Miller School Receives $8.5 Million Grant, Joins National HIV Study

Bringing Florida into the NIH-funded Women’s Interagency HIV Study, Miller School HIV/AIDS researchers have been awarded $8.5 million over five years to provide clinical, behavioral and basic science insights into the changing demographics of the HIV epidemic among women in the United States.

Given its diverse patient population and the vast experience, expertise and contributions to HIV/AIDS research and clinical care of its faculty, the Miller School is a natural addition to the Women’s Interagency Health Study (WIHS), which had sites in New York, San Francisco and other high-incidence areas, but none in the South. Established in 1994 to investigate the impact of HIV infection on women in the U.S., the study is expanding to the southern region specifically to better understand the epidemic’s changing epidemiology among minority women.

As Miller School Dean Pascal J. Goldschmidt, M.D., noted in supporting the Miller School’s WIHS application, Florida has the highest number of HIV-infected individuals in the South and the city of Miami has the highest incidence of HIV/AIDS in Florida. According to recent data, 29 percent of the people living with HIV in Miami­-Dade County are adult women, while 29 percent of the new cases of HIV infection are in women and female youth, 56 percent of whom identify themselves as black, and 23 as Latina or Hispanic.

“The HIV epidemic has changed significantly over the past few decades, with rates of HIV infections among minority women on the rise,’’ the Dean said. “The Miller School’s addition to the WIHS will fill a critical gap for HIV/AIDS research in Florida and promises to make significant contribution to the aims of the WIHS, thanks to our outstanding clinicians and scientists.”

A joint project between the Miller School and the Columbia University Mailman School of Public Health, with collaboration from the University of Florida, the Miami WIHS will be led by Principal Investigators Margaret Fischl, M.D., professor of medicine, Director of the Miami AIDS Clinical Research Unit and Co-Director of the Miami Center for AIDS Research (CFAR), and Lisa Metsch, Ph.D., who formerly led the CFAR’s behavioral/social sciences and community outreach core, and is now chair of Columbia’s Department of Sociomedical Sciences.

They and other members of their WIHS team, which includes clinical, basic and behavioral/social scientists with strong ties to the community, plan to enroll 300 diverse women and youth in Miami, many of them immigrants, who are either at-risk for HIV or have limited disease progression or newly recognized infections. The participants also will include people who have never been on antiretroviral treatments, those who have been, and those who are in care, have been in intermittent care, or not in care at all.

“By coupling the diverse population base of HIV-infected and at-risk women with the recognized strengths in HIV/AIDS research, the Miami WIHS is perfectly situated to advance the overall WIHS scientific agenda of defining clinical outcomes among women across their lifespan,” said Fischl, who is also co-director of the Regulatory component of the Clinical and Translational Science Institute (CTSI). “Not only does Miami have high rates of immigration from the Caribbean and Central and South America, the HIV-infected population of women here spans generational boundaries – from pediatrics to the elderly. Compounding these issues, heterosexual transmission and intravenous drug use are major risk factors for infection among women in Miami, which also ranks high in measures of social and economic distress.”

The researchers plan to examine critically important and scientifically rigorous research questions, including the impact of aging on immune functionality, reproductive decision-making, increasing viral diversity, and crack cocaine use and associated co-occurring epidemics (such as mental illness, poverty, unemployment and interpersonal violence) on the uptake of optimal antiretroviral therapy and engagement and retention in care.

Funded by the NIH’s National Cancer Institute, National Center for Research Resources, National Institute of Allergy and Infectious Diseases, and National Institute on Drug Abuse, WIHS researchers have, to date, enrolled more than 4,100 participants for detailed and structured interviews, physical and gynecologic examinations, and laboratory testing. They also have published a number of important findings and conducted a variety of sub-studies, for example, on cardiovascular, physical and metabolic function, and neurocognition in women with HIV/AIDS.

In addition to Florida, the WIHS is also expanding to sites in Atlanta, Birmingham, Alabama, and Chapel Hill, North Carolina.

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