Twenty-five years ago, as he witnessed the devastation of HIV/AIDS on the developing world, Dr. Ken Bridbord came up with a new concept to create in-country expertise in the regions where the need was greatest. Bridbord - Fogarty's Director of the Division of International Training and Research - conceived an innovative program consisting of mentored research projects, in addition to formal coursework. The AIDS International Training and Research Program (AITRP) has since trained more than 2,000 scientists and clinicians in more than 100 developing countries.
How did Fogarty's AIDS International Training Program (AITRP) come about?
Dr. Ken Bridbord
My inspiration for AITRP began with conversations I had during the international AIDS meeting in Washington, D.C. in June 1987. While we knew much less then about infection rates and spread than we do today, it was clear to all of us that to really tackle the problem we would need to enter into a partnership with colleagues in those countries hardest hit. That experience encouraged me to do more to combat the global HIV/AIDS epidemic. The release of the Institute of Medicine report, Confronting AIDS, also had a profound impact on my thinking about what our responsibilities as a wealthy nation should be in response to a growing global epidemic largely impacting poorer populations.
What is unique about the program?
AITRP aims to teach research by engaging its trainees in actual research projects designed to address the issues that are most pressing to that country's health problems. The program takes a systematic approach to training and research capacity strengthening, combining both short- and long-term training with support for research conducted in the participants' home countries. AITRP is designed to build enduring scientific partnerships between both the participating institutions and the individuals. It also provides critical support so research can be continued at home once training is completed, which helps prevent brain drain. The long-term nature of the capacity building process was recognized from the beginning of AITRP, but is even better appreciated today. It's clear that building sustainable international research and public health capacity requires an investment measured in decades, not years.
What has it accomplished?
AITRP's success is built primarily upon the energy, talent, and commitment of the numerous foreign trainees and their U.S. teachers. Through AITRP, these two groups of people became scientific colleagues. Trainees who have returned home have ample opportunity to continue the mentorship process with former teachers becoming, over time, true and equal collaborators with their former professors. Trainees also have opportunities to return to the U.S. for shorter-term training and continuing education in modern research techniques or to obtain specialized skills. Eventually, trainees who have returned home and established their research and public health careers become mentors for new trainees, and so the process continues. Many of the scientific advances - preventing mother-to-child transmission, therapy as prevention, and the benefits of microbicides and male circumcision - have been discovered by research teams led by or including former trainees.
What is the significance of in-country expertise?
AITRP would not have succeeded if it did not provide skills and support for research that is responsive to the needs and priorities of the collaborating countries. The program has emphasized the support of research to include prevention and development of interventions that are realistic, practical and affordable for the collaborating countries. Perhaps no single word captures the essence of AITRP more than empowerment. AITRP trainees are empowered with the knowledge, experience and increased confidence to return home and become scientific and public health leaders in the struggle against HIV/AIDS. This empowerment enables former trainees to be on a par with scientists from the developed world and - armed with this knowledge - returning AITRP trainees help their countries to craft and implement locally relevant strategies to tackle HIV/AIDS.
How do the trainees benefit other NIH and U.S. government activities?
Fogarty's AITRP and other research-capacity building programs complement and expand on the major research investments of the other NIH components. At the start, AITRP awardees were immediate beneficiaries of NIH's considerable grantmaking investments in AIDS research. Over time, NIH research programs have become the beneficiaries, as former AITRP trainees became the major foreign collaborators on numerous NIH-supported research projects. In addition, they have gone on to lead projects supported by the Bill & Melinda Gates Foundation, the Elizabeth Glaser Pediatric AIDS Foundation, the World AIDS Foundation and others. There is still much to be done but I'm confident the talented AITRP alumni are well-equipped for the challenge.