For the last 35 years, GHESKIO investigators have been conducting research studies to improve the care of patients with HIV, tuberculosis, and related infections. During the 1980s and 1990s, before antiretroviral therapy was developed, they worked to understand how to prevent transmission of the HIV virus and how to most effectively prevent and treat opportunistic infections and other complications of HIV/AIDS. For the past 15 years, since lifesaving antiretroviral therapy became available for the treatment of HIV, they have conducted studies to understand how to provide the highest possible quality of patient-centered care to maximize the survival and well-being of persons who are living with HIV. GHESKIO investigators have published over 200 peer-reviewed papers. Their research productivity has been recognized with uninterrupted support from the National Institutes of Health since 1983 including a MERIT award, a Clinical Trials Unit (CTU), and a TB Research Unit (TBRU).
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TB Research Unit
The multi-project program is supported by a contract from NIAID, the Weill Cornell CTSC, and the Milstein Foundation. This program is studying the ability of M. tuberculosis to resist elimination by the human immune system during latency and by antimicrobials during drug treatment. Dr. Fitzgerald is the TBRU Clinical Core Director responsible for recruiting and characterizing unique cohorts in Haiti, including families with multiple siblings with TB, people who are resistant to TB infection, and longitudinal cohorts of patients with MDR-TB. Other TBRU projects are led by world-class investigators from Weill-Cornell, GHESKIO, Memorial Sloan Kettering, and the Rockefeller University with multiple cross-disciplinary collaborations.
The World Health Organization estimates that about
Antimicrobial therapy for active infection by drug-sensitive Mtb is effective, but current drugs must be given for 6 months to achieve relapse-free cure rates of >95%. Despite substantial efforts to understand these two critical features of M. tuberculosis infection—latency and persistence—fundamental questions remain about the genetic, immunologic, pharmacologic, and microbiologic contributors to both.
Care for HIV infected Adolescent Girls
Since 2004 the number of adult HIV-related deaths in the world decreased by 30% as antiretroviral therapy (ART) expanded. However, during the same period, HIV-related deaths for adolescents increased by 50%. Adolescents account for 40% of all new HIV infections in Haiti, and 80% of these occur among sexually-active girls, many of whom live in poverty with little protection from
ART with other medical and behavioral interventions can prolong the life of persons living with HIV and prevent them from transmitting HIV. However, the social factors which lead to HIV infection (poverty, unstable families, and gender inequality) coupled with high-risk taking adolescent behavior
In 2014 Cornell-GHESKIO piloted an innovative model of care, FANMI (My FAMILY), to improve retention among HIV-infected adolescent girls. Adolescent girls attend monthly HIV care in cohorts of 5-8 peers to address social isolation, gender inequality, and unstable families. HIV care takes place in a community center rather than in a medical clinic to strengthen social support and decrease stigma. Each monthly visit integrates clinical care, group counseling, and social activities in a single session by the same provider to simplify care and strengthen the relationships between peers and providers. Data suggest that FANMI dramatically improves retention compared to adolescent girls receiving standard care at GHESKIO.
NIAID HIV Clinical Trials
Clinical trials often take 5 years to conduct and involve scores of investigators and are beyond the scope and timeline of an individual trainee’s project. However, we have found that well-defined participation with ~ 10 – 20% effort is extremely beneficial for our trainees. Trainees learn about the rigor of NIH clinical trials, recruitment and retention strategies, good clinical practice, clinical trial design, data collection tools, and advanced laboratory assays. Trainees attend network meetings and meet leaders in the field. The rigor and knowledge gained from participating in the clinical trials