News

Partnership to Provide Clinical Training for Scientists and Establish TB-AIDS Clinical Training and Research Unit in St. Petersburg, Russia

Dr. Robert Heimer, associate professor in the School of Public Health's Epidemiology of Microbial Diseases Division, and Dr. Andrei Kozlov, director of The Biomedical Center in St. Petersburg, Russia, are partnering in the development of the TB-AIDS Clinical Training and Research Unit (the TB-AIDS Unit) in St. Petersburg, Russia. The partnership is funded by a five year, $3 million International Clinical, Operational, and Health Services Research Training Award for AIDS and Tuberculosis (ICOHRTA-AIDS/TB) from the Fogarty International Center, a part of the National Institutes of Health. This is the first time that ICOHRTAs were made to partnerships of U.S. and foreign institutions. Along with The Biomedical Center, institutions in China, Haiti and Uganda, and their partner institutions in the U.S., have received funding. The ICOHRTA-AIDS/TB program funds multidisciplinary research training for health professionals in developing countries heavily impacted by HIV/AIDS and tuberculosis (TB).

While the Russian government reported more than 300,000 registered cases of HIV infection as of December 1, 2004, expert estimates of the actual number of infections range from 850,000 to 1,800,000. Of the approximately 71,000 Russians that the World Health Organization and the Joint United Nations Programme on HIV/AIDS estimate will need highly active antiretroviral therapy this year, only about 1,800 will receive it. While the majority of HIV positive Russians became infected through injection drug use, there is concern about the possibility of a more generalized epidemic spread through sexual contact.

Kozlov and his Russian colleagues will work to establish the TB-AIDS Unit, which will bring trainees who have completed their training and returned to their home institutions together on a regular basis for seminars and the planning and implementation of research projects. The TB-AIDS Unit will also seek to build cooperation between St. Petersburg's HIV/AIDS and TB research and treatment organizations. Meanwhile, Heimer and his U.S. colleagues at Yale and the State University of New York/Downstate Medical Center (SUNY Downstate) will provide the clinical research training to the Russian physicians and health professionals who will ultimately populate the TB-AIDS Unit. The partnership is bringing together scientists from The Biomedical Center, St. Petersburg State University, and the Pavlov State Medical University, all renowned St. Petersburg institutions, for the first time.

The partnership's first two trainees arrived in New Haven in the fall of 2004. Ksenia Blinnikova, M.D., of The Biomedical Center, is working with the Yale AIDS Program, receiving training in epidemiology and biostatistics in the management of clinical trials. Yulia Zorina, M.D., of Pavlov State Medical University, is receiving training in substance abuse treatment that she will use in work on Pavlov's clinical trials of pharmacotherapeutic approaches to substance abuse, opiate addiction and alcoholism.

The emphasis on training in a variety of clinical care aspects is important, says Heimer, because the “[HIV/AIDS] epidemic in Russia, which began in… 1995-96, has… reached the point where those people who were infected early in the epidemic are now needing care.” Heimer's hope is that the approximately 19 people who ultimately receive training, either at Yale, SUNY Downstate, or the Wadsworth Lab (a TB diagnostic center in Albany, New York), will use the TB-AIDS Unit to train their Russian colleagues, first in St. Petersburg and then throughout Russia.

Another critical need, notes Heimer, is to provide trainees with the tools necessary to conduct analyses to determine whether the money being spent on AIDS care in Russia is used in a cost-effective, clinically appropriate way. Tommy Thompson, the former Secretary of the U.S. Department of Health and Human Services, announced last summer that the Global Fund to Fight AIDS, Tuberculosis and Malaria had awarded Russia $34.2 million over two years. While Russia currently spends $4-5 million annually on AIDS, substantially less than does the state of Connecticut, that will have to change, says Heimer. “They will be spending lots of money on it whether they want to or not as people begin to get sick and require care, and so the question is, will that money also be properly directed? Will people be properly trained? Will levels of care be adequate to meet the need? Will the people most in need get the care? Will systems grow to accommodate the increasing demand or will they just simply become so inept and inadequate that people are just left to die?”

Russia's challenges in facing its HIV/AIDS epidemic go beyond economic issues, however. Heimer compares Russia's epidemic today to the American epidemic in the early 1980's, explaining that “issues of stigma and prejudice still have to be dealt with. Issues of establishing adequate support services and mechanisms for people who are afflicted by the disease have to be imagined first and then implemented.” One critical aspect of dealing with stigma and prejudice, he noted, is reform of Russia's substance abuse treatment system. Russian law forbids substitution therapy, and drug users are thus put through lengthy periods of stigmatizing and punitive detoxification, and then released into the community with very little of the follow-up care that is critically important to staying drug-free. “What we need to do is to train people who can, within the limits of Russian law, look at new and promising substance abuse treatment modalities, integrate substance abuse care with HIV care and in the end generate systems that address the difficult situation that exists when people… have comorbidities of HIV and substance abuse,” says Heimer.

In addition to focusing on clinical research on HIV/AIDS, the TB-AIDS Unit will also address the high prevalence of multi-drug resistant TB found in Russian prisons. Heimer notes that the problem is complicated because it has economic and systemic components. TB treatment resources available to prison authorities are inadequate. Exacerbating the problem, however, is the fact that conditions in prison TB wards are better than conditions in general population prison blocks, creating a great disincentive to complete TB treatment while in prison. The partnership's trainees will be trained to “introduce evidence-based medical practices and to evaluate the extent to which evidence-based practices are being implemented [within the prison system],” says Heimer. Prison system officials trained in medical research will work with the partnership's trainees “to implement clinical trials, to improve clinical care in the prison setting and to transition people effectively from the prison setting back to the community so they don't go back into the community and spread multi-drug resistant TB that hasn't been effectively or completely treated while they were incarcerated.”

–Story by Christy Gordon