Goals and objectives

The overall objective of the Dartmouth/Boston University AITRP is to establish critical biomedical and behavioral science expertise in HIV and tuberculosis among scientists in Tanzania at the Muhimbili University College of Health Sciences (MUCHS). The specific components of the program will strengthen basic research capability and will also facilitate the development of new or expanded research efforts in four priority areas and long term collaborations between MUCHS, Dartmouth Medical School, and Boston University School of Public Health. It is recognized that these priorities may evolve over the 5 years of the program based on new research findings and new programmatic developments. Thus, they will be reviewed and revised annually by the Training Advisory Group and the Dartmouth/Boston University Fogarty Executive Committee. The ultimate goal of the resultant training and the associated research is reduction in morbidity and mortality due to HIV and tuberculosis.

• Vaccine research. Expertise will be developed in vaccine immunology, vaccine trials, vaccine safety, ethics, regulatory issues, cost-effectiveness and public policy. This expertise will be applied to multidisciplinary research studies of vaccines for the prevention of HIV and vaccines for the prevention of tuberculosis.
• Mucosal immunity. Expertise will be developed in innate and adaptive immune responses at mucosal sites, mucosal immune responses to HIV and tuberculosis, mucosal vaccine delivery, mucosal responses to vaccines against HIV and tuberculosis, and development of vaginal microbicides.
• Behavioral change. Expertise will be developed in behavioral sciences, behavioral interventions and their effects on the epidemiology of HIV and tuberculosis.
• Treatment research. Expertise will be developed in statistics, clinical trials, HAART therapy, drug side effects, laboratory monitoring, concurrent treatment of HIV and tuberculosis, and diagnosis and treatment of disseminated tuberculosis

Program Direction

C. Fordham von Reyn, M.D. Dr. von Reyn is the Program Director and has overall responsibility for the Program including selection of candidates, matching trainees to programs and mentors, assessment of trainee progress, fiscal oversight, and liaison with other participating institutions and faculty. Dr. von Reyn is Professor of Medicine and Chief, Section ofInfectious Disease and International Health, Dartmouth Hitchcock Medical Center. Dr von Reyn has conducted three sequential NIH-funded research studies on HIV-associated mycobacterial infections in Africa and these studies were the first to demonstrate the high rate of unrecognized and untreated M. tuberculosis bacteremia among hospitalized patients with AIDS in Africa. He has conducted parallel studies in the US, Zambia and Finland with an inactivated whole cell mycobacterial vaccine for the prevention of HIV-associated tuberculosis. During a recent sabbatical with the Vaccine Branch, National Public Health Institute of Finland, he conducted a review of that country's BCG immunization policy which led to a recommendation for the country to move from universal to selective BCG immunization. Dr. von Reyn has served as a consultant to the World Health Organization on AIDS in Africa, vaccines in HIV infection and vaccines against tuberculosis. He is a member of the Tuberculosis Committee of the Infectious Disease Society of America. He has served as Acting Chairman, Department of Medicine, and has twice received the DMS faculty teaching award. He has mentored numerous fellows in Infectious Disease.

C. Robert Horsburgh Jr., M.D., M.U.S. Dr. Horsburgh is Co-Program Director for the training site at Boston University. He will have responsibility for mentoring trainees, matching trainees to programs, assessing trainee progress, and organizing group training programs. Dr. Horsburgh is Professor of Epidemiology, Biostatistics and Medicine and Chairman of the Department of Epidemiology at BU School of Public Health. His current research interests include epidemiological studies of HIV, including HIV/TB interactions, HIV and TB vaccine trials, and drug trials for the treatment and prevention of TB in HIV-infected persons. Dr. Horsburgh is the PI of a NIH-funded prospective cohort study of HCV-HIV interactions that is examining clinical, epidemiologic and immunologic parameters of HIV+/HCV+, HIV+/HCV- and HIV-/HCV+ subjects. He is a co-investigator on a project investigating the effects of alcohol and HCV on HIV infection (NIAAA RO1-AA13766, Samet -PI). Dr. Horsburgh is also studying the interactions of HIV, TB, M. avium and syphilis in a community-based study in rural Florida. He is also a Principal Investigator in the CDC-funded Tuberculosis Epidemiologic Studies Consortium, a co-investigator in the NIH-funded Boston AIDS Clinical Trials Group, and a co-investigator in the CDC-funded Tuberculosis Clinical Trials Consortium. Finally, Dr. Horsburgh is the Principal Investigator and Director of the Boston University Clinical HIV/AIDS Research Training Program (NIH T32; award pending). While at Emory University he was a faculty member for the AITRP at that institution. Dr. Horsburgh has extensive experience in mentoring MD and non-MD clinical research trainees.

Kisali Pallangyo, M.D., M. Med. Dr. Pallangyo is Co-Program Director in Tanzania with responsibility for recruitment and selection of candidates, liaison with Dartmouth and Boston University, administrative and other support of trainees and faculty in Tanzania, and facilitation of placement in long term research positions for Program trainees. Dr. Pallangyo is Professor of Medicine and former Dean, Faculty of Medicine at Muhimibili University College of Health Sciences (MUCHS); he currently holds the appointment as Principal at MUCHS. Dr. Pallangyo is a widely recognized authority on HIV infection in Africa and serves as a member of the WHO WHO/UNAIDS Vaccine Advisory Board and is Chair of the Clinical Sub-committee for Tanzaniašs National AIDS Control Program. He is a co-Principal Investigator for the DARDAR Health Study. His research has focused on opportunistic infections associated with HIV/AIDS including Kaposišs sarcoma, disseminated and pulmonary tuberculosis, and dermatologic complications, as well as the epidemiology and natural history of HIV in Tanzania.

Program Abstract

The Dartmouth/Boston University AIDS International Training and Research Program (AITRP) is a 5-year comprehensive program designed to provide diverse degree and non-degree training to Tanzanian scientists with the overall goal of strengthening research capacity in HIV and tuberculosis at the Muhimbili University College of Health Sciences. This AITRP builds on an existing and successful collaboration which has launched the first efficacy trial for a vaccine against tuberculosis among persons with HIV infection. This collaboration has identified critical training needs and has defined key research objectives for positioning Tanzanian scientists to continue to develop and apply programs to control both HIV and tuberculosis. This AITRP is based on a sequenced plan of training and subsequent research mentored by recognized experts in international public health, health outcomes research, behavioral science, immunology, HIV, tuberculosis and vaccine research. The Program will enhance research capacity in all basic areas (e.g. epidemiology, clinical trials) and will also provide innovative training in new and specialized areas (e.g., mucosal immunity, evaluative clinical sciences) to facilitate the growth and development of novel research projects relevant to the prevention of HIV and tuberculosis in developing countries. The Program will be closely managed by a core faculty group at the three academic institutions with extensive experience in international health training and a strong commitment to ensuring the long-term benefits of the Program for Tanzania. A detailed plan provides for increasing transfer of training and research to Tanzania over the 5-year duration of the Program and for continuous re-evaluation of Program priorities.