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1 THE ANRS& research in resourcelimited settings \1

2 2 / THE ANRS& research in resourcelimited settings

3 \ The ANRS: commited to resource-limited countries and the developed world Funding of research proposals The ANRS sites: a partnership at the heart of research between the developed world and resource-limited countries Managing research in resource-limited countries The main lines of research in resource-limited countries Ethics and good research practice ANRS Research in resource-limited settings department Bibliographic references Map of partner countries The ANRS sites The Burkina Faso site The Cameroon site The Côte d Ivoire site The Senegal site The Cambodia site The Vietnam site The Egypt site The Brazil site Ongoing projects

4 / 4 The ANRS: commited to the resource-limited countries and the developed world n Since 1992, the Research Agency ANRS (France Recherche Nord&Sud Sida-HIV Hépatites) has been executing, coordinating and funding research on HIV/AIDS and, since 2003, on viral hepatitis, in France and in countries with limited resources. Its annual budget, comprising mainly public funding, amounts to approximately 44 million euros. Annual budget of the ANRS: approximately 44 million euros 1992 Creation of the French Agency for AIDS Research 1999 n Despite the progress made in the fight against these two epidemics, UNAIDS estimates that approximately 35 million adults and children around the world are infected by the AIDS virus. More than 240 million people are infected by the hepatitis B virus and 184 million by the hepatitis C virus. This is a global public health problem that spares neither the developed world nor resource-limited countries. This is why the ANRS supports research in both the developed world and in resource-limited settings and every year earmarks over 20% of its budget for countries with limited resources. Funding of research proposals n ANRS calls for research Two annual calls for research proposals (January and June) are open to all public or private research laboratories, whatever their field of research. proposals open to resourcelimited countries n First proposal funded: ANRS DITRAME PLUS ANRS scope extended to viral hepatitis 2012 The ANRS became an autonomous agency of Inserm Proposals for research in countries with limited resources must include at least one French team and one relevant team from the country or countries where the research will be conducted. n Proposals are reviewed by an ANRS independent and multidisciplinary scientific committee (CSS6) comprising 15 French and foreign researchers and clinicians from the developed world and from resource-limited settings1. Representatives of patient groups from resource-limited settings and the developed world are also voting members. n Between 2011 and 2013, on average, 30% of proposals submitted to the ANRS were funded2. 2e APP APPEL PEL À PRO PROJETS OJETS TS P ROJETS D E RECHERCHE, CONTRA INITIA UNE RECHERCHE, PROJETS DE CONTRATS NTRA ATS TS D D INITIATION IA ATION D D UNE A LLOCA ATIONS D E RECHERCHE, COLLOQ UES ET P UBLICA ATIONS ALLOCATIONS DE COLLOQUES PUBLICATIONS 2013 A new identity for the ANRS and a new logo DOMAINES DOMAINE S DE DE RECHERCHE ERCHE : ENSEMBLE D DES ES RECHERCHES S SUR UR LE V VIH/SIDA IH/SIDA ; RECHERCHES S SUR UR D D AUTRES AUTRES THÉMA THÉMATIQUES TIQ TIQ I UES D DÈS ÈS LORS Q QU ELLES U ELLES SONT U UTILES TILES DE PHYSIOPATHOLOGIE DE PAR À LA COMPRÉHENSION D E LA PHYSIOP ATTHOLOGIE OLOGIE D E LL INFECTION INFECTION INFECTION P A AR LE VIH. VIH. H ENSEMBLE DES DES RECHERCHES SUR SUR LES V HÉPATITES É ATITES IRUS D ES HÉPA ENSEMBLE VIRUS DES VIH/HÉPA ATITES. ET LES CO-INFECTIONS VIH/HÉPATITES. INFORMATIONS INFORMA ATIONS ET FORMULAIRES FORMULAIRES SUR SUR www s.frr Utiliser impérativement les formulaires du 2e appel à projets 2014 L appel à projets est ouver ouvertt à tout laboratoire de rec recherche, herche, public ou pri privé vé 1. Proposals concerning cohort follow-up studies are reviewed by a specific evaluation committee. 2. The complete list of ongoing projects funded by the ANRS can be found on pages 30 to ANRS DITRAME PLUS-1. Evaluation of peripartum interventions in prevention of mother-to-child HIV transmission in Africa.

5 \5 The ANRS sites: a partnership at the heart of research between the developed world and resource-limited countries Africa, Southeast Asia, Egypt, and Brazil Sustained support in personnel, equipment, and buildings n The Research Agency ANRS (France Recherche Nord&Sud Sida- HIV Hépatites) concentrates its human and financial resources in its country sites 4 : in Africa: Côte d Ivoire, Senegal, Burkina Faso, Cameroon in Southeast Asia: Vietnam and Cambodia Egypt Brazil. n In partnership with national health and research authorities, the ANRS sites 5 are placed under the joint responsibility of a coordinator from the developed world and a coordinator from a resource-limited country who in collaboration define the key lines of research. The ANRS sites facilitate the establishment of research programs between: national institutions of the partner countries (university hospitals, laboratories and research centers, local Institut Pasteur, national AIDS programs ), French research organizations like the Research Development Institute (IRD), the National Institute of Health and Medical Research (Inserm), the National Center for Scientific Research (CNRS), the Institut Pasteur network, universities, the Network for Therapeutic Solidarity in Hospitals (Esther), institutions in other countries (National Institutes of Health, Centers for Disease Control, United States, London School of Hygiene and Tropical Medicine, United Kingdom ), - international institutions (World Health Organization, European & Developing Countries Clinical Trials Partnership ). n ANRS provides its sites with sustained support in personnel, laboratory equipment, and buildings. n Scientific days are held regularly at each site. They offer an opportunity for ANRS managers and researchers, clinicians, civil society representatives, national authorities, and the press, to discuss how projects are moving forward, the results obtained, and future perspectives. n About 70% of the budget that the ANRS allocates to countries with limited resources is earmarked for research at the sites, 30% being allotted to projects conducted off-site, mainly in Africa. 4. Map of sites, pages Site activities, pages 14 to 29.

6 6 / Managing research in resourcelimited countries Defining emerging research areas n The Research Agency ANRS (France Recherche Nord&Sud Sida-HIV Hépatites) coordinated action "Research in resource-limited countries" (AC12) covers scientific and strategic research in these countries 6. n AC12, which comprises coordinators from the developed world and from ANRS sites and experts in various fields, defines emerging areas of research. n Several multidisciplinary working groups draw up proposals in these areas and support the creation of networks between countries with limited resources. The main lines of research in resource-limited countries Supporting the creation of networks between resource-limited countries Antiretrovirals for adults: early treatment of adults, management of patients in whom first and second-line antiretroviral treatment has failed, evaluation of WHO recommendations, prevention and treatment of opportunistic infections (cryptococcosis ). Tuberculosis and HIV co-infections: search for the best therapeutic strategies using combinations of antiretrovirals and tuberculosis drugs, prevention of tuberculosis in HIV-positive patients. Prevention of mother-to-child HIV transmission and pediatric research: transmission of HIV in breast milk and early treatment of the child, comparison of treatment regimens in children, long-term effect of antiretrovirals. Viral resistance in countries with limited resources: collaboration with the WHO in national programs on monitoring resistance in untreated subjects and in patients on antiretrovirals. Alternative techniques in virology: development and quality control of low-cost virological tests. Prevention of sexual transmission of HIV: clinical and social sciences research on prevention, mostly in the biomedical field (circumcision, peri-exposure prophylaxis, treatment as prevention ). Social sciences and health economics research: screening and access to healthcare, experience of living with the disease, public epidemic control policy, drug policy, pharmaceutical market Hepatitis: hepatitis C and hepatitis B-HIV co-infections, prevention of HIV infection and viral hepatitis in drug users. 7. President of the AC12: François Dabis, Inserm U897, Université Victor Segalen, Bordeaux

7 \7 Ethics and good research preactice Since 2002, the ANRS has a charter of ethics and good research practice which is applied in countries with limited resources and serves as the reference for all researchers seeking to conduct an ANRS-funded project in such countries. The key principles of the ANRS Ethics Charter for research in developing countries are as follows: The notion of partnership between the developed world and resource-limited countries in all fields: composition of committees (evaluation committee, working groups) and teams responsible for research, collaboration with national public health programs on the definition of research priorities, delivery of results in the corresponding country. Protection of human research participants. ANRS assumes its responsibilities as sponsor and has taken out a civil liability insurance to cover all patients participating in biomedical research. An independent monitoring committee evaluates the adherence to ethical principles during research, the application of good practice guidelines, and the validity of certain results. The ANRS ensures medical management of patients throughout the research and a commitment by the national authorities is required for follow-up treatment after every trial. The increased role of viral hepatitis research and changes in resourcelimited settings in terms of the ethics of research and the protection of participants are such, that the ANRS anticipates a revision of its charter in the medium term. To ensure that the optimal conditions for the implementation of research are respected ANRS Research in resource-limited settings department A team of six people oversees: the science policy and general strategy for all research conducted in resource-limited settings, the organization and implementation of the research projects, the coordination of activities, and the management of the sites. It also provides scientific and administrative support for the research teams. 7. The ethics charter covering research in developing countries (2008 update) is available on the ANRS website: Contact : Brigitte Bazin Director of the Research in resource-limited settings department Tél. : + 33 (0) November 2008 November 2008 Ethics charter Ethics charter for research in developing countries for research in developing countries W RITTEN M AY 2002 AND AMENDED O C T O B E R 2008 W RITTEN M AY 2002 AND AMENDED O C T O B E R 2008 I GENERAL PRINCIPLES I GENERAL PRINCIPLES 1.1 Adherence to texts page A top priority: improving the health of populations page Partnership and cooperation page Adherence to texts page A top priority: improving the health of populations page Partnership and cooperation page 5

8 8 / 1999 Preventive treatment Cotrimoxazole prophylaxis of opportunistic infections at the first stages of HIV infection Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Cote d Ivoire : a randomized trial. Cotrimo-CI Study Group. Anglaret X, Chene G, Attia A, Toure S, Lafont S, Combe P, Manlan K, N Dri-Yoman T, Salamon R. Lancet 1999; 353 (9163); (ANRS 059) Bibliographic references Origin of the virus 2001 The history of transmission of HIV-1 Dating the common ancestor of SIVcpz and HIV-1 group M and the origin of HIV-1 subtypes using a new method to uncover clock-like molecular evolution. Salemi M, Strimmer K, Hall WW, Duffy M, Delaporte E, Mboup S, Peeters M, Vandamme AM. FASEB J. 2001; 15 (2): Epub 2000 Dec 8. Treatments 2004 Efficacy of a generic combination for first-line treatment in Africa Effectiveness and safety of a generic fixed-dose combination of nevirapine, stavudine, and lamivudine in HIV-1-infected adults in Cameroon : open-label multicentre trial. Laurent C, Kouanfack C, Koulla-Shiro S, Delaporte E, for the ANRS 1274 study group (2004). The Lancet 2004; 364 (9428): (ANRS 1274) Biomedical prevention 2005 Male circumcision greatly reduces (60%) the risk of HIV transmission to men Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk : The ANRS 1265 Trial. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. PLoS Med. 2005; 2 (11): e298 (ANRS 1265)

9 \9 Origin of the virus 2006 The gorilla (DRC) is the natural reservoir of HIV-1 group O Human immunodeficiency viruses : SIV infection in wild gorillas. Van Heuverswyn F, Li Y, Neel C, Peeters M. Nature 2006; 444 (7116): 164 (ANRS 12125) Treatments 2007 Valaciclovir reduces genital viral load of HIV-1 in women with HIV- 1/HSV-2 co-infection Reduction of HIV-1 RNA Levels with Therapy to Suppress Herpes Simplex Virus. Nagot N, M.D., Ouédraogo A, Foulongne V, Van de Perre P, Mayaud P, for the ANRS 1285 Study Group. N Engl J Med. 2007; 356: (ANRS 1285) Mother-to-child transmission 2005 Short zidovudine treatment and single-dose nevirapine effectively reduce mother-to-child HIV transmission Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission. Dabis F, Bequet L, Koumavi Ekouevi D, Leroy V. AIDS 2005; 19 (3): (DITRAME ANRS 1201) Origin of the virus 2006 The chimpanzee subspecies Pan troglodytes troglodytes (Cameroon) is the natural reservoir of HIV-1 strains M and N Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1. B F Keele, Van Heuverswyn F, Li Y, Peeters M and H Hahn B. Science 2006; 313 (5786): Treatments 2011 Efficacy of early antiretroviral treatment of patients co-infected with HIV and tuberculosis Earlier versus later start of antiretroviral therapy in HIVinfected adults with tuberculosis. Blanc FX, Sok T, Laureillard D, Borand L, Goldfeld AE. N Engl J Med. 2011; 365 (16): (ANRS 1295)

10 10 / Mother-to-child transmission 2011 Efficacy of triple antiretroviral therapy in reducing the risk of mother-to-child transmission Triple antiretroviral compared with zidovudine and singledose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study) : a randomised controlled trial. The Kesho Bora Study Group. Lancet Infect Dis. 2011; 11 (3); (ANRS 1289 Kesho Bora) Management 2012 Morbidity and mortality of patients before initiating ARV treatment, stratified by CD4 counts AIDS and non-aids morbidity and mortality across the spectrum of CD4 cell counts in HIV-infected adults before starting antiretroviral therapy in Cote d Ivoire. Anglaret X, Minga A, Gabillard D, Ouassa T, Messou E, Morris B, Traore M, Coulibaly A, Freedberg KA, Lewden C, Menan H, Abo Y, Dakoury- Dogbo N, Toure S, Seyler C. Clin Infect Dis. 2012; 54 (5): (ANRS Morbidity/Mortality STU) Management 2012 Clinical monitoring alone versus monitoring of viral load and CD4 cell counts in Cameroon Monitoring of HIV viral loads, CD4 cell counts, and clinical assessments versus clinical monitoring alone for antiretroviral therapy in rural district hospitals in Cameroon (Stratall ANRS 12110/ESTHER) : a randomised non-inferiority trial. Laurent C, Kouanfack C, Laborde-Balen G, Aghokeng AF, Mbougua JB, Boyer S, Carrieri MP, Mben JM, Dontsop M, Kaze S, Molinari N, Bourgeois A, Mpoudi-Ngole E, Spire B, Koulla-Shiro S, Delaporte E. Lancet Infect Dis. 2012; 11 (11); (ANRS STRATALL) HIV/tuberculosis co-infection 2012 Association between natural killer cell degranulation and risk of immune reconstitution inflammatory syndrome in patients co-infected with HIV and tuberculosis Natural killer cell degranulation capacity predicts early onset of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients with tuberculosis. Pean P, Nerrienet E, Madec Y, Borand L, Laureillard D, Fernandez M, Marcy O, Sarin C, Phon K, Taylor S, Pancino G, Barré-Sinoussi F, Scott-Algara D. Blood 2012; 119 (14); (ANRS 1295 CAMELIA) Treatments 2013 Use of nevirapine as an alternative to efavirenz in patients co-infected with HIV and tuberculosis Nevirapine versus efavirenz for patients co-infected with HIV and tuberculosis : a randomised non-inferiority trial. Bonnet M, Bhatt N, et al. (ANRS CARINEMO). Lancet Infect Dis. 2013; 13 (4);

11 2/03/10 10:09 Page 1 Sous la direction de Fred Eboko Claude Abé Christian Laurent Sous la direction de Alice Desclaux Philippe Msellati Khoudia Sow \ The Political Economy of HIV/AIDS in Developing Countries. Trips, public Health Systems and Free Access. Benjamin Coriat (Edited by), Edward Elgar Publishing Ltd, 2008, 384 p. Reference works on social sciences research 2010 Accès décentralisé au traitement du VIH/sida. Évaluation de l expérience camerounaise. Fred Eboko, Claude Abé, Christian Laurent. ANRS, Collection Sciences sociales et sida, 2010, 324 p. Collection Sciences sociales et sida Accès décentralisé au traitement du VIH/sida Évaluation de l expérience camerounaise 2011 Les femmes à l épreuve du VIH dans les pays du Sud. Genre et accès universel à la prise en charge. Alice Desclaux, Philippe Msellati, Khoudia Sow. ANRS, Collection Sciences sociales et sida, 2011, 555 p. Collection Sciences sociales et sida Les femmes à l épreuve du VIH dans les pays du Sud Genre et accès universel à la prise en charge more at [ ] Collection Sciences sociales et sida 2012 From collaborative research to community-based research. A methodological toolkit. Élise Demange, Émilie Henry, Marie Préau. ANRS, Collection Sciences sociales et sida, 2012, 211 p. From collaborative research to community-based research A methodological toolkit Elise Demange Emilie Henry Marie Préau These publications can be accessed on the ANRS website: Accès aux antirétroviraux dans les pays du Sud. Propriété intellectuelle et politiques publiques. Cristina Possas, Bernard Larouzé. ANRS, Collection Sciences sociales et sida, 2013, 272p.

12 12 / Partner countries Canada Norway United Kingdom Belgium France United States Morocco Dominican Republic Suriname Senegal Guinea Côte d Ivoire Mali Burkina Faso Togo Republic of Brazil Partner countries-sites in resource-limited settings Partner countries in resource-limited settings Partner countries in the developed world

13 \13 n Concentration of means at 8 country sites n One third of the budget for limited-resource settings devoted to 19 other countries n Collaboration with 9 countries in the developed world Germany Luxembourg Switzerland Georgia Cameroun Democratic Republic of Congo Gabon the Congo Egypt Central African Republic Uganda Burundi India Cambodia Laos Vietnam Zambia Malawi Madagascar South Africa

14 14 / Burkina Faso SITE The Muraz Center at Bobo-Dioulasso. The site The site was created in Historically, it was structured around the Muraz Center, a multidisciplinary research facility that became a Burkina Faso public institution in 2001 (HIV/AIDS, malaria, tuberculosis). In this setting, the Research Agency ANRS (France Recherche Nord&Sud Sida-HIV Hépatites) provided the Muraz Center with equipment and with reception facilities for the recruitment and followup of cohorts, a molecular virology laboratory (biosafety level 2), and an immunology laboratory. A computing, methodological and statistical (IT center) resources center was built there by the ANRS and inaugurated in A second research center was developed at Ouagadougou in the Health Sciences Faculty, at the International Health Research Center of the University of Ouagadougou. Areas of research Above, the Charles-de- Gaulle Hospital in Ouagadougou. Below, the Internal Medicine Department of the Yalgado Ouédraogo Hospital in Ouagadougou. The main area of research at the site is the prevention and treatment of HIV infection in women and children. Since its creation, the site has developed clinical research programs comprising clinical trials on prevention of mother-to-child HIV transmission (particularly through breastfeeding) and antiretroviral treatment of children. Social sciences and public health research relates to anthropological analysis of clinical trials, how children experience the disease and how it is treated, and to the study of the social and economic conditions of access to healthcare for women living with AIDS. Lastly, laboratory research is being conducted on the immunological and virological determinants of HIV transmission (sexual and mother-to-child), resistance to antiretrovirals, and the impact of HIV/tuberculosis coinfection on the dynamics of the HIV epidemic. Between 1998 and 2010, studies of a cohort of vulnerable women (Cohort Yerelon-ANRS 1222) yielded various publications and enabled investigation of the immunological and virological mechanisms of viral interactions, notably between HIV and the herpes virus. Also, a program on viral hepatitis is under way consisting of the followup of a cohort of children infected by hepatitis B virus, using a realtime in-house PCR method to detect and quantify hepatitis B viral DNA in serum.

15 \15 PARTNERS IN BURKINA FASO n Centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou n Centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou n Comité ministériel de lutte contre le sida du secteur santé (CMLS/Santé) n Conseil national de lutte contre le sida (CNLS-IST) n Direction régionale de la Santé du Centre à Ouagadougou n Direction de la Santé de la famille (DSF) du ministère de la Santé n Groupe de recherche action en santé (GRAS) n Université de Ouagadougou n Université de Ouagadougou, unité de formation et de recherche en sciences de la santé (UFR-SDS) PARTNERS IN FRANCE AND IN EUROPE n Centre hospitalier universitaire Arnaud de Villeneuve, Montpellier n Centre hospitalier universitaire du Luxembourg, CRP-Santé, Luxembourg n Faculté de médecine Paris-Descartes n GIP Esther (Ensemble pour une solidarité thérapeutique hospitalière en réseau) n Hôpital Cochin, Paris n Hôpital Necker, Paris n Hôpital universitaire des enfants de la reine Fabiola, Belgique n Institut de médecine tropicale d Anvers, Belgique n Institut national de la santé et de la recherche médicale (Inserm) n Institut Pasteur n Institut de recherche pour le développement (Ird) n Université Montpellier 1 Developed world coordinator Pr PHILIPPE VAN DE PERRE Inserm U1058 «Infection par le VIH et par agents à tropisme cutanéo-muqueux : de la pathogénèse à la prévention» Département de bactériologie-virologie CHU Arnaud de Villeneuve 371, avenue du doyen Gaston-Giraud Montpellier cedex 5 France Resource-limited setting coordinator Pr NICOLAS MEDA Centre Muraz/Ministère de la Santé 2054, avenue Mamadou Konate 01 BP 390 Bobo-Dioulasso 01 Burkina Faso UFR Sciences de la Santé CRIS/Site ANRS Burkina Université de Ouagadougou 09 BP 168 Ouagadougou 09 Burkina Faso

16 16 / Cameroon SITE Opposite, the ANRS site, Yaounde Central Hospital. Below, a view of Yaounde. The site Historically, the site was set up through a strong partnership developed by the «Centre IRD de Montpellier». Collaborations between Cameroonian and French teams started in 1999 through the creation of a research site set up and equipped by the Research Agency ANRS (France Recherche Nord&Sud Sida-HIV Hépatites) on the grounds of the Yaounde Central Hospital. This collaboration was formalized in 2005 by a tripartite agreement between the Cameroonian Health and Research Ministries and the ANRS. The Centre Pasteur of Cameroon is an essential partner in research conducted at the site. Areas of research Research currently under way at the site relating to HIV infection: virology (origin and transmission of the virus from monkeys to humans, resistance and genetic diversity of different types of HIV), clinical research trials to evaluate new treatment strategies in adults, the clinical and psychosocial impact of early multidrug therapy in children, and opportunistic infections (cryptococcosis). Research on viral hepatitis is also carried out onsite: studies on the prevalence and treatment evaluations for hepatitic C. A large public health and social sciences research program, set up at the request of the Ministry of Health, is analyzing the political, economic, and social aspects of upscaling and decentralization of access to antiretroviral therapy in Cameroon, and the history of public policies for epidemic control.

17 \17 PARTNERS IN CAMEROON n Centre hospitalier de Yaoundé n Centre hospitalier de Douala n Centre Pasteur du Cameroun n Clinique de la Cathédrale (TAC) n École nationale supérieure polytechnique n Fondation Paul Ango Ela de géopolitique en Afrique centrale n Hôpital central de Yaoundé n Laboratoire mixte de l Institut de recherches médicales et d études des plantes médicinales (IMPM) Centre de recherche sur les maladies émergentes et réémergentes (Cremer) Institut de recherche pour le développement (IRD) n SCAC/Ambassade de France n Université catholique d Afrique centrale n Universités de Yaoundé I et II PARTNERS IN FRANCE n Centre hospitalier universitaire de Montpellier n Centre hospitalier universitaire de Rouen n Centre national de la recherche scientifique (CNRS) n Faculté de médecine Paris-Descartes n GIP Esther (Ensemble pour une solidarité thérapeutique hospitalière en réseau) n Institut de médecine et d épidémiologie appliquée (IMEA) n Institut national de la santé et de la recherche médicale (Inserm) n Institut Pasteur n Institut de recherche pour le développement (IRD) Developed world coordinator Pr ÉRIC DELAPORTE UMI 233 «TransVIHMI» Centre IRD de Montpellier 911, avenue Agropolis BP Montpellier cedex 5 France Resource-limited settings coordinator Pr SINATA KOULLA-SHIRO Service des maladies infectieuses Hôpital central de Yaoundé et faculté de médecine et des sciences biomédicales de l université de Yaoundé I BP Yaoundé Cameroun

18 18 / Côte d Ivoire SITE Above, the Public Health Unit, Treichville Hospital, Abidjan. Below, the Treatment and Training Center (CePReF) in Yopougon, Abidjan. The site Site PAC-CI ANRS, Treichville Hospital, Abidjan. The PAC-CI/ ANRS Côte d Ivoire site program was set up in 1994 and formalized in 1996 by an agreement between the Côte d Ivoire Ministry of Public Health, ANRS, and the French Ministry of Foreign Affairs. This agreement set forth two goals: the training of healthcare personnel in medical research on HIV/AIDS and the implementation of HIV/AIDS research of interest for the general population. The agreement was renewed in 2010 and extended to include three new signatories: in Côte d Ivoire, the Ministry of Higher Education and Research, and in France, Inserm and Bordeaux Segalen University. Within this framework there is a plan to set up an Inserm international associated laboratory. The Research Agency ANRS (France Recherche Nord&Sud Sida-HIV Hépatites) has supported the establishment and equipping of laboratories for molecular virology, parasitology, bacteriology, and immunology, and the creation of reception facilities at several sites in Abidjan. The ANRS has also constructed a building dedicated to the coordination of the site s research programs and activities, within the grounds of the Treichville University Hospital. Areas of research The site's main lines of research are the improvement in care of infected adults and amelioration of treatment of children living with HIV. Research on these subjects relates above all to clinical questions on the management of HIV-positive patients at all stages of the disease: early treatment, treatment of patients who have experienced first and second-line treatment failure, evaluation of new drugs and strategies, treatment of patients infected by HIV-2. A cohort of patients of known date of infection has been in place for a number of years. Lastly, a clinical trial on treatment of hepatitis C virus infection will start soon. In laboratory work, studies on virus quantification and viral resistance to antiretrovirals are prioritized. Research is conducted by multidisciplinary teams including clinicians, laboratory technologists, epidemiologists, statisticians, economists, modelers, sociologists, and anthropologists.

19 \19 PARTNERS IN CÔTE D IVOIRE n Centre hospitalier universitaire de Treichville n Centre hospitalier universitaire de Yopougon n Centre intégré de recherches biocliniques à Abidjan (CIRBA) n Centre national de transfusion sanguine (CNTS) n Centre de prise en charge et de formation (CePReF) n École nationale supérieure de statistique et d économie appliquée (ENSEA) d Abidjan n Unité de soins ambulatoires et de conseil (USAC) n Université d Abidjan-Cocody (Institut d Ethno-sociologie, GIRFOS-CI) n Université de Bouaké, laboratoire de sociologie du développement PARTNERS IN FRANCE, GERMANY, AND THE UNITED STATES n Centre hospitalier universitaire de Bordeaux n GIP Esther (Ensemble pour une solidarité thérapeutique hospitalière en réseau) n Hôpital Necker, service de virologie, Paris n Hôpital Saint-Louis, Paris n Hôpital Saint-Antoine, Paris n Institut national de la santé et de la recherche médicale (Inserm) n Institut de recherche pour le développement (IRD) n Munich University Hospital, Germany n University of Harvard (CEPAC), United States Developed world coordinator Dr XAVIER ANGLARET Inserm U897, Université Bordeaux Segalen Bordeaux cedex France Resource-limited settings coordinator Pr THÉRÈSE N DRI YOMAN Service de gastro-entérologie, CHU de Yopougon 08 BP 412, Abidjan 08 Côte d Ivoire Programme PAC-CI/site ANRS 18 BP 1954, Abidjan 18 Côte d Ivoire

20 20 / Senegal SITE The site The Regional Center for Research and Training in HIV/AIDS Treatment (CRCF), Fann National University Hospital, Dakar. Created in 1990, the site has its foundations on a close partnership with the National AIDS Control Committee (CNLS). Since 2005, the creation of the Regional Center for Research and Training in HIV/AIDS Treatment (CRCF) in the Fann National University Hospital has facilitated the organization of clinical research, strengthened training programs, and improved treatment of people living with HIV/AIDS. The Research Agency ANRS (France Recherche Nord&Sud Sida-HIV Hépatites) provides funds for infrastructure, equipment (real-time PCR, sequencers), and staffing at the National Virology Laboratory at the Le Dantec Hospital, and at the Fann National University Hospital (consultation center, social services, pharmacy, analytical laboratory, clinical trial management center, IT department, etc.). Areas of research The vegetable garden of the Infectious Diseases Department, Fann National University Hospital, Dakar. Onsite research is focused in particular on clinical research: randomized, multicenter clinical trials on antiretroviral treatment in treatment-naive patients and antiretroviral treatment failure patients, trials on new drugs for treatment of hepatitis C in monoinfected and co-infected patients, and a cohort of children and adolescents infected by HIV. In the field of social sciences and public health, ongoing studies are considering the risk and prevention of HIV transmission, notably in the vulnerable populations of male homosexuals and injecting drug users, the assessment of the cost-effectiveness of second-line treatments, the social determinants of treatment failures, the conditions of assisted reproduction in the context of HIV infection, the experience of treatment and its relation to gender, and the consequences of the adverse effects of treatments. Following several studies of the genetic diversity of HIV and its implications, current research in virology is focusing on resistance to antiretrovirals and on the immunological and virological efficacy of different therapeutic strategies. Along with the other ANRS sites, the Senegal site is implementing in the ANRS quality policy by recording quality indicators for clinical trials, strengthening research ethics through community participation, training, and respecting good clinical practice.

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