Haiti Program

The Weill Cornell program in Haiti began in 1980 with the establishment of a unit for the study and treatment of infantile diarrhea at the State University Hospital and Medical School. This program was very successful, with in-hospital mortality reduced from 40% to 1%. The Weill Cornell team began its AIDS research in 1982 and was instrumental in the formation of Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO). Since 1983, Cornell and GHESKIO have had uninterrupted NIH support resulting in over 65 publications, including the first detailed description of AIDS in a developing country (NEJM, 1983). In addition to the established AIDS program, Weill Cornell-GHESKIO provides STD and tuberculosis screening and treatment, as well as family planning, health education, and counseling programs to ~ 28,000 persons annually. Weill Cornell-GHESKIO also conducts NIH-sponsored HIV vaccine and ART clinical trials (see below). Presently, one senior medical student (Peter Bendix) is conducting advanced research in Port-au-Prince, Haiti.

The Mission, History, and Organizational Structure of GHESKIO

Mission

GHESKIO is a Haitian non-governmental organization dedicated to providing clinical service, conducting research, and offering training in HIV/AIDS and related diseases. Working in partnership with the Haitian Government, GHESKIO provides integrated primary care services, including HIV prevention, AIDS care, prenatal care, and management of tuberculosis and sexually transmitted infections. Through the conduct of research, GHESKIO defines HIV/AIDS treatment and prevention models for Haiti. Through training, GHESKIO expands these models to the national level.

History

In the early 1980s, a group of Haitian clinicians and public health professionals began to notice a growing number of patients dying from Kaposi's sarcoma and unusual opportunistic infections. In 1982, they founded the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO). In 1983, GHESKIO published their experiences in The New England Journal of Medicine, documenting the first cases of AIDS in a developing country. In 1987, GHESKIO was recognized as an official independent Non-Governmental Organization by the Haitian Government. In 2000, the Haitian government conferred upon GHESKIO a status of "Public Utility," a designation reserved for institutions "essential to the welfare of the Haitian people" such as the Haitian Red Cross. For more than twenty years, GHESKIO has served as the Haitian Government's research and training center for HIV/AIDS, and it is now an internationally recognized center of excellence.

Organizational Structure

Dr. Jean Pape has been the director of GHESKIO since its inception, and many of GHESKIO's staff have been with the center for more than twenty years. Dr. Pape and the GHESKIO Board of Directors work with the Community Advisory Board, the Weill Cornell Medical College and other universities to coordinate the core sections of the center, such as the laboratory service clinics, the data management center, and the research and training programs.

Research at GHESKIO

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 received 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.

Seminal Publications of GHESKIO

1983
"Characteristics of the acquired immunodeficiency syndrome (AIDS) in Haiti." The first description of the syndrome in a tropical developing country. NEJM 309:945-50

1985
"The acquired immunodeficiency syndrome in Haiti." Identified the role of contaminated blood transfusions early in the HIV epidemic in Haiti. Ann Int Med 103:674-8

1986
"Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome." Described isosporiasis in AIDS patients and the effectiveness of trimethoprim-sulfamethoxazole in therapy and prevention of recurrence. NEJM 315:87-90

1989
"Treatment and prophylaxis of Isospora belli infection in patients with the acquired immunodeficiency syndrome." Established the efficacy of trimethroprim-sulfamethoxazole in initial therapy and prophylaxis of cyclosporiasis and isosporiasis. NEJM 320:1044-7

1993
"Effect of isoniazid prophylaxis on incidence of active tuberculosis and progression of HIV infection." Determined that isoniazid prevents tuberculosis and delays the progression of HIV infection to disease in symptomatic HIV persons. Lancet 342:268-72

1996
"Heterosexual transmission of HIV in Haiti." Described the dramatic shift in HIV transmission in Haiti from blood transfusions and men who have sex with men to the general population. Ann Int Med 125:324-30

2000
"Effect of post-treatment isoniazid on prevention of recurrent tuberculosis in HIV-1-infected individuals: a randomized trial." Documented the high rate of tuberculosis recurrence after therapy in patients with AIDS and the value of post-treatment secondary prophylaxis. Lancet 356:1470-4

2000
"Trimethoprim-sulfamethoxazole compared with ciprofloxacin for treatment and prophylaxis of Isospora belli and Cyclospora cayetanensis infection in HIV-infected patients." Established ciproflaxin as acceptable therapy for patients with cyclosporiasis and isosporiasis who cannot tolerate trimethoprim-sulfamethoxazole. Ann Int Med 132:885-8

2002
"Comprehension during informed consent in a less-developed country." Evaluated comprehension during the informed consent process and made recommendations for improvement in developing country settings. Lancet 360:1301-2

2003
"Decreased congenital syphilis incidence in Haiti's rural Artibonite Region following decentralized prenatal screening." Described improved program for syphilis screening and treatment for pregnant women to prevent congenital syphilis. Am J Publ Health 93(3):444-6

2005
"Antiretroviral therapy in a thousand patients with AIDS in Haiti." Reported GHESKIO's experience treating the first 1,000 AIDS patients with outcomes comparable to US clinics. NEJM 353:2325-34

Major GHESKIO Research Projects

The Natural History of HIV Infection in Haiti (1983 - 2002) The goal of this project is to define the natural history of HIV and its effects on the Haitian family. The project has lead to developments in treatment strategies for coccidial diarrheal infections, tuberculosis prophylaxis in HIV infected adults, and voluntary HIV counseling and testing. Support was from a MERIT Award from the National Institutes of Health.

A Randomized Controlled Clinical Trial of Early vs. Late Antiretroviral Therapy for AIDS Patients (CIPRA) (2003 - 2008) Research is focused on finding the optimal time to start antiretroviral therapy in patients with CD4 counts between 200 and 350 cells/ml. Funding is from the National Institutes of Health.

HIV Vaccine Trials Network (2001 - present) GHESKIO is a member of this international collaboration of scientists and educators searching for an effective and safe HIV vaccine. Support is from the National Institutes of Health. GHESKIO Director Dr. Jean Pape is the Principal Investigator in the HIV Vaccine Trials Network in Haiti and GHESKIO investigators conduct clinical trials of promising new HIV vaccine candidates. GHESKIO researchers, the Haitian Ministry of Health, and the Haitian Medical Association worked together for ten years to prepare for the conduct of HIV vaccine trials in Haiti.

AIDS Clinical Trials Group (2002 - present) GHESKIO is a member of an international group of scientists dedicated to developing treatment strategies for HIV and related disorders. GHESKIO conducts clinical trials to evaluate the efficacy of antiretroviral treatment for HIV infected individuals in resource-limited countries. The collaboration is supported by the National Institutes of Health.

Evaluation of Rapid Syphilis Diagnostics for the Elimination of Congenital Syphilis in Haiti (2002 - 2010) The goal of this project is to improve syphilis screening throughout the country to reduce deaths due to congenital syphilis. Support is from the United Nations Development Program, the World Bank, and the World Health Organization's Special Program for Research and Training in Tropical Disease.

Targeted Evaluation of AIDS Treatment in Haiti (2003 - 2009) GHESKIO investigators conducted the largest study of treatment outcomes for AIDS patients in a developing country, following 1,000 AIDS patients receiving antiretroviral therapy. Research continues to evaluate the efficacy and feasibility of other AIDS prevention and treatment programs. The studies are funded by the United Nation Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Presidents Emergency Plan for AIDS Relief.

National Seroprevalence Studies (2003 - present) The aim of the project is to conduct sentinel HIV surveillance across Haiti. GHESKIO conducts all HIV testing and was responsible for the training of study site lab personnel in sample collection. This nationwide project is supported by the United States Centers for Disease Control and Prevention and the Haitian Ministry of Health.

AIDS Diarrhea and Antiretroviral Therapy (2004 - 2008) The goal of this project is to determine the effect of tropical AIDS diarrhea on absorption of antiretroviral drugs, virologic response to therapy, and the development of HIV genomic drug resistance. GHESKIO investigators also seek to identify other co-factors that may relate to the response to antiretroviral therapy in AIDS patients with tropical diarrhea, including the etiologic agents of diarrhea, nutritional status, drug toxicity, and adherence. Support is from the National Institutes of Health.

Cost Effectiveness of HIV Prevention and Care Services (2003 - 2007) GHESKIO investigators are evaluating the cost-effectiveness of HIV prevention and care services to maximize efficiency and demonstrate the feasibility of treatment programs in developing countries. This research is funded by the National Institutes of Health.

Research Training of U.S. Fellows and Haitian Collaborators Fitzgerald, Pape, Johnson, Ho, Gulick, Glesby, Charles. There are currently two infectious diseases fellows and one PhD graduate student in nutrition who are receiving advanced research training in Haiti. They are listed below with their research areas of interest.

  • Serena Koenig, M.D., Fellow in Medicine (Harvard): Cost-effective analysis of national antiretroviral therapy program

  • Dahlene Fusco, Fellow in Medicine (Weill Cornell): HIV mucosal immunity

  • Rebecca Heidkamp, PhD candidate (Weill Cornell) Ready to use therapeutic foods for children of HIV-infected mothers

There is also an extensive training program for Haitian biomedical personnel in country and at Cornell and Vanderbilt Universities. Currently, over 40 GHESKIO staff are receiving NIH-funded training at Gheskio, Cornell, and Vanderbilt to facilitate HIV research and care in Haiti. In addition, 10 "Centers of Excellence for HIV/AIDS Prevention and Care" have been established with training at GHESKIO;the goal is 25,000 AIDS patients on therapy in 2008. GHESKIO has also been designated by UNAID, WHO, USAID as an "International Caribbean AIDS Training Center."

For additional information, please see the Gheskio Brochure and the Weill Cornell Medicine 2005 Publication (Haiti).

CONTACT US

Infectious Diseases

Kristen Marks, MD, Program Director
Leyla Pistone, Program Coordinator
Room: A-421
Tel: (212) 746-7587
Fax: (212) 746-8675
lef2009@med.cornell.edu

Top of page