ICART : Fostering an AIDS Research and Training Center Infrastructure in Russia

Over the past decade, HIV incidence has increased more sharply in Russia and other post-Soviet countries than almost anywhere else in the world. Eastern Europe's recent and rapidly-escalating HIV epidemic has been driven by widescale cultural, social, and economic transformations that followed the sudden collapse of the former Soviet Union. These transformationsЧaccompanied by only uneven, mixed success in economic and political developmentЧhave produced profound changes in cultural and individual values. There have been sharp declines in young people's age at first sex, a liberalization of sexual behavior values, high prevalence of unprotected sex, and escalating STD rates. Drug use and commercial sexЧonce uncommon in the regionЧare now widespread. Although the HIV epidemic in Russia and other postsocialist countries was at first primarily associated with injection drug use, the region is now undergoing an epidemiological transition to predominantly sexual transmission. To forestall the emergence of a widescale sexual epidemic, it is essential to stimulate social and behavioral science research that can guide the development of improved HIV primary and secondary prevention interventions culturally appropriate for the region. The need for prevention efforts carefully grounded in social sciences is especially critical because Russia's HIV epidemic is so closely intertwined with rapidly-changing social, cultural, and behavioral values.

Botkin Hospital is the largest medical HIV care provider in northwestern Russia and is also the central hub for many HIV/AIDS prevention and care nongovernmental organizations (NGOs) in the area. ICART will consist of a consortium in Russia that is led by Botkin Hospital but also includes participation by investigators from the St. Petersburg Center for Independent Sociological Research, the Faculty of Economics at Moscow State University, the Pasteur Institute in St. Petersburg, the St. Petersburg State Medical Pediatric Academy, and the NGO "Doctors to Children," an NGO active in community HIV/AIDS prevention and care services. ICART will also be partnered in the collaboration with experienced senior investigators at the Center for AIDS Intervention Research (CAIR) at the Medical College of Wisconsin. CAIR has been an NIMH-funded P30 HIV prevention research Center since 1994 andЧover the past decadeЧhas undertaken successful HIV prevention studies in Eastern Europe in collaboration with many of the behavioral and social science investigators who will be affiliated with ICART. Support provided under this RFA will expand and strengthen the independent research capacity of the multidisciplinary investigational team in Russia; create a research support infrastructure to facilitate the entry of experienced Russian investigators into the HIV/AIDS social and behavioral science arena; attract into the field and support the training of promising new investigators; and carry out activities that will disseminate findings, methods, and research supports so as to benefit investigators and public health providers in Russia and in other Eastern European countries. Thus, the broad aims of ICART are to:

(1) create a multidisciplinary HIV/AIDS social and behavioral science infrastructure to strengthen research capacity at Botkin Hospital and other Russian institutions participating in this consortium;

(2) train new generations of Russian social and behavioral scientists able to address emerging needs in the HIV primary and secondary prevention fields, and support their initial developmental studies;

(3) function as a center-of-excellence resource to disseminate HIV prevention research advances to public health service providers, governmental and nongovernmental organizations, researchers, and other entities on a local but also on a Russian national and an Eastern European regional basis; and

(4) conduct two HIV social and behavioral research studiesЧone a randomized controlled trial of a social network primary prevention intervention and the other a randomized intervention study that integrates social and behavioral services into HIV care provisionЧboth targeting young people in St. Petersburg.

ICART's thematic research mission will be the theoretical conceptualization, conduct, and evaluation of HIV primary prevention interventions carried out with vulnerable community populations; the conduct of behavioral and social science research related to needs of HIV-infected persons, including research on stigma, treatment adherence, psychosocial coping with HIV, and prevention of HIV transmission from infected to uninfected persons; and qualitative and quantitative basic social science research necessary for the development of effective, culturally-tailored HIV primary and secondary prevention interventions. To achieve its aims in these thematic areas, ICART will be structured around 5 research infrastructure Cores, selected because they will provide resources essential across multiple studies expected to be It conducted by ICART investigators. The Training Core will oversee the recruitment, selection, and training of new investigators, and serve as a vehicle for cross-training investigators in one another's areas of expertise. The Data Management and Analysis Core will provide ICART investigators with centralized data entry and data management supports for both quantitative and qualitative studies carried out by Center investigators and trainees, perform data collection quality assurance/quality control (QA/QC) functions, and provide consultation in study design, methodology, and statistical analysis. The Fieldwork Research Support Core will constitute a resource of experienced personnel trained in field data collection, recruiting study participants, and carrying out both qualitative and quantitative assessment interviews following an investigator's protocol. The Core will also include staff experienced in facilitating behavioral interventions and counseling. The Dissemination, Community, and Liaison Core will disseminate methods, findings, and training for local, national, and regional service providers. The Core will be responsible for ICART's relationships with external entities including NGOs, AIDS service providers, governmental and nongovernmental agencies, and other institutions. The Core will identify and invite the participation of external investigators and consultants with specialized expertise, and be responsible for the Center's public information activities. The Research Ethics Core will provide training and consultation to ICART investigators, trainees, and staff in issues related to research ethics and the protection of human research participants. The Core will conduct annual 3-day comprehensive research ethics seminars as well as regular brief seminars on selected ethics topics that arise in HIV behavioral and social science research. The Ethics Core will also consult in the development of plans to ensure the protection of participants in the studies of Center investigators. ICART's overall operations will be overseen by an Administrative Division and Executive Committee which will receive input and solicit recommendations from a Community Advisory Board. To ensure close partnership with seasoned and senior HIV prevention investigators at the Medical College of Wisconsin, each ICART Core and its Administrative Division will be linked for ongoing collaboration with its counterpart Core at CAIR. ICART and CAIR Core Directors will visit one another's Centers for cross-training and collaboration.

In addition to the development of a research support infrastructure, this application proposes the conduct of two research studies that will address urgent but understudied HIV social and behavioral science questions pertinent to HIV research needs in Eastern Europe, draw upon the ICART Core resources, serve as vehicles for training, and stimulate additional research initiatives. Consistent with the Center's overall thematic focus, one study will be a randomized trial of a social network-level HIV primary prevention intervention to be carried out with a community population of high-risk migrant young people in St. Petersburg. The other will be a randomized HIV secondary prevention intervention study to promote adaptive psychosocial coping antiretroviral treatment adherence, and risk behavior reduction among persons in St. Petersburg newly diagnosed with HIV infection. The two proposed studies are described in detail later in this application. To determine success in meeting its aims and to guide ongoing program refinements, ICART will conduct in-depth annual self-evaluation activities. These will include: (1) detailed review of each Core's provision of research support resources and activities to Center investigators, trainees, and studies during the past year; (2) performance review of current trainees and new investigators, as well as tracking the research accomplishments of persons who completed training earlier; (3) indicators of academic productivity of ICART-affiliated investigators as reflected by presentations made at public health conferences, journal publications, grant applications submitted for funding, and outcomes of these grant submissions; (4) review of ICART's research portfolio with a particular emphasis on the relationship of investigators' studies to the Center's thematic focus; and (5) planning areas for new research development. ICART's annual self-appraisal process will be overseen by the Center's Executive Committee with input from its Community Advisory Board, institutional affiliates in St. Petersburg, and colleagues from the Medical College of Wisconsin.

ICART's multidisciplinary social and behavioral research infrastructure will strengthen HIV prevention science in St. Petersburg, in Russia, andЧthrough its dissemination activitiesЧin other parts of Eastern Europe. The Center will provide resources to support research excellence in areas related to its thematic mission, increase the pool of experienced investigators who work in the HIV prevention research field, and inform the development effective public health efforts to prevent HIV and minimize adverse consequences to persons living with the disease in Russia and other postsocialist countries in the region.

Although Russia Has a Longstanding Tradition of Academic Excellence, Scientific Partnerships with the Community and Even Across Academic Disciplines Remain Rare

For centuries, Russia has produced some of the world's greatest scientific minds, and its academicians have made among the leading contributions of all time to the fields of science, medicine, chemistry, mathematics, literature, and the arts. With very little funding support, few resources, and meager salaries that scarcely met their subsistence needs, Russian academicians made world-class scientific contributions throughout the Soviet era. They continue to do so. Russia's education systems, although underfunded, are among the best in the world and its population is among the most literate.

At the same time, there is very little history of multidisciplinary collaboration in Russian academic institutions. The planned economy that characterized the entire Soviet state system relied almost entirely on bureaucratic units organized in vertical hierarchies, with each unit responsible to those higher up in the same chain but with very little horizontal cross-communication. The same vertical hierarchical structure characterized the organization of universities. As a result, there is little precedent and almost no management experience in using approaches that bring together scientists from different disciplines to work on the same problem. It is precisely this kind of multidisciplinary collaboration that is needed to advance HIV prevention science in the region, and it is this type of multidisciplinary collaboration that (CART will strengthen and facilitate.

There is also very little precedent in Russia for collaborations between academic researchers and community-based organizations or community populations. This is partly due to the traditional nature of Russian science, which is typically more theoretical than applied. It is also partly due to the only-recent appearance in the region of NGOs. Because the state was defined in the communist era as the only necessary provider of services, NGOs representing community-based interests did not exist. The traditionally theoretical focus of Russian academic disciplines and the absence of NGOs that could serve as "bridges" to reach community members limited the potential for community research on applied social and health problems.

Fortunately, this situation is now changing. Applied sociology and behavioral sciences are becoming more prominent, and NGOs representing AIDS-vulnerable and AIDS-affected populations have developed over the past decade. Thus, there are now bridges to facilitate the conduct of applied social and behavioral research with at-risk young people, young MSM, drug users, and persons living with HIV. As we will describe shortly, our investigational team has productively carried out lines of programmatic HIV prevention research with these community populations in Russia and elsewhere in Eastern Europe. The research infrastructure development support that will be provided by this grant will strengthen these relationships, and attract and train new generations of social and behavioral scientists for careers in HIV primary and secondary prevention research.

The text above is cut'n'paste from Y.A. application to NIH (just an illustration)

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