A Center for the Epidemic
Sitting in his office along Pennsylvania Avenue, Alan E. Greenberg, M.D. ’82, M.P.H., radiates an air of excitement. Greenberg, professor and chair of the Department of Epidemiology and Biostatistics at the Milken Institute School of Public Health (formerly the GW School of Public Health and Health Services), recently learned that the National Institutes of Health (NIH) has selected the group he leads — a partnership of Washington, D.C., institutions — to establish the District of Columbia Developmental Center for AIDS Research (D.C. D-CFAR). This designation marks the University’s first-ever NIH Center grant and instantly vaults his consortium into a network of the 21 most elite HIV/AIDS research organizations in the United States.
News of the grant could not have come sooner. By all accounts, the nation’s capital is in the grip of an epidemic. Washington, D.C. has an HIV/AIDS prevalence of more than three percent among adults, the highest infection rate in the country and more than three times the Centers for Disease Control and Prevention’s threshold for a severe epidemic. African-American residents account for 57 percent of D.C.’s population, but they total 81 percent of all new HIV cases and approximately 86 percent of people living with AIDS. The challenges confronting African-American women in the District are still more daunting: They represent 90 percent of all new female HIV cases and 93 percent of women living with the disease.
NIH founded the Center for Aids Research (CFAR) program in 1988 with the goal of providing administrative and shared research support to academic institutions that conduct the best investigations involving HIV/AIDS. NIH currently supports 17 full CFARs and four developmental centers. The program emphasizes interdisciplinary collaboration, especially between basic, clinical, and behavioral investigators, to achieve translational research in which findings from the laboratory are brought to the clinic and community and vice versa. It also stresses creating opportunities for early stage and minority investigators and research on prevention and behavioral change.
The five-year D-CFAR designation, with funding totaling $3.75 million, brings together the MISPH, School of Medicine and Health Sciences (SMHS), and Columbian College of Arts and Sciences, Children’s National Medical Center, Georgetown University, Howard University, and the Veterans Affairs Medical Center (VA). “What the D.C. D-CFAR can do in Washington, D.C., is create a community of scientists who can conduct the highest level of research on this disease,” explains Greenberg.
Many would say that Greenberg had excellent preparation to make the D.C. D-CFAR a success. He earned his medical degree from GW’s School of Medicine and Health Sciences in 1982 and his M.P.H. from the Harvard School of Public Health in 1999, and then served for two decades as a U.S. Public Health Service Commissioned Corps Officer at the Centers for Disease Control and Prevention (CDC). He ultimately rose to head the center’s HIV Epidemiology Branch, where he supervised research studies in 28 states and nine countries in Africa and Asia. Greenberg also has co-authored more than 100 articles and book chapters on the epidemiology and prevention of HIV/AIDS and related diseases in the U.S. and Africa. Among his numerous other appointments, he is a principal investigator of the Public Health-Academic Partnership with the D.C. Department of Health; clinical research site leader for the D.C. site of the NIH-funded HIV Prevention Trials Network; chair of the Global Work Group on the Advisory Committee to the director at the CDC; and a voluntary HIV/AIDS physician at the D.C. Veterans Affairs Medical Center.
With GW serving as the administrative home of the D.C. D-CFAR and Greenberg as the principal investigator, this partnership will provide the infrastructure to facilitate collaboration, data sharing, and enhanced research opportunities among the entities. The center will be led by an executive committee and five coordinating bodies, or “cores” — administrative; developmental; clinical; basic science; and behavioral science, prevention, and biostatistics.
“Our main deficiency in HIV/AIDS research in Washington is in basic science. That’s the area we’re focusing on,” explains Michael Bukrinsky, M.D., Ph.D., professor and vice chair for research at SMHS’ Department of Microbiology, Immunology, and Tropical Medicine, director of the developmental core, and interim director of the basic science core. The region has a talented pool of clinical and public health researchers, Bukrinsky explains, but “there are very few HIV/AIDS researchers doing basic science work. This is an area we need to develop in order to support the other research studies. The only way to accomplish that is to attract new people, especially young investigators.”
Earning such a prestigious research classification was no small task for Greenberg and his colleagues. Successful applicants need to have a significant level
of funded research already in place, as well as a demonstrated commitment to HIV/AIDS care. To meet that standard, Greenberg and D.C. D-CFAR co-director Gary Simon, M.D., Ph.D., who is also the director of the Division of Infectious Diseases and vice chair of the Department of Medicine at SMHS, decided to pool resources from across Washington. “Our vision was that by getting people together from institutions throughout the city, we could assemble a successful D-CFAR,” explains Greenberg. At the time the application process began, GW might not have met those criteria on its own. By creating a proposal that included all the major HIV/AIDS research institutions in the city, however, the application exceeded all benchmarks.
“The HIV/AIDS community in the nation’s capital is allied and deeply committed,” says Greenberg. “The idea is to transfer this positive energy into increasing the quantity and quality of research.”
Each of the institutions in the D.C. D-CFAR has a robust HIV/AIDS care and treatment program and boasts active, federally funded researchers. Together, they bring strengths to the center that are simultaneously diverse and complementary. The VA and Children’s National have distinct patient populations. Children’s National is actively involved in adolescent and pediatric HIV trials networks. Fred Gordin, M.D., chief of Infectious Diseases at the VA and professor of Medicine at GW, leads HIV/tuberculosis studies and the local component of the Community Programs for Clinical Research on AIDS, a community-based clinical trials network. Georgetown University is home to the Women’s Interagency HIV Study, and Howard University is a critical partner for its own HIV/AIDS research initiatives and for the recruitment and training of minority scientists. GW, in addition to having strong epidemiology, surveillance, behavioral, and biostatistics resources, is home to Simon and his team’s clinical, patient-based work that uses antiretrovirals and antiretroviral regimens.
Greenberg notes that the developmental designation is a one-time, nonrenewable probationary step. After that five-year period is over, centers may apply for full CFAR status. The new D.C. D-CFAR, he says, will be judged on the collective success of the participating institutions in conducting outstanding HIV/AIDS research that will influence the field and, they hope, lead to better prevention and treatment in the future. “If the research and financial contributions are strong, and we do the things necessary to demonstrate that we took this opportunity and made the most of it, I’m confident that we can make the transition to a full CFAR,” says Greenberg. “This is something we can all be proud of because it gives us the chance to have a major impact on an epidemic that is harming so many people in our nation’s capital.”