AIDS international training and research program Aitrp Fogarty International Center National Institutes of Health

This program began in 1988 as one of a new generation of research training programs designed to help scientists from institutions in low-and middle-income countries build research and public health capacities in those same countries. Grants are awarded to US institutions with strong HIV-related research training experience and with HIV-related research collaboration with institutions in low-and middle-income countries. The grantees, in partnership with their foreign collaborating institutions, identify foreign health scientists, clinicians, and allied health workers from the foreign countries to participate in their joint research training programs. The primary goal of this program is to build multidiscipli-nary biomedical and social science research capacity to address the HIV/AIDS epidemic in the collaborating country. The training programs provide a variety of short-, medium-, and long-term training opportunities. While academic courses may be taken at either the US or foreign site, to the greatest extent possible the research takes place at the foreign site, working on problems considered to be of high priority for that country. The AITRP supports a broad variety of research training opportunities, including pursuit of MS, MPH, or PhD degrees; postdoctoral experiences; special training in laboratory procedures, data management, administration and other activities; and in-country practical and applied short-term training. In addition, it may support advanced research training for current and/or former trainees. For the US side of the collaboration, support may be provided to the faculty for research training activities at the foreign site and, in some programs, to US health science students to receive overseas health research experiences. Currently, grants to 26 US schools of medicine and public health support research training in nearly 60 low- and middle-income countries where HIV/AIDS is endemic or epidemic. More than 1000 individuals have received long-term training of more than six months in this program - which does not include the secondary training that these individuals have provided to others -and many more have participated in short-term training.

The principles outlined in the previous section have been closely observed throughout the 18 years of the program. From the beginning, the collaboration between the US and foreign institutions and program leaders has been one of full partnership, and the training and research priorities and activities have focused on needs relevant to the foreign site. The long-term stability and mutual trust that has evolved has allowed an unusual degree of flexibility as needs, priorities, and circumstances change. Many returning scientists have established successful centers of clinical research excellence in their home countries to serve national and regional needs, including creating important sites for multicentered clinical trials. These "Fogarty Fellows" have assumed major roles in directing HIV/AIDS activities in government, public health, science, and teaching. They comprise a cadre of committed global health workers who have a major impact on policy and programs, and serve as a network of communication and support for trainees and others in the field.

As the AITRP program has matured it has helped to spawn other global health research training investments, including four second-generation programs designed to strengthen the overall research capacity building effort:

1. The International Clinical, Operational, and Health Services Research and Training Awards for AIDS and Tuberculosis (ICOHRTA-AIDS/TB). This program addresses the "know-do" gap by supporting research that spans the spectrum from clinical science to operational and health service measures that will bring tangible benefits to the population. A novel feature of this award is that the foreign site is the initiator in choosing its collaborating partner, and receives direct funding from FIC/NIH.

2. The Global Health Research Initiative Program for New Foreign Investigators (GRIP). This initiative fosters career development for NIH-trained foreign investigators by providing salary and research support as they establish themselves upon re-entry to their home countries.

3. Framework Programs for Global Health. This program encourages the bringing together of multiple disciplines, such as engineering, business, chemistry, biology, communication, public health, medicine, bioethics, and environmental studies, to form centers of excellence in support of global health activities.

4. FICEllison Overseas Fellowships in Global Health and Clinical Research. This program seeks to build both sides of the collaboration bridge by providing early career opportunities for US and developing country graduate students in the health professions to participate in one year of mentored clinical research at an NIH-funded research center in a developing country. It pairs US students with students from the host country, creating partnerships and contributing to building a new international community of global research scholars. The program is designed to give the trainees a substantive experience in global health research at a time when they are making career choices, so that their decisions regarding global health careers will be more fully informed.

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