Training the next generation of HIV researchers in Georgia

May/June 2024 | Volume 23 Number 3

A person in a mask puts on gloves as they talk with a woman at an HIV testing clinic in Tblisi, Georgia

Photo courtesy of the AIDS Healthcare FoundationA worker at an HIV testing clinic in Tblisi, Georgia, meets with a patient.

While HIV is decreasing around the world, its incidence and mortality are increasing in Eastern Europe and Central Asia. The country of Georgia lies at the intersection of these two regions. HIV prevalence is lower in the country than in other nations in the region, but it remains higher than in the U.S. Data suggests that certain populations, such as people who inject drugs and men who have sex with men, are particularly at risk in Georgia. This led Dr. Rick Altice, a professor of medicine and public health at Yale University, and his colleagues to ask, "What needs to be done differently here?"

Altice and teams at Yale and Ilia State University in Tbilisi used Fogarty funding to develop the Georgian Implementation Science Fogarty Training (GIFT) program. The program includes a center to train researchers in implementation science, with an emphasis on biostatistical methods. The ultimate goal is to develop researchers who can help overcome prevention and treatment gaps that exist in the country.

Throughout his career, Altice has done research in Eastern Europe, Central Asia, Peru, Malaysia, and the U.S., and he believes in democratizing education and training. “High-income countries should not have a monopoly on this research. Instead, the next generation of researchers should be homegrown, and this is where Fogarty makes such a big difference."

Gaps in HIV care

Altice and his colleagues noticed several gaps in the HIV research in Georgia. Before their project, no Fogarty grant in the region focused on the intersection between HIV and substance use, and the country lacked expertise in implementation science methods, specifically in biostatistics. That's where the unique expertise of the grant's co-principal investigator, Dr. Denise Esserman, professor of biostatistics at Yale, comes into play. “The role of a biostatistician in a clinical trial is to help the team come up with the best design to answer their research question, and to make sure that this design is implemented appropriately,” she says. “And at the end, they conduct the analysis and help to interpret the results."

Because so many people with HIV in Georgia go undiagnosed, prevention and treatment methods are underused in the country. Those most at risk continue to be stigmatized, an issue that Dr. Irma Kirtadze, GIFT's co-principal investigator from Ilia State University, says remains a barrier to prevention and treatment. She referenced a qualitative study of men and women who use drugs in Georgia, funded by the National Institute on Drug Abuse (NIDA) in 2012, which found that stigma was much higher for women than men, resulting in worse outcomes for this group. “Those with HIV who chose to start addiction treatment can and should be tested for HIV,” says Altice. Being in addiction treatment helps people both initially access HIV care and continue with it.

Training the trainers

The first stage of the program is to train five postdoctoral researchers from diverse medical and behavioral fields, with some working knowledge of advanced biostatistics, in methods related to biostatistics and implementation science and to provide them with immersive opportunities in implementation. These researchers, who began online training in fall 2023, followed by in-person courses at Yale in the spring of this year, will act as mentors for the first group of public health doctoral students who will enter the program in the fall of 2024.

This summer, Ilia State University will host an intensive, three-day boot camp, open to students, faculty, and Ministry of Health public health practitioners. Trainees will learn the principles and the theory, gain skills and experience, share learning experiences, and interact with faculty. The boot camp is supported by the Tbilisi regional office of the U.S. Centers for Disease Control (CDC) and by the WHO. Altice believes this part of the program is integral to GIFT’s overall success: “We don't want to leave the country without building in-country expertise."