Faculty from the Yale School of Medicine (YSM) and the Yale School of Public Health (YSPH) are partnering with Ilia State University (ISU) in Tbilisi, Georgia to provide advanced training in implementation research methods related to HIV prevention and treatment with a specialized emphasis on biostatistics.
The Georgian Implementation Science Fogarty Training (GIFT) program aims to leverage the combined resources of Yale University and ISU to improve HIV prevention and treatment in at-risk populations throughout Georgia, located in Eastern Europe.
Georgia’s ability to control the HIV epidemic has been hampered by a lack of expertise in implementation science and biostatistics, a core strength at Yale. Faculty at Yale bring considerable experience with implementation science research methods and biostatistics, including being world leaders in the development and application of statistical methodologies, including methods for implementing research. Faculty and students from ISU – Georgia’s top research institution – are gaining new research skills and collaborating with Yale mentors to gain real-world experience analyzing data from HIV implementation trials underway or completed at Yale.
The Yale researchers are transporting a program “that was mostly developed in high-income settings to a low- and middle-income area where probably the need is the greatest,” said Dr. Frederick Altice, MD, professor of medicine (infectious diseases) at YSM and epidemiology (microbial diseases) at YSPH, one of three principal investigators (PI) for the program. Denise Esserman, professor of biostatistics at YSPH, and Dr. Irma Kirtadze, MD, associate professor at Ilia State University, also are PI’s and each bring unique expertise to the program.
“The longer-term goal is to build up the capacity within the programs that they have at ISU,” said Esserman. “Especially within this realm we need more complex methodologies to address the challenges they experience in a resource-limited setting.”
Addressing HIV in Eastern Europe
New infections and mortality associated with HIV in Georgia have grown 30% and 335%, respectively. The goal of the GIFT program is to meet the growing need to train the next generation of public health researchers more effectively, recognizing the need for better implementation with HIV prevention and treatment, the researchers said.
The HIV epidemic in Georgia is heavily concentrated in key at-risk populations, like people who inject drugs and men who have sex with men, which is where the virus spreads the fastest. Although there are multiple elements of HIV prevention and treatment present in Georgia, including voluntary counseling/testing, pre-exposure prophylaxis (PrEP), opioid agonist therapies, and syringe services programs, they are under-scaled in terms of coverage and, importantly, are not adequately implemented to improve access for at-risk populations, where stigma and discrimination are high.
“We ‘married’ both high-quality biostatistical methods with implementation science to come up with a training plan to strengthen research opportunities in Georgia,” said Altice.
Training the next generation of HIV researchers
During the first year of the program, five ISU professors took rigorous online courses before traveling to Yale during the Spring 2024 semester where they trained in both implementation science and biostatistics – they will serve as mentors for future doctoral students who start in Fall 2024. In July 2024, multiple Yale faculty traveled to Tbilisi to provide a 3-day intensive training program. On the third day, the training was divided into advanced biostatistic methods led by Esserman and HIV- implementation science and skills-building workshops led by other Yale faculty, including seminal lectures from Dr. Luke Davis, MD, associate professor of epidemiology (microbial diseases) and medicine (pulmonary, critical care and sleep medicine), Dr. Jennifer Edelman, MD, professor of medicine (general medicine) and public health (social and behavioral sciences), Dr. Mona Sharifi, M.D., associate professor of pediatrics, Ashley Hagaman, assistant professor of public health (social and behavioral sciences), and Dr. Sten Vermund, MD, the Anna M.R. Lauder Professor of Public Health. The program is a five-year collaborative that extends through 2028.
With support from international stakeholders, including the U.S Centers for Disease Control (CDC) and the World Health Organization, the program held a summer bootcamp from July 10-12, 2024, and trained students and faculty from universities in Georgia and from other low- and middle-income countries from Central Asia. The goal of the summer bootcamp is to transfer knowledge and build capacity within ISU, the Caucasus and Eastern Europe, and Central Asia. The team developed the program with funding from the NIH’s Fogarty International Center, which is dedicated to supporting and facilitating global health research conducted by U.S. and international investigators.
“Our goal is to fill the education gap by training the faculty members so that they can teach the next generation, as well as educating junior scholars who will become doctoral candidates,” said Altice. “The idea is that we can create and strengthen home-grown skills and ability to handle the local HIV epidemic rather than relying on international outsiders.”
The program was well-received due to the hands-on, skill building provided by the YSPH faculty, Altice said. In fact, over 100 faculty, students, and researchers from other countries, including from Kazakhstan, Kyrgyzstan, Tajikistan, Moldova, China, and Nigeria, attended the three-day bootcamp at ISU.
Altice also co-directs the Malaysian Implementation Science Training (MIST) program at the University of Malaya (UM) in Kuala Lumpur. The program, started in 2020, trains the next generation of Malaysian researchers in implementation science, and builds on 20 years of research collaboration between the two universities to address critical issues surrounding HIV, viral hepatitis, tuberculosis, and addiction.