The Division has an in-depth focus in the area of HIV/AIDS. The NIH funded Lifespan/Tufts/Brown Center for AIDS Research, based at The Miriam Hospital under Charles C.J. Carpenter, continues to support laboratory and clinical HIV prevention and treatment research. The total external HIV/AIDS research funding, from all sources, for Brown University faculty per year exceeds $10,000,000. The NIH Center grant strongly supports the primary thematic goal of the Lifespan/Tufts/Brown CFAR, which is to carry out translational research dealing especially with the treatment and prevention of HIV infection in hard-to-reach populations, both in New England and in several countries in the developing world. The NIH Fogarty HIV Training Program (AIETRP) supports international clinicians and scholars who receive further HIV related training at Brown and affiliated hospitals.

The AIDS Clinical Trials Unit (ACTU) at The Miriam Hospital/Brown University has been an outstanding success. This is one of 30 units around the country, which is NIH funded to participate in multi-center HIV and AIDS treatment trials. The Miriam Hospital/Brown University has played a leading role in the development and enrollment of HIV treatment trials, specifically for women. We have been chosen as one of six sites to develop a new international treatment initiative for HIV and AIDS as part of the ACTG. We have developed a multi-center treatment protocol which will be implemented in Chennai, India with our collaborative partners at YRG Care.

A priority for the Division of Infectious Diseases has been innovative models for improved prevention, diagnosis, and treatment of HIV, particularly in the clinical setting. Support has generously been provided through Ryan White Titles II, III, and IV programs, as well as two Special Projects of National Significance funded through the Ryan White Care Act. Infectious disease physicians with a focus on HIV and AIDS provide care not only in the hospital setting, but also at the state prison, substance abuse treatment centers, and community health centers in the surrounding towns of Woonsocket, Fall River, and Newport. The overlap between HIV, Hepatitis C and addiction has led to integrated models of care and prevention. Under the leadership of Dr. Rich, the Center for Prisoner Health and Human Rights has been established to promote diagnosis and treatment of infectious diseases within the correctional settings nationwide. A NIH funded T32 training grant supports faculty and fellows who focus on infectious diseases among communities that suffer disproportionately from addiction.

The new Center for Biodefense and Emerging Pathogens at Memorial Hospital directed by Dr. Andy Artenstein continues its successful role both within Brown and within Rhode Island. Dr. Artenstein, along with the Center's Associate Director, Dr. Peggie Neill at Memorial Hospital, has provided substantial community based education around biodefense since 9/11 to a variety of medical and public safety personnel. The Center has been awarded a substantial contract from the Rhode Island Department of Health for which it has developed educational tools for the health care community, as well as for the broader public, and the Center's physicians provide 24/7 consultative services for the RI DOH for bioterrorism concerns. Under the leadership of Dr. Artenstein, Memorial Hospital will participate in Phase I/II trials to evaluate the safety and efficacy of new more effective smallpox vaccines. Dr. Peggie Neill chairs the Bioterrorism WorkGroup for the Infectious Disease Society of America, which has played a leading role in education of Infectious Disease physicians since 9/11. As part of that effort, she has spearheaded the development and maintenance of the IDSA web site on bioterrorism, developing authoritative materials, including clinical pathways, for evaluation of disease syndromes, with full text access to the references and citations supporting the content.

The Rhode Island State Tuberculosis Treatment Program moved to The Miriam Hospital, Brown University School of Medicine. This has been a nationally recognized program of excellence that was cited by the Centers for Disease Control for its leadership nationwide in establishing directly observed therapy programs for all persons with TB. This program has participated in national trials to improve TB therapy. Dr. Jane Carter has established a outstanding collaboration with Moi University Medical School in Eldoret, Kenya, which will investigate improved TB therapeutic strategies for patients who have TB alone and for those patients who are co-infected with HIV and TB in the developing world, which poses unique challenges.

The Division of Infectious Diseases has played a lead role in defining improved strategies to prevent nosocomial infections, particularly related to intravascular catheters. Intravascular catheter infections are a major cause of morbidity among inpatients. Dr. Leonard A. Mermel has spearheaded efforts to better define and institute strategies aimed at prevention of such infections. He was the senior author of the Infectious Diseases Society of America guidelines on Management of Intravascular Catheter-Related Infections and Dr. Mermel co-authored national guidelines from the Centers for Disease Control on the Prevention of Intravascular Catheter-Related Infections. Dr. Mermel is the 25th President of the Society for Healthcare Epidemiology of America, a society whose members are infection control opinion leaders from over 30 countries. In addition, Dr. Mermel is an invited Technical Expert Panel Member of the Medicare Patient Safety Task Force for the US Dept. of Health & Human Services. This committee guides the Centers for Medicare & Medicaid Services in determining patient safety outcome indicators for hospitalized elderly patients. Dr. Mermel just completed a 4-year term as a Special Government Employee of Anti-Infective Drug Products Advisory Committee, Center for Drug Evaluation & Research, US Food & Drug Administration.

The Division of Infectious Diseases has established a new consultative service to prevent and treat infections among solid organ transplant recipients. As the number of kidney and pancreas transplants performed at RIH has increased, the Division has responded by providing inpatient and outpatient consultative services for this vulnerable patient population, led by Staci Fischer, M.D. Newly recognized infections, for example LCM Virus, are a focus of clinical research.

The Division of Infectious Diseases, in conjunction with Pulmonary and Critical Care Medicine, have established the Ocean State Clinical Coordinating Center (OSCC)] at Rhode Island Hospital. Steven P. LaRosa, MD serves as the Director of the OSCCC and Steven Opal, MD serves as Associate Director. The OSCCC is an academic group of physicians, research nurses, and research assistants who, working in conjunction with a study sponsor, serve as the "real-time" main point of contact for study sites for a variety of services. These services include: assessment of patient eligibility for the study, direction regarding protocol procedures, and answering questions regarding concomitant medications and safety concerns. The OSCCC secured a grant from Chiron Corporation in April 2004 to be the clinical coordinating center for a worldwide, randomized. placebo-controlled, Phase III trial of rTFPI in severe community acquired pneumonia (CAPTIVATE Study).

Dr. Ken Mayer has recently received multiple awards for his outstanding work in the area of HIV prevention. He was honored by the American Federation for AIDS Research to receive its yearly award for leadership in the area of HIV clinical research. He was chosen as the Paul Galkin Lecturer for Distinguished Leadership in HIV and AIDS. He also received honorary lifetime membership in the Indian Medical Association due to the establishment of the HIV/AIDS prevention and treatment collaboration with YRG Care in Chennai, India. Dr. Mayer leads the HIV Prevention Trials Network program at The Miriam Hospital/Brown University, which has played a leading role in developing and evaluating microbicides for the prevention of HIV, both in this country and in resource poor settings.

Dr. Timothy P. Flanigan and Dr. Jennifer A. Mitty have spearheaded a program of modified directly observed therapy for HIV treatment for individuals who are marginalized and would otherwise not receive the benefit of our new combination HIV treatments. A pilot program for active substance abusers to provide community based treatment strategies is ongoing and has been cited nationally. This work has been presented at the Infectious Disease Society of America, the Conference on New Advances in HIV Therapies sponsored by the American Federation for AIDS Research, and the National Retroviral Conference, and has received funding through an RO1 from the National Institutes of Health. Pilot programs to extend these community based therapies for pregnant women and persons leaving prison have begun.

Bharat Ramratnam, M.D. directs the Virology Core laboratory at Brown for the Center for AIDS Research. His work investigates viral dynamics, and particularly HIV viral decay. He has received funding from the Doris Duke Foundation, NIH/ NIAID, and the Culpepper Foundation. Recent work has focused on inhibitory activities of siRNA and the use of lactobacillus as vectors for mucosal microbicide delivery.

Jane Carter, who is a national expert on TB, oversees opportunities for clinical research for residents in Africa (Moi Medical School, Kenya). Drs. Mayer, Flanigan and Cu-Uvin collaborate on HIV clinical research in Chennai, India, Cambodia, Philippines and Indonesia related to HIV prevention and treatment of AIDS and opportunistic infections. Herb Harwell, M.D., who was trained in both Pediatrics and Medicine, has expertise in the area of sexually transmitted diseases and HIV. He has developed ongoing projects in Phnom Penh, Cambodia to evaluate the long-term morbidity and mortality related to HIV and the potential impact of antiretroviral therapy in Southeast Asia. He currently provides HIV treatment guidance and training for the Clinton Foundation.