goal is to improve the clinical care, survival and quality of life of the millions of HIV-positive people living in these countries and prevent further spread of this disease,” says Susan Cu-Uvin, MD, an HIV physician at The Miriam Hospital and director of the Brown University Global Health Initiative.

    The Miriam Hospital has had one of the longest and most productive collaborations with researchers in India, where there are an estimated 2.4 million people living with HIV. Over the years, research projects initiated in India have resulted in more than 100 peer-reviewed publications. Kenneth Mayer, MD, an infectious diseases physician at The Miriam Hospital and an international HIV/AIDS expert, has been at the forefront of many of these projects. During the last decade, he has led research projects in India ranging from biological and behavioral approaches to prevent the spread of HIV to the development of community-based clinical research activities. He has also been a principal investigator of the NIH HIV Prevention Trials Network, which includes international research on HIV prevention in the southern Indian city of Chennai, the region that has been hardest hit by the country's AIDS epidemic. Mayer is currently spearheading several CFAR-funded projects, including one aimed at identifying barriers that impact HIV testing and condom use among HIV-infected and high-risk uninfected individuals in Chennai. He is also leading an initiative that will strengthen the foundation for future research collaborations with Indian investigators, with the goal of developing innovative HIV prevention programs targeting several at-risk, yet understudied, groups—truck drivers, cleaners and men who have sex with men.

    “Our research projects in India provide a unique opportunity for investigators to gain valuable, hands-on experience while helping to advance prevention and treatment efforts in a country that has been devastated by HIV and AIDS,” Mayer says.

    Elsewhere in India, Rami Kantor, MD, is studying the prevalence of treatment failure and drug resistance among HIV-infected women receiving first-line antiretroviral therapy. The women are being treated at the Y.R. Gaitonde Centre for AIDS Research and Education, a non-governmental organization in southern India that collaborated with researchers from the Lifespan CFAR for many years.

    World Map
    Researchers are leading global health projects to help stem the tide of HIV/AIDS and associated diseases, like tuberculosis.

    Kenya is another nation that has long welcomed Miriam Hospital researchers—including pulmonologist E. Jane Carter, MD, who is world renowned for her work on TB and HIV co-infection. More than 1.5 million Kenyans are living with HIV/AIDS, and nearly half of new TB patients in that country also have HIV. Globally, TB is the leading cause of death in patients living with HIV. Carter's research centers on intensified efforts to find cases of TB—regularly screening for evidence of TB in people with HIV or at risk for HIV—to limit transmission and make earlier diagnoses. She also focuses on “best practices” in TB/HIV management, including the development of TB lab services and combination treatment and screening regimens in the developing world. Carter has been funded through CFAR to look at TB transmission in HIV-affected households. She also received support from the President of the United States' Emergency Plan for AIDS Relief and The Global Fund to Fight AIDS, Tuberculosis and Malaria to expand her intensified TB screening programs from 50 to more than 300 sites in western Kenya. In the last three years, more than 60,000 Kenyans have been screened for TB, thanks to her efforts. Approximately 13 percent have already been diagnosed with contagious TB and have received medical care.

    Other Kenya-based projects include one directed by Cu-Uvin that compares the accuracy of Pap smears versus visual inspection as a cervical cancer screening tool for HIV-positive women in Eldoret, a mid-sized city in western Kenya. Kantor is currently studying HIV drug resistance in western Kenya in three populations: patients who are new to antiretroviral therapy, those who have previously received treatment and residents who were exposed to Kenya's post-election violence in 2007 and 2008. Meanwhile, oncologist Anthony Mega, MD, from The Miriam Hospital, and David Berz, MD, from Rhode Island Hospital, are working to establish standards to help Kenyan practitioners evaluate and manage patients with HIV-associated Kaposi's sarcoma, a type of skin cancer common in HIV patients.

    Along with their on-the-ground research, physicians and researchers with The Miriam Hospital's Immunology Center are also dedicated to training and mentoring foreign scientists with an interest in HIV/AIDS. Mayer is director of the Brown/Tufts/Miriam Fogarty AIDS International Research and Training Program, which has provided interdisciplinary training for nearly 100 foreign clinical, laboratory, behavioral science, and public health investigators interested in AIDS research. The program helps develop international, site-specific scientists who can become competent and independent researchers and can address critical issues facing their own countries' HIV/AIDS epidemics.

    In Kenya, Carter leads the Brown-Kenya Medical Exchange Program, a partnership with Moi University in the city of Eldoret that helps medical students and fellows from both countries learn from each other. As part of this reciprocal program, Brown University trainees work and study in Kenya, while their Kenyan counterparts spend time training at The Miriam Hospital and other major teaching hospitals affiliated with Brown. Carter also received a grant from the Fogarty International Clinical Research Scholars & Fellows program that allows U.S. and Kenyan residents and fellows to work side by side on research projects and obtain hands-on global research experience at Moi University. In addition to India and Kenya, Miriam investigators have also led immunology-focused research projects or training initiatives in Cambodia, Ghana, the Philippines, Russia, Iceland, South Africa, Uganda, Thailand and China.