1. Advances in care and treatment of AIDS, TB and other OIs through research capacity building in Haiti
JEAN WILLIAM PAPE, MD
Howard and Carol Holtzmann Professor of Clinical Medicine,
Center for Global Health, Department of Medicine,
Weill Cornell Medical College, New York, New York, USA
Director, Les Centres GHESKIO,
Port-au-Prince, Haiti
Session: Ending AIDS through Research Training and Capacity Building in low and middle income countries
IAS 2017, Paris, July 25, 2017
I have no conflicts of interest to declare

2. GHESKIO Centers and Haiti
GHESKIO Centers: 1st comprehensive AIDS center dedicated to research, training, care (1982)
Partnership: Ministry of Health and 116 local institutions
Strong international collaboration: Cornell, F. Mérieux
Continuous support from NIH (1983), Fogarty (1990)
Haiti Profile: highest HIV prevalence outside of Africa
Highest TB incidence in Americas
Among the 5 most fragile countries in the world : UN Data analysis of >7,000 disasters resulting in million people disasters deaths
90% are from low/middle-income countries
1/6 of all deaths were in Haiti

3. Capacity Building by FIC
: I was a Fogarty trainee
: FIC grantee : AITRP, ICOHRTA, Framework, training grants for HPV/cervical cancer and MDRTB led to the training of 482 Haitians at the MDs, PhDs, Masters level, essential to:
Conduct translational research on OIs, TB, AIDS care/RX leading to development of HIV prevention and care models
Train >16,000 health workers (public, private sectors)
Scale-up GHESKIO HIV, STI, TB, cholera at the national level
Establish public health programs with local institutions
Laboratory with the Ministry of Health Public Health Lab
1st MPH and NP with local institution (Quisqueya University)
5) Develop research network within the Americas:
Trans Caribbean HIV/AIDS Network Initiative (TCHARI)
Caribbean Central America South A. AIDS network (CCASAnet)

4. Chronic diarrhea and TB S/S : hallmark of AIDS in Haiti
Establish the definitive epidemiology isosporiasis and cyclosporiasis as well as the treatment and prophylaxis with TMT-SMX

5. Pape JW et al: The Lancet 1993: 342
Isoniazid (INH) prevent active tuberculosis (TB) in persons infected by HIV and TB
INH also delays the progression to AIDS
Most cost-effective intervention in dually infected HIV-TB patients (WHO)
Pape JW et al: The Lancet 1993: 342

6. Isoniazid post-treatment prophylaxis is effective to prevent TB Recurrence among HIV+ patients
Kaplan-Meier estimate of proportion of patients with recurrent tuberculosis
Proportion free of recurrent tuberculosis
Population free of recurrent tuberculosis
Time from completion of TB therapy (months)
Fitzgerald D, Johnson WD Jr, Pape J.W. The Lancet :

7. Factors associated with mortality in the 1st 6 months : Age
Survival at 1 year = 90%
Survival at 5 years - 75%
Factors associated with mortality in the 1st 6 months :
Age
CD4 counts < 50/mm3
Malnutrition
Hgb < 8.5gm) TB
Leger P et al NEJM 2009;361:

8. 10-Year Survival on Antiretroviral Therapy in Haiti
January 28, 2016
January 28, 2016
10-Year Survival on Antiretroviral Therapy in Haiti
70% of AIDS patients on ART in 2004 still alive today although 80% with advanced AIDS and severely underweight at ART start
The 10-year survival rate estimate of AIDS patients on ART in Haiti is similar to that among patients on ART in the United States. 
Long-term sustainability of international efforts to provide ART in resource-poor settings
Pierre S, Jamat-Khat D, Pape JW, Fitzgerald D, McNairy ML. Ten year survival of patients with AIDS receiving antiretroviral therapy in Haiti. NEJM 2016; 374: January 28, 2016 DOI: /NEJMc

9. Mortality decreased fourfold and TB incidence decreased twofold when ART is initiated prior to AIDS or CD4 less than 200
Improved retention and outcomes with same-day HIV testing and treatment PLOS Medicine July 25, 2017

10. Psycho/social workers Nurses / Nurses assistant
GHESKIO Training HIV counseling, prevention /care: OI, TB/MDRTB, ART, PMTCT, Malaria , Cholera, FP
Healthcare providers
TOTAL
Lab technicians
1,253
592
143
1,988
Psycho/social workers
1,165
216
100
1,481
Nurses / Nurses assistant
3,765
1,276
1,104
6,145
Physicians
2,774
866
643
4,283
Others
851
1,063
353
2,267
9,808
4,013
2,343
16,164
Community
IEC
127,216
19,628
291,166
438,010
Specialized Training Programs
1. 1st MPH (2005)
2. 1st Nurse Practitioner (2009)
3. Laboratory Technicians in collaboration with MOH (2003)

11. National scale-up of the GHESKIO model in Haiti 1993–2017
ART in Haiti
31% of all ART patients in Haiti are in the GHESKIO network
National HIV prevalence

12. Responses to Haiti 2010 earthquake:
Acute care field hospital, refugee camp, clinics
>10,000 refugees; 75% women and children

13. Response to Haiti 2010 Cholera epidemic
1. Cholera Treatment Centers (CTC)
2. Chlorine factory
3. Introduction of oral cholera vaccine

14. Summary National HIV, TB, cholera GHESKIO models scaled-up
nationwide through FIC training . GHESKIO credited
with “slowing the AIDS epidemic in Haiti” and serving as
“a model for how poor countries with few resources can
combat AIDS, TB,and diarrhea” (NY Times )
Long term ART complications
Samuel Pierre, MD
Oral cholera /Chikungunya vaccines
Dosing MDRTB drugs in
pediatric patients
Karine Sévère, MD
Vanessa Rouzier, MD
Head of Pediatrics
Nitazonamide (NTZ) forMDRTB
HPV vaccination
Cynthia Riviere, MD,
Katey Walsh, MD