William A. Blattner MD
William A. Blattner MD is Co-Founder and Associate Director of the Institute of Human Virology (IHV) and Professor of Medicine, University of Maryland, School of Medicine. His pioneering HIV research was initiated in 1981 during his 22 year tenure in the Public Health Service at the National Cancer Institute. He has currently authored over 400 peer reviewed publications, many targeting the international dimensions of the epidemic. He serves as an advisor to the NIH (Office of AIDS Research), the CDC (Division of HIV/AIDS Prevention (DHAP) Surveillance, Research, and HIV Prevention Programs), the US Military (Chairman, HIV Review Panel, Military Infectious Disease Research Program) and the Office of the Global AIDS Coordinator (HIV/AIDS Prevention of Mother-to-Child Transmission Expert Panel) and as a grant reviewer for NIH, Doris Duke Foundation and Bill and Melinda Gates Foundation. He also chairs the Baltimore City Commission on HIV/AIDS Prevention and Treatment. As founding Editor-in-Chief of the Journal of Acquired Immune Deficiency Syndromes
his editorship is premised on the principle that good public health policy is driven by scientifically sound data.
As scientific leader of the Division of Epidemiology and Prevention, Dr. Blattner is directly involved in the research activities of the Division’s scientists and their science, in mentoring their career development as independent academic investigators, and in building structures to support their research. In most cases these research projects take advantage of the substantial clinical and laboratory infrastructure built through a $240 million PEPFAR investment in IHV-Nigeria. Over his career Dr. Blattner has integrated laboratory science into his epidemiological research and this continues to be a major focus, abetted by Dr. Carr’s molecular epidemiology expertise and collaborative interactions with Institute and some scientists outside of IHV. Since the last Scientific Advisory Board review with the recruitment of Dr. Clement Adebamowo his longstanding interest in cancer epidemiology has been rekindled in partnership with the emerging Viral Oncology Program of IHV and the Greenebaum Cancer Center. He views PEPFAR as a unique public health intervention that affords substantial opportunity to conduct clinical and operations research of fundamental relevance to the sustainability of the new public health. His study of the role of HIV in inducing neurocognitive impairment and its impacts on program outcomes and HIV natural history is one such project. Another grows from the challenges of TB and HIV and his interest in characterizing core transmission groups for HIV and TB through epidemiological studies of marginalized most at risk groups such as commercial sex workers. The research agenda for the Division engages epidemiological science to derive practical and fundamental insight through multidisciplinary and collaborative research investigations to impact quality and sustainability of this new public health paradigm.
Alash’le G. Abimiku, Assistant Professor
Dr. Abimiku has played a critical role in the successful emergence of the Division and IHV-Nigeria in garnering success in PEPFAR and research funding. A major ongoing focus of Dr. Abimku’s research has it origins in her postdoctoral training in Dr. Gallo’s laboratory at NIH when she first demonstrated non B subtype G HIV-1 isolates in Nigeria. She works closely with Dr. Carr in characterizing HIV-1 diversity in Nigeria and in determining the role of subtypes in disease pathogenesis such as investigating the transmitting subtypes from mother to child. An important new direction in her research focuses on improved TB diagnosis, an outgrowth of her technical engagement in developing IHV-Nigeria’s internationally recognized laboratories, a quality improvement program in collaboration with Dr. Constantine, and establishment of a containerized BL3 laboratory. She is Principal Investigator for a multicountry CDC sponsored study on the impact of improved TB diagnosis on survival of AIDS patients. In collaboration with Dr. Lukashevic, she screened for Lassa antibodies in Nigeria and observed an overlap of Lassa and HIV. A NIH new investigator’s R01 in development targets the hypothesis that recurrent Lassa virus infection impacts risk for HIV infection. Having received an HVTN minority supplement she continues to pursue vaccine research, collaborating with Dr. Charurat in an incident HIV infection study; and with IAVI to identify long term non progressors. Aliquots from the IAVI protocol will be employed to study antibodies targeting epitopes of the IHV’s vaccine construct, in collaboration with Dr. Lewis. She is co-Chair of the African AIDS Vaccine Program and member of the International Vaccine Advisory Committee to guide HIV vaccine trials in Nigeria and throughout Africa. As co-PI of the IHV-UMD NIH Fogarty AITRP grant, Dr. Abimiku serves as Nigeria Director, helping to guide research and training in collaboration with Dr. Adebamowo.
Manhattan E. Charurat, Assistant Professor
Dr. Charurat is leading a collaborative study between the U.S. Centers for Disease Control and Prevention (CDC) and the Nigerian Federal Ministry of Health to improve the surveillance and follow-up of acute HIV infections, based on pooled nucleic acid amplification (i.e. pooled plasma PCR). Using a mobile counseling and testing approach, this work targets female sex workers. By following acutely HIV infected individuals before and after seroconversion, this study provides serial specimens for validating several different assays for distinguishing recent from established HIV infection. A valuable biological repository of samples being collected during early period of acute infection is being used to investigate early host-virus interaction. Because the early period of acute infection is when individuals are highly infectious and are unlikely detected by conventional antibody-based HIV tests, this study also augments the President’s Emergency Plan for AIDS Relief (PEPFAR)’s initiative to provide prevention for positives.
In his translational research with acutely HIV infected individuals, Dr. Charurat is focusing on characterizing the impact of HIV acquired during pregnancy on mother-to-child transmission in a newly funded R01. This research focus builds on Dr. Charurat’s expertise in the area of mother-to-child transmission of HIV and pediatric issues related to HIV-infection. Although the risk of mother-to-child transmission associated with maternal acute HIV infection is not known, we now know that there is an increased risk of HIV acquisition during pregnancy due to the hormonally-induced structural changes in genital tract mucosa and/or immunologic changes occurring during pregnancy. This research affords opportunities to further dissect early host-virus interaction within the context of mother-to-child transmission and within the setting of non-B subtype virus infection.
In addition, Dr. Charurat works actively to improve the monitoring and evaluation of the Division’s PEPFAR program in Nigeria including the development of cohort studies embedded within the HIV treatment and care program and is sponsored as the Principal Investigator by the NIAID’s International Epidemiologic Database to evaluate AIDS (IeDEA).
Beyond these research areas, as a co-investigator for the Fogarty’s AIDS International Training and Research Program, Dr. Charurat also provides primary academic advisement for all international students receiving Baltimore-based training and is a member of the Program Leadership Team to ensure seam-less integration of the sandwich training.
Clement A. Adebamowo MD, DrSc, Associate Professor
Dr. Adebamowo’s research is focused on the epidemiology and clinical trials in AIDS associated malignancies; molecular epidemiology of breast cancer including exploration of the potential role of infectious agents in the etiology of receptor poor breast cancer; clinical trials of prevention and treatment of breast and other cancers. Dr. Adebamowo is also working to develop overall research infrastructure in Nigeria through establishment of sustainable research ethics regulatory framework, training in GCP and research misconduct, principles and practice of clinical trials and building collaborative research groups. Viral oncogenesis was an early and important contributor to understanding carcinogenesis. The Institute of Human Virology’s large HIV treatment and prevention program in Nigeria provides an opportunity to explore viral oncogenesis in the HIV+ and HIV- population through the application of modern epidemiology and molecular biology techniques based on the hypotheses that a) HIV by causing immunodeficiency increases the relative carcinogenesis of virus thereby enhancing their identification; b) Altered immunity and immune re-constitution in HIV patients on HAART alters the response to oncogenic viruses; and c) Similarities between the Baltimore and Nigerian HIV epidemics creates opportunities for comparative translational viral oncogenesis research. Dr. Adebamowo also continues to pursue research into molecular subtypes of breast cancer and an exploration of the role infectious agents in their etiology. In order to achieve these Dr. Adebamowo is developing the necessary in-country infrastructure including a) Creation of multidisciplinary medical research teams at Universities, Teaching Hospitals and Research Institutes; b) Creating and strengthening institutional ethics committees; c) Provision of Training to enhance research and clinical diagnosis skills as well as application of modern diagnostic and treatment guidelines; d) Development and Resuscitation of the National Cancer Registries system in order to improve cancer case finding and follow up; e) Development of a Clinical Trials Consortium associated with the AIDS Malignancy Consortium; and f) Enhancement of capacity for ethical conduct of research.
Patrick Sunday Dakum MBBS, MPH, Assistant Professor
Dr Dakum has been a practicing Public Health Physician and has spent about 24 years managing Public Health Programs in Nigeria. In the past 5 years with funding through UMD from CDC with Dr Blattner as PI, Dr Dakum provided leadership in the rapid scale up of HIV/AIDS prevention and treatment. He has served on many National Health Review committees including the Governing Council of the University of Jos, one of the foremost universities in Nigeria. As an Adjunct Professor in IHV since 2006, Dr Dakum has participated in mentoring summer students and contributed to the writing of a Book Chapter (Public Health Aspects of HIV/AIDS) recently published by Springer in 2008. Dr Dakum only recently in June 2009 was appointed as Assistant Professor in the Department of Epidemiology and works with the Epidemiology Division but based in Nigeria where he continues to provide Programmatic and Administrative oversight to the affiliate of the IHV in Nigeria, IHVN. In addition to mentoring visiting MPH students Dr Dakum is developing research interest in 2 areas:
Establishing a Cohort of HIV positive Couples (Concordant and Discordant). Possible studies that can be carried out using this cohort include but are not limited to the following:
Social and Behavioral Characteristics related to Risk Behaviour
Incidence and determinants of Sero Conversion of HIV negative Partners in a discordant couple
Genetic Variations amongst Concordant couples
Reproductive Health Practices and Choices amongst Couples
Vaccine Trials amongst Discordant Couples
HIV in the Elderly – There are currently very few studies in West Africa on HIV in the Elderly and specific areas to look into will be
Testing and Counseling Options
Treatment and Adherence Issues
Epidemiology in Nigeria
With a population base of over 70,000 in the PEPFAR Cohort, Dr Dakum will spend time refining the specific aims of the studies so as to contribute not only to the science but to providing avenues for clinical trials of vaccines and new treatment drugs.
Mary Ann Etiebet, MD Assistant Professor
Dr. Etiebet’s multidisciplinary research interests focus on areas of implementation research (by investigating optimal strategies for ARV therapeutic monitoring), clinical care (by investigating factors associated with patterns of drug resistance mutations), and molecular epidemiology and pathogenesis (by investigating how viral genetic sequence modulates pattern of mutation) in order tocontribute to evidence-based science that can inform the development of public health strategies to successfully scale up HIV care and treatment programs and public policy in resource constrained settings.
Based on work conducted in the Division’s PEPFAR program in Nigeria, she has presented findings on the poor performance of WHO immunological criteria for determining virological treatment failure in low resource settings (Oral Presentation, 16thConference on Retroviruses and Opportunistic Infections,Montreal, February 2009), the high levels of drug resistance mutations present among patients failing first-line anti-retroviral regimens in Nigeria (Poster Presentation, XVII International AIDS Conference, Mexico City, August 2008), and the lower number of NRTI drug resistance mutations found in patients taking Tenofovir rather than thymidine analogue based NRTI first-line regimens (5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Capetown July, 2009). Working with Dr. Jean Carr (IHV), she is also investigating the impact of circulating HIV-1 subtypes on the pattern of drug resistance mutations and their effect on virological, clinical and immunological outcomes.
Dr. Etiebet is also a Co-Investigator in the proposed ACTION Adult Cohort (AACT) Study. The AACT Study is a multi-site prospective observational cohort study created to comprehensively assess the long-term outcomes of 3,600 HIV-positive patients in care at 6 tertiary university teaching hospital outpatient clinics supported by IHV. Proposed operations research will also assess durability of virological suppression of second-line regimens among HIV-1 positive patients who receive routine viral load testing versus those who do not.
Beyond these research areas, Dr. Etiebet also works actively to improve clinical care, mentoring and training of the Division’s PEPFAR program in Nigeria. She has spearheaded initiatives to better monitor and improve patient-level quality of care indicators, as well as operations research to define site and programmatic characteristics affecting quality of care.
Emilia Iwu, MSN, Assistant Professor School of Nursing
Since joining IHV as full time/in-country Technical Advisor for nursing care in 2006, Emilia Iwu has transitioned into a faculty position in UMSON where she has aligned her technical PEPFAR work with a nursing research agenda that addresses unique challenges of public health scale up of care and treatment for HIV/AIDS. Her operational research agenda targets involve studying impacts of non physician providers, particularly nurses in expanding and improving HIV services. She utilizes qualitative assessments, largely observational and quantitative measures employing metrics of the WHO Integrated Management of Adolescent and Adult Illness framework. Coming from the background of a registered midwife and Nurse Practitioner (NP), she is familiar with “task shifting” in the Nigerian health care system which evolved from the role of traditional birth attendants in West Africa as well as clinical roles of NPs in the USA. The concept of “nurse practitioner” however encroaches on “traditional” physician roles in that it involves a more complex medical paradigm with “prescribing and monitoring” medical outcomes. The success of this role expansion for non physicians is dependent on effective preparation & mentorship; physician preparation as mentors, readiness for teamwork and collegial relationships with non-physician providers in countries like Nigeria with physician-oriented health systems. A second research focus is to investigate the impact of upgrading nursing capacity at traditional clinics or wards to support HIV care and treatment as part of a health care team. This research focus targets impacts on quality of care, behavioral outcomes such as treatment adherence and retention in care. A related activity involves the issue of occupational safety and prevention of medical transmission of HIV and other blood borne pathogens in the clinical settings. The final area of interest is the impact of nurses in bridging facilities-based and community-based linkages to optimize the role of non-medical volunteers and staff [e.g. persons living with HIV/AIDS (PLWHA)] in treatment adherence support and “mother to mother” interventions to address the breakdown in the Prevention of Mother to Child Transmission cascade.