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Vol. LX, No. 1
January 11, 2008

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Mission Possible: Breaking Down Boundaries with Global Health

On the front page...

The health workers at the Ugandan International Center for Excellence in Research (ICER), funded by NIAID, accept an unorthodox mission. They climb into an off-road vehicle and use a global positioning system to locate 50 rural communities in the Rakai district of southwestern Uganda. In the past, village healers administered traditional remedies to those needing treatment. Today, villagers can participate in ICER’s clinical trials, which study the efficacy of HIV and STD treatments and aim to decrease the transmission of infectious diseases.

The Rakai Health Sciences Program—like its sister ICER laboratories at the University of Bamako, Mali, and the Tuberculosis Research Centre in Chennai, India—conducts research on tropical and infectious diseases in areas burdened with high rates of such problems. NIAID renovated existing labs at these centers and outfitted them with modern tools used in the study of infectious diseases. The centers help scientists working with HIV/AIDS in Uganda, malaria in Mali and tuberculosis and filariasis in Chennai to answer essential questions on how medicines and vaccines affect people’s health.


  NIAID employees (from l) Mark Pineda, Karyl Barron, Tom Nutman and Kathryn Zoon opened an ICER in Chennai, India, last August.  
  NIAID employees (from l) Mark Pineda, Karyl Barron, Tom Nutman and Kathryn Zoon opened an ICER in Chennai, India, last August.  
Collaborations between NIH and these programs began more than 20 years ago, yet they did not become an official part of the ICER program until 2002. That year, NIAID conceived the ICER program as a new model for developing sustained research programs in resource-poor countries.

“The goal of the ICER program is to partner with in-country scientists to address major endemic diseases and foster research in areas such as malaria and tuberculosis,” said Dr. Kathryn Zoon, director of NIAID’s intramural division. “We focus on building sustainable research programs because we recognize the need to make long-term commitments to address difficult research challenges, and, importantly, to train local scientists so that they are prepared to tackle emerging and re-emerging infectious diseases into the future.”

Mali first caught NIAID’s attention in the late 1980s, when Dr. Yeya Toure and his research team were working on the genetics of Anopheles gambiae, a mosquito that is the primary vector for the malaria parasite in sub-Saharan Africa. Like the Ugandan ICER, the program in Mali conducts a number of field studies in rural villages. Dr. Louis Miller, chief of the Malaria Vaccine Development Branch, has been a driving force in the development of new malaria vaccines in this region.

The distinct cultural and social norms of the villagers in these settings influence how NIAID’s Malian collaborators initiate trials. They first explain the goals of the study to the village chief and elders. If the heads of the village agree, they do so on behalf of the whole community. This doesn’t relieve the scientists of their duty to receive consent from each person who participates, but it’s necessary to respect societal differences.

Technologic and economic differences surface in these countries as well. Poor health care systems cannot afford or put into practice the complicated diagnostic tools used in the United States to detect when to change antiretroviral drug regimens. Instead, physicians must wait until drug resistance clinically manifests in patients. By that time, the patient’s condition is often much worse, complicating treatment even under the best conditions. To circumvent this problem, scientists are testing an algorithm and surrogate markers that detect evolving drug resistance and allow for earlier intervention.

For Dr. Thomas Quinn, principal investigator at the ICER site in Uganda, preventing the spread of HIV/AIDS to children in particular is of great importance.

HIV/AIDS is also a growing problem in India, and the TRC in Chennai conducts studies on new drug treatment for HIV-tuberculosis coinfection as well as lymphatic filariasis. Recently, the Indian government expanded the mandate of the TRC to include studies on HIV/AIDS and HIV vaccine trials. This new development creates an opportunity for NIAID and TRC scientists to develop collaborations in these areas.

“One of the main goals of the ICER program is to broaden the collaborations as much as possible, to bring in other disciplines, to bring in more of our intramural scientists and, ultimately, to have other extramural involvement as well,” said Mark Pineda, coordinator of the ICER program and several other international collaborations involving NIAID scientists. “We have achieved this at the ICER in Mali, and now this is occurring at the ICER in India as well.”

The majority of people in Chennai live in poverty, their streets littered with garbage and overrun with cattle. Few people understand why or how infectious diseases spread and those struggling with diseases are often feared and stigmatized. A poster in the TRC shows that sharing food or shaking hands will not cause HIV/AIDS. Hospitals advertise ICER’s trials—mostly observational studies—as a way to conduct research while educating the public.

The future of Chennai’s center is in the hands of its research scientists and students. Although the permanent scientists are Indian, many foreign postdoctoral fellows come to work with these experts. “Good training is extremely important because trainees have the ability to bring the tools, knowledge and research experience they gain to their home countries and establish successful projects,” said Pineda. “Hopefully, seeing the new center open will encourage young Indian scientists to get involved in this enterprise. If they get excited, we get more people interested in wanting to work in these disease areas, then I think we’ll consider that a tremendous success.” NIHRecord Icon

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