The Weill Cornell program in Haiti began in 1980 with the establishment of a unit for the study and treatment of infantile diarrhea at the State University Hospital and Medical School by Dr. Jean Pape and Dr. Warren Johnson. This program was very successful, with in-hospital mortality reduced from 40% to 1%. The Weill Cornell team began its AIDS research in 1982 and was instrumental in the formation of Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO).
GHESKIO's three part mission includes clinical service, research, and training in HIV/AIDS and related diseases. Working in partnership with the Haitian Government, GHESKIO provides integrated primary care services, including HIV counseling, AIDS care, prenatal care, and management of tuberculosis and sexually transmitted infections. Through the conduct of research, GHESKIO defines HIV/AIDS treatment and prevention models for Haiti. Through training, GHESKIO expands these models to the national level.
In 1985, GHESKIO opened the first Voluntary Counseling and Testing center in Haiti. As the link between HIV/AIDS, sexually transmitted infections, tuberculosis, and overall reproductive health became clear, GHESKIO developed a model of comprehensive care for HIV/AIDS and related illnesses. Central to the GHESKIO model is the concept that an individual at risk or already infected with HIV should be quickly identified and provided access to a package of services including voluntary counseling and testing, management of sexually transmitted infections, tuberculosis screening and treatment, reproductive health services, HIV care including antiretroviral therapy, and services to prevent mother to child transmission of HIV. Currently, GHESKIO receives about 100,000 patient visits annually. Importantly, the health care provided by GHESKIO is free of charge, including services and medications. This is critical because the population served by the clinic comprises Haiti's extreme poor and includes those at highest risk for communicable diseases. The standard of care offered approximates that offered by the best private practitioners and facilities in Haiti. A complete deScription of GHESKIO's primary care services can be found on GHESKIO's website.
GHESKIO offers training to a broad array of Haitian health care workers and medical personnel, including medical students, housestaff, social workers, laboratory technicians, nurses, dentists, physicians, staff of the Haitian Red Cross, and investigators interested in research careers. GHESKIO trainees also include community and religious leaders, parents, teachers, and journalists. Short-term training (one week to six months) is offered to support clinical services and research activities at partner organizations in Haiti in support of the national efforts to scale up HIV/AIDS care and prevention services. For example, GHESKIO is the national center for training laboratory technicians how to conduct HIV serologic testing, and hundreds of laboratory technicians from across Haiti have trained at GHESKIO. GHESKIO developed national algorithms for the management of sexually transmitted infections and has trained thousands of clinicians in the syndromic management of sexually transmitted infections. In short, GHESKIO trainees can be found in any hospital or health clinic in Haiti where HIV services are provided.
GHESKIO also recruits talented young Haitian investigators for long-term training in Haiti and abroad. Trainees focus on the priority research areas necessary for developing and expanding HIV care and prevention services: HIV vaccines, pediatric and adult antiretroviral therapy, health outcomes of HIV care and prevention, pediatrics and the prevention of mother to child transmission, tuberculosis and other HIV-associated opportunistic infections, ethics, and HIV pathogenesis, immunology, and virology. About 95% of these trainees remain in Haiti, and many stay at GHESKIO to continue their work.
Training for North American and European Students and Physicians
GHESKIO hosts undergraduate, graduate, and medical students and postdoctoral fellows from North America and Europe for research training. Students are assigned a Haitian mentor and perform behavioral, clinical, public health, or laboratory-based research. Past trainees have published research articles in The New England Journal of Medicine, The American Journal of Public Health, and Clinical Infectious Diseases and presented their research at international conferences.
Through clinical and operational research, GHESKIO seeks to define treatment and prevention models for HIV/AIDS and related diseases that are appropriate and effective for Haiti. The main focus of the research is HIV, sexually transmitted infections, and tuberculosis. The GHESKIO research program has evolved from early observational studies to large clinical trials and its designation as an international research center of excellence. In 1983, GHESKIO established its initial funding from the National Institutes of Health to define the epidemiology, natural history, risk factors, and associated co-infections of HIV/AIDS. Since then, GHESKIO's consistent research productivity has been recognized by uninterrupted support from the National Institutes of Health, a MERIT award in 1990, and twenty new or competitive renewal grants. GHESKIO also conducts research with support from the World Health Organization and the French Government's National Agency for AIDS Research.
Research Ethics and the Institutional Review Board
GHESKIO is committed to the ethical conduct of research following the international standards of the Helsinki Declaration. In 1983, GHESKIO established an Institutional Review Board (IRB) responsible for reviewing the ethics of research protocols. The IRB has United States Federal Wide Assurance and is registered with the Office for Human Research Protections. There are nine members of the board, eight of whom are independent from GHESKIO. With support from the Fogarty International Center, IRB members receive training from the Hastings Center for Bioethics.