Fellowship Site Directors:
Daniel Fitzgerald, MD, Weill Cornell Medical College
Jean Pape, MD, GHESKIO

Site Contact: Lindsey Reif

Site Specialties: HIV/ID, maternal-child health, TB, oral health, health outcomes, ethics and policy, eye diseases, cholera, nutrition

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Site Highlights
Training
Facilities and Resources
Research Opportunities
Trainee Housing & Safety
Previous Trainees

Site Highlights: 

• Over 30 outstanding Haitian clinician investigators who rival in quality the faculty of major departments in US academic medical centers, along with 3 outstanding senior laboratory investigators. GHESKIO investigators are on site to teach and co-mentor undergraduate, graduate, and medical students and postdoctoral fellows from North America and Europe for research training.
• The GHESKIO-Cornell-Vanderbilt research and training collaboration has received 28 years of uninterrupted NIH support including an NIH MERIT award (1990-2002; W Johnson, PI).
• Past trainees have published articles in the New Engl J Med, Am J Public Health, Lancet, PLoS journals, Clin Infect Dis, and J Infect Dis and have presented their research at major international conferences.
• The Fondation Rodolphe Mérieux Laboratory Training Program is focused on strengthening GHESKIO’s laboratory capacity through the purchase of laboratory equipment and support for a full time laboratory specialist from Europe to live in Haiti and provide training to local laboratory staff.  Research trainees benefit from the infrastructure, technology and highly trained personnel in the GHESKIO Laboratory. The Laboratory also serves as a national reference laboratory, providing QA/QC and proficiency testing for other laboratories and hospitals in Haiti.
• The AIDS International Training and Research Program (AITRP), in its 24th year, supports HIV vaccine, AIDS therapeutic, cervical cancer and TB research training in Haiti.  Research conducted by trainees includes clinical and translation studies.
• The International Training and Education Center on HIV (I-TECH) program supports clinical and laboratory faculty members from the Weill Cornell Medical College to work in Haiti.
• The International Clinical, Operational, and Health Service Research Training Program (ICOHRTA) increases capacity in integrated clinical, operational, and health services research in support of Haiti’s national scale-up of HIV prevention and care services.
• US trainees benefit from the support of the GHESKIO Data Management Center (DMC), which is responsible for the management of source documents, study case report forms, and electronic data for GHESKIO research projects. The DMC operates an EMR for all clinical services at GHESKIO.

The HAITIAN GROUP FOR THE STUDY OF KAPOSI’S SARCOMA AND OPPORTUNISTIC INFECTIONS (GHESKIO) is a Haitian non-governmental organization dedicated to providing clinical service, research, and training in HIV, TB, and other communicable diseases. GHESKIO has collaborated with Cornell University since 1982 and with Vanderbilt University since 1992. GHESKIO is a prime example of the mutual benefits derived from ernal-child health, TB, oral health, health outcomes, ethics and policy, eye diseases, cholsustained training that is focused in Haiti but continues to draw heavily from the expertise available through U.S. collaborators. The GHESKIO-Cornell-Vanderbilt research and training collaboration has received 28 years of uninterrupted NIH support including an NIH MERIT award in 1992 (1990-2002; PI Johnson).

GHESKIO, Cornell, and Vanderbilt are genuine partners in multiple ongoing NIH research and training programs in Haiti and the Caribbean, including: 1) an NIAID-funded Clinical Trials Unit at GHESKIO, with involvement in the HVTN and the ACTG; 2) a Fogarty AIDS International Training and Research Program (AITRP); 3) the NIAID-funded Caribbean, Central America, South America network for improving data management (CCASAnet); 4) the NCI-funded Natural History and Pathogenesis of HPV/HIV infection in Haiti and 5) the NIH-funded International Training and Education Center for Health (I-TECH).

Training:
GHESKIO hosts undergraduate, graduate, and medical students and postdoctoral fellows from North America and Europe for research training.  Students are assigned a Haitian mentor and perform behavioral, clinical, public health, or laboratory-based research.  Past trainees have published research articles in The New England Journal of Medicine, The Lancet, The American Journal of Public Health, and Clinical Infectious Diseases and presented their research at international conferences.

GHESKIO also recruits talented young Haitian investigators for long-term training in Haiti and abroad.  Trainees focus on the priority research areas necessary for developing and expanding HIV care and prevention services: HIV vaccines, pediatric and adult antiretroviral therapy, health outcomes of HIV care and prevention, pediatrics and the prevention of mother to child transmission, tuberculosis and other HIV-associated opportunistic infections, ethics, and HIV pathogenesis, immunology, and virology.  About 95% of these trainees remain in Haiti, and many stay at GHESKIO to continue their work.

• AIDS International Training and Research Program (1988-2008): Since the beginning of the program, GHESKIO has mentored more than fifty Haitian long-term trainees.  Funding is from the Fogarty International Center, and GHESKIO’s support was competitively renewed in 2003.  The initial focus of the grant was to provide short-term, high-impact training in epidemiology and laboratory techniques to rapidly characterize the epidemiology of HIV.  Over time, as the AIDS epidemic matured and the needs of our collaborators changed, the focus has shifted to long-term training with an emphasis on interventions for both the treatment and prevention of HIV/AIDS and associated co-infections.
• The Fondation Rodolphe Mérieux Laboratory Training Program (2001 – present): The Fondation Rodolphe Mérieux was established in the memory of Rodolphe Mérieux, who died tragically in the 1996 TWA Flight 800 accident.  The French foundation has been an important supporter of GHESKIO’s service, research, and training agenda since the program’s inception.  The focus has been on strengthening GHESKIO’s laboratory capacity through the purchase of laboratory equipment and support for a full time laboratory specialist from Europe to live in Haiti and provide training to local laboratory staff.
• The International Training and Education Center on HIV (I-TECH) (2003 – present): With support from the United States President’s Emergency Plan for AIDS Relief, I-TECH leads a consortium of international and domestic partners with expertise in diverse areas of HIV/AIDS planning, clinical care, training, and support. The I-TECH program supports clinical and laboratory faculty members from the Weill Medical College of Cornell University to work in Haiti.
• International Clinical, Operational, and Health Service Research Training Program (2004 – 2009): The goal of this training program is to increase capacity in integrated clinical, operational, and health services research in support of Haiti’s national scale-up of HIV prevention and care services.  Support is from the Fogarty International Center.  GHESKIO, in collaboration with Haitian and international partners, will develop short and long term training curriculum in clinical, operational, and health services research methodology.  A Masters in Public Health Program offered in Haiti in collaboration with Quisqueya University will be the culmination of this curriculum development
• Through clinical and operational research, GHESKIO seeks to define treatment and prevention models for HIV/AIDS and related diseases that are appropriate and effective for Haiti.  The main focus of the research is HIV, sexually transmitted infections, and tuberculosis. The GHESKIO research program has evolved from early observational studies to large clinical trials and its designation as an international research center of excellence. In 1983, GHESKIO established its initial funding from the National Institutes of Health to define the epidemiology, natural history, risk factors, and associated co-infections of HIV/AIDS. Since then, GHESKIO’s consistent research productivity has been recognized by uninterrupted support from the National Institutes of Health, a MERIT award in 1990, and twenty new or competitive renewal grants. GHESKIO also conducts research with support from the World Health Organization and the French Government’s National Agency for AIDS Research.

Facilities and Resources:
Haitian Research Mentors
GHESKIO has a team of ~30 outstanding Haitian clinician investigators who rival in quality the faculty of a major Department in a US academic medical center. GHESKIO investigators are on site to teach and co-mentor trainees. The team is led by Dr Jean William Pape. He is a member of the Institute of Medicine (2004) and was awarded the Clinton Global Citizen Award by former President Bill Clinton (2010). Dr Pape meets with US trainees weekly. Dr Marie Marcelle Deschamps is Deputy Director of GHESKIO with an interest in HIV and women’s health. She is an investigator in the HVTN and ACTG. She was awarded the Legion d’Honneur by the President of France for her commitment to the women of Haiti and the world (2003). Dr Patrice Severe led GHESKIO’s scale up of ART. He was first author on two research articles in the New England Journal of Medicine, and is now director of the GHESKIO adult therapeutic trials unit. Dr Patrice Joseph directs the recruitment of high risk cohorts and the HIV Vaccine Trials Unit in Haiti. Dr Oksana Ocheretina is a Weill Cornell faculty member based in Haiti and directs the GHESKIO BSL3 mycobacteria laboratory. Dr Macarthur Charles is expert in HIV drug resistance and directs the molecular biology laboratory and is also based in Haiti.

Clinics
In 1985, GHESKIO opened the first HIV Voluntary Counseling and Testing Center in Port au Prince, Haiti.  As the link between HIV/AIDS, sexually transmitted infections, tuberculosis, and reproductive health became clear, GHESKIO developed a model of comprehensive care for HIV/AIDS and related illnesses. In 2010, GHESKIO offered HIV testing to 25,000 people, provided antiretroviral therapy to ~7,000 patients, and TB treatment to ~1,200 patients. GHESKIO also operates an MDRTB treatment facility in Port au Prince with 50 hospitalized patients. This population serves as the recruitment pool fo rtrainees’ projects.

Laboratory
Research trainees benefit from the infrastructure, technology, and highly trained personnel in the GHESKIO Laboratory, which is the premier laboratory in Haiti.  The GHESKIO Laboratory also serves as a national reference laboratory, providing QA/QC and proficiency testing for other laboratories and hospitals in Haiti.  The laboratory has 3 PhD investigators, (Charles, Germain, Ocheretina) and senior Haitian leadership with US training (Beaulieu, Apollon, Nolte). The Clinical Laboratory performs routine serology, hematology, chemistry, and microbiology tests.  The lab also runs BD FACS count for CD4/CD8 cells, Amplicor HIV-1 Monitor PCR Test, the Easy Q HIV-1 PCR Test, and Bayer Truegene HIV genomic drug resistance testing. GHESKIO has a rigorous quality control program with proficiency testing provided by the American College of Pathologists and site visits by NIH and CDC monitors. The GHESKIO Research Laboratory performs the following assays for the conduct of clinical and translational research studies: counting, and freezing of peripheral blood monocytes (PBMCs), FACS count, non-commercial PCR assays, amplification and isolation of DNA products for sequencing at the Cornell core facility in the US, hybridization assays, and Luminex multiplex PCR. GHESKIO recently opened the Rudolphe Merieux laboratory, which is the only BSL3 TB laboratory in Haiti. The TB laboratory performs solid and liquid (BACTEC) culture, drug sensitivity testing, molecular identification and drug resistance testing, and spoligotyping. The combination of a large clinic population and an on-site modern laboratory opens up a multitude of exciting research opportunities for trainees.

Research Data Management
US trainees benefit from the support of the GHESKIO Data Management Center (DMC), which is responsible for the management of source documents, study case report forms, and electronic data for GHESKIO research projects. The GHESKIO DMC has benefitted from capacity building related to NIH sponsored projects with the HVTN, ACTG, CIPRA, and the Caribbean, Central America, South America epidemiologic network (CCASAnet). The GHESKIO DMC also works with the Cornell and Vanderbilt CTSC and has the NIH supported Red Cap research data management system available for individual investigator initiated research projects. The GHESKIO DMC center is led by Abdias Marcelin with a team of 8 computer programmers and 20 data entry staff. This team assists US trainees to design case report forms, study flow sheets, and data management systems in Red Cap for their research training projects. The GHESKIO DMC also operates an electronic medical record (EMR) for all clinical services at GHESKIO. The well structured EMR facilitates the identification and referral of study volunteers from the GHESKIO clinics to research teams.

IRB and US Regulatory Compliance
All clinical studies at GHESKIO comply with NIH and Haitian Government regulations. The administration, laboratories, data management, and clinical facilities of GHESKIO have been repeatedly site-visited and approved for NIH research studies. GHESKIO established an institutional review board (IRB) in 1983, which has a US Federal Wide Assurance (IORG00005515).   Alix Lasegue MD, a former Director General of the Haitian Ministry of Health, and current Director of the State University Hospital, is the Chair.  With Fogarty support, IRB members have received training from the Cornell University IRB and from the faculty of the Hastings Center of Bioethics, Garrison, New York. Review and approval of trainee’s research projects by the GHESKIO IRB generally takes one month.

Equipment
2 autoclaves, 1 CBC analyzer (Cell-Dyn), 2 centrifuges (Beckman Coulter), 4 chemistry analyzers, 2 BACTEC, 3 ELISA (mini-VIDAS), 4 ELISA (Tecan), 7 Revco -70 Freezers, 5 -20C Freezers, 25 refrigerators, 7 incubators, 2 microbalances, 8 microfuges, 11 microscopes, 1 COBAS HIV RNA machine, 2 HIV RNA viral load (Easy Q), 2 Luminex multiplex PCR; 2 Genprobe 1 pH meter, 10 Vortex shakers

Current and potential future research opportunities for Global Health Fellows:

U01AI069923 (Pape)
Caribbean, Central and South America Network
The major goal of this grant is to determine the epidemiology of HIV disease in Latin America.

D43 TW000018 (Johnson)
AIDS International Training and Research Program
The major goal of this grant is to enhance international research and training related to HIV/AIDS.

K23AI073190-04 (Charles)
Monitoring Response to Antiretroviral Therapy and Development of HIV-1 Drug Resistance
The major goal is to study emergence of HIV drug resistance in patients receive anti-retroviral treatment in a resource limited setting.

5U91HA06801-06 (Fitzgerald)
International Training and Education Center for Health
The major goal of this grant is to provide clinical and laboratory training to support the PEPFAR AIDS treatment programs.

U01 AI069421 (Pape/Fitzgerald)
GHESKIO HIV Clinical Trial Unit
The major goal is to conduct clinical trials as part of HVTN and AIDS Clinical Trial Group in Haiti.

U2R TW006896 (Pape/Fitzgerald)
Haiti AIDS Research Training: Models to Implementation (ICOHRTA)
The major goal of this grant is to increase capacity in integrated clinical, operational, and health services research in support of Haiti’s national scale-up of HIV prevention and care services.

R01 CA142422 (Fitzgerald)
Natural History and Pathogenesis of HPV/HIV co-infection in Haiti
The major goal of this grant is to determine the natural history and pathogenesis of HPV/HIV co-infection

Other Potential Projects:
(Project Title, Discipline, Field, Mentor, Funding)

• HIV Vaccine Trials Network (HIVTN), HIV, Pape, Fitzgerald NIAID U01AI069421
• Clinical Trials of Antiretroviral Therapy, HIV, Pape, Fitzgerald, NIAID U01AI069421
• Chronic Inflammation and Cervical Cancer,  Oncology, Dannenberg, NCI R01CA142422
• Tuberculosis Biomarkers, TB, Rhee, Nathan, Gates Foundation
• Epidemiology of MDRTB in Haiti, TB, Pape, Fitzgerald, PEPFAR, CDC, BioMerieux
• Modeling the Impact of PEPFAR Program, Health Outcomes, Schackman, Fogarty D43TW000018
• AIDS in Adolescents and Children, HIV/AIDS, Pape, Fitzgerald, UNICEF
• Evaluation of Rapid Syphilis Diagnostics for the Elimination of Congenital Syphilis in Haiti, Health Outcomes, Schackman, WHO
• Studies of Informed Consent in Haiti, Ethics, Fitzgerald, WCMC NIH CTSC

Trainee Housing & Safety:

US research trainees live for free in a 3-bedroom apartment rented by Cornell University. The apartment is in a closed compound with security. There are ~30 other townhouse style apartments in the same compound rented by Haitian families, staff from other non-profit organizations, and foreign embassies. The apartment has electricity with a back-up generator and internet. The apartment is ~ 20 minutes drive from GHESKIO. GHESKIO provides a 4-wheel vehicle with driver to transport trainees to and from GHESKIO every day. The vehicle and driver are also available on weekends for shopping and social functions. GHESKIO has operated in Port au Prince for 29 years and has learned to deal with political and social instability in Haiti. GHESKIO staff take great care to assure the safety of visiting trainees. GHESKIO is well connected to the Haitian community and US embassy. The clinics have never shut down, and research projects have always continued.

Thousands of people in January 2010 were killed when a magnitude 7.0 earthquake struck near Port-au-Prince, causing widespread damage and disruption to vital infrastructure and services such as power, communications and transport, including operations at Port-au-Prince’s Toussaint Louverture International Airport (PAP). At IMIS the Warren D. Johnson Jr. clinic building was rebuilt and the Merieux laboratory has become fully functional, including its BSL-3 space. A tuberculosis hospital is in the design phase to replace a set of tents which have housed complicated tuberculosis patients since the earthquake. At GHESKIO, the perimeter walls have been rebuilt, a model refugee tent city has been established, vocational and primary schools are operational, a permanent school structure for 400 children is being built with funds from the Principality of Monaco. These initiatives are being integrated into the overall GHESKIO HIV/TB training, research, and comprehensive care program.  All facilities at both campuses have been renovated and are fully operational since the January 2010 Haiti earthquake.

Previous Trainees:
Curtis O’Neal, MPH 
Linda Severe, MD, MPH 
Kendra Harris, MDc, PhDc
Aynsley Duncan, MD 
Samuel Pierre, MD
Kathleen Walsh, MD, MPH 
Mario Camblart, MD
Jacky Petion, MD
Olga Tymejczyk, MPH
Yvetot Joseph MD
Daniel Oduro PhD
Genevieve Vanessa Hilaire MD