Bethesda, Maryland

October 10-11, 1996

The AIDS International Training and Research Program (AITRP) of the Fogarty International Center (FIC) was established in 1988 in response to a Congressional mandate reflecting concern for the increasing global impact of the AIDS epidemic. Since its initiation, funding for the AITRP has grown from $4.5 million to $10.3 million in fiscal year 1997. During the first five years of the program, the focus was on training scientists and health professionals from Africa and Latin America; during the second five years, the program was expanded to include Asia, Eastern Europe, and the former USSR, and research collaboration was added to the focus.

In anticipation of the third five-year funding cycle of the AITRP, a panel of 12 experts was convened October 10-11, 1996 to review the AITRP and to make recommendations to the Director, FIC concerning future directions for the program (agenda and list of panel members at appendix A). Under the leadership of Drs. Palmer Beasley and Michael Merson, the Panel considered eight questions, which were provided to initiate discussion rather than limit the Panel's deliberations (list of issues related to review questions at appendix B). After discussion, the Panel added an additional review question and identified a need to develop a mission statement for the AITRP. The initial questions were:

How should the AITRP address competing geographical concerns?

What should be the appropriate balance of training in the AITRP?

What role might the AITRP play in facilitating regional approaches to AIDS research, prevention and control?

What should be the research perspective of the AITRP?

What should be the role of the AITRP in dissemination of information?

Should special review procedures be instituted under the AITRP?

Should access to the AITRP be broadened?

What is the adequacy of collaboration/coordination in the AITRP?

In 1991, prior to the second five-year funding cycle, a review of the AITRP was conducted and included an expert panel (copy of report at appendix C). The Panel of October 1996 revisited the recommendations from the first review as part of its effort and notes that it generally agrees with the content of recommendations 5, 9, 14, 16, 17, 23, and 26 from the first review, as reflected in the recommendations given below.

BACKGROUND

The stated objectives of the AITRP have been:

to increase the capacity of developing countries to deal with the AIDS epidemic through epidemiological research, clinical trials and other prevention programs;

to support collaborative HIV/AIDS-related research between U.S. and foreign scientists in the epidemiology, diagnosis and treatment of AIDS; and

to stimulate cooperation and sharing of research knowledge by scientists combating AIDS worldwide.

To meet these objectives, the AITRP provides research training and supports unique research opportunities to advance knowledge related to HIV infections and AIDS across a wide range of scientific areas. In this regard, it provides scientific and health resources, particularly to developing countries, necessary to stem the tide of the epidemic and ease the global burden of HIV infection. The AITRP also is a key component of the NIH strategy to develop safe and effective vaccines and other interventions against HIV/AIDS. Research currently conducted under the AITRP includes HIV pathogenesis, cell-mediated immune responses, mechanisms for destroying HIV-infected cells, epidemiology of maternal-fetal transmission, and clinical and laboratory features of HIV disease.

The AITRP operates through grants to U.S. universities, which identify collaborating institutions in developing countries and select trainees in collaboration with their foreign colleagues. The AITRP currently consists of 15 grants to 11 U.S. institutions. It has three components: International Training in Epidemiology Related to AIDS; International Postdoctoral Research and Training in AIDS; and the Fogarty International Research Collaboration Award (full descriptions of these programs at appendix D).

The AITRP provides both long-term training in the U.S. and short-term training in the U.S. and in other countries. Most research funded by the AITRP takes place in foreign countries. A new aspect of the AITRP, initiated during the second five-year funding cycle, is advanced in-country research training, frequently known as "re-entry grants," to support research projects of trainees upon return to their countries. Through fiscal year 1995, the AITRP has trained over 1,000 foreign scientists from 77 countries in the U.S. and 28,000 foreign health professionals from 46 countries through 430 in-country courses (list of participating countries at appendix E).

CONCLUSIONS AND RECOMMENDATIONS

The panel congratulates FIC for its success in implementing the AITRP. Without doubt, the program has played an important role in furthering HIV/AIDS research in developing countries. Its flexibility in providing resources for training and related activities has proved invaluable to both NIH institutes and academic institutions participating in the program. This flexibility also has elicited a creative and productive response from all participants.

The panel recognizes that the AITRP was conceived at a time when high priority was placed on informing health professionals about HIV infection and AIDS and on developing an infrastructure for vaccine trials. During the past 10 years, the epidemic has spread to all countries, the number of investigators working in AIDS research has increased greatly worldwide, the need for more multidisciplinary research has become apparent, and other developed nations have expanded their support of training and research programs in developing nations. It is important that the AITRP adapt to these changes in its next phase.

Above all else, the panel emphasizes the importance it attaches to AITRP support of truly collaborative efforts between developed and developing country institutions and scientists.

For the future, the panel recommends that FIC adopt the following mission and goal statement for the AITRP:

Five specific goals are to:

Encourage development of genuine collaboration and equal partnerships between investigators in different countries

Assist developing countries achieve independent capacity to conduct their own research and training

Encourage independent local research on HIV prevention

Assist NIH institutes to conduct their research missions related to HIV

Stimulate multidisciplinary cooperation.

Embedded within this statement of mission and goals are four major emphases identified by the panel for future activities under the AITRP: prevention of HIV infection; multidisciplinary research training; development of independent, sustainable research capacities in developing countries; and continued flexibility to respond to HIV research priorities.

Prevention is paramount. HIV infection has spread to all regions of the world. It continues to exert dramatic effects in Africa, and incidence rates are exploding in Southeast Asia. The natural history of HIV infection and AIDS is becoming better understood, and some preventive efforts have been demonstrated to be effective. Utilizing the vast number of individuals trained through the AITRP and similar programs, it is now possible to make a real impact on preventing HIV infection through continued research and implementation of research results. The focus of research and training under the AITRP should therefore be expanded beyond epidemiology to include all aspects of prevention research (e.g., clinical research, social and behavioral sciences, policy studies).

By including "HIV-related conditions" among activities related to the AITRP, the panel acknowledges that HIV and AIDS do not occur in isolation, but in association with specific HIV-related conditions, such as tuberculosis and other respiratory tract infections, sexually transmitted diseases, and a variety of opportunistic infections. Prevention and treatment of these conditions may benefit prevention and treatment of HIV infection and AIDS. This broader focus is not intended, however, to include the whole panoply of emerging and reemerging infectious diseases.

By expanding the focus of the program to include all aspects of prevention research, training will need to be multidisciplinary. Potential interventions may be biomedical, behavioral or social in nature, or include a combination of approaches. At a minimum, researchers will need an appreciation of all these disciplines, and the most productive research institutions will have expertise across disciplines. In addition, an understanding of the principles of data management and analysis is essential to the conduct of research. By adopting a multidisciplinary approach, the AITRP can foster the talents, skills, and understanding needed for international research on HIV/AIDS prevention.

The mission statement also specifies that training under the AITRP should be oriented to research. This orientation is consonant with NIH's mandate as a research institution. Being a component of the NIH, the FIC has a clear advantage to promote research internationally. Previous AITRP trainees have assumed academic, research, administrative, and policymaking positions in the public and private sectors; by supporting research training, the AITRP can enhance the research competence of individuals and nations. Skills are acquired across the research spectrum and include social-behavioral, as well as laboratory expertise. This enhanced competence benefits all countries participating in the AITRP, including the United States.

Certain aspects of HIV infection cannot be studied as well in the United States as they can abroad (e.g., heterosexual transmission, mother-to-child transmission and blood-borne transmission) and require international collaboration. Such collaboration must be mutually beneficial and will depend on the establishment of equal partnerships between U.S. and foreign investigators as well as long-term commitments between research institutions in developed and developing countries. Investigator collaboration and infrastructure building have been included among the initial objectives for the AITRP, but need to be reemphasized and specified for the future. The main goal for the AITRP is thus the development of independent and sustainable capacities in developing countries to conduct research and training on HIV prevention.

Much of the AITRP's past success has been due to its flexibility; that is, its ability to accommodate varying training needs, resources, and locales. Continued flexibility will be important for meeting the research training needs of ICDs, fostering research cooperation across disciplines, and eliciting creative approaches from AITRP participants. Maintaining this flexibility will help FIC accomplish the mission and goals of the AITRP during the next phase of the program.

In the sections below, the panel makes 11 recommendations in response to the questions addressed during its review of the AITRP.

I. RESEARCH PERSPECTIVE OF THE AITRP

The AITRP is becoming an important component of global research on AIDS and related diseases. By integrating research and research training, the AITRP is adding significant value to the human resource capability for research and disease prevention. The timely application of the AITRP's resources has enabled many ICD grantees to extend their research activities internationally, and FIC's collaboration with several NIH components (e.g., NIAID, NICHD, NCI) has resulted in significant findings.

As FIC prepares for the next 10 years, it is appropriate to reexamine the research perspective for the AITRP in light of the new dictums for research on HIV prevention. Broadening of the research perspective to include all "intervention-oriented research" was recommended in the 1991 review of the AITRP, but has not been sufficiently realized. Although some steps have been taken, the FIC is supporting relatively few intervention components of larger epidemiology-based AITRP programs and few components that reflect true behavioral or social science research.

A refocusing of the AITRP from epidemiology to prevention research involving multiple disciplines, will require a broader research perspective. This research perspective must include three essential components: basic and clinical biomedical sciences; behavioral and social sciences and policy research; and biostatistics and information sciences. The AITRP will need to support research training in all these areas. Such broadening will assist in the development of an international comprehensive prevention science approach that encompasses behavioral and vaccine and other biomedical strategies and, further, will provide the knowledge base for the conduct of interdisciplinary research. This direction is consonant with recommendations contained in the "Report of the NIH AIDS Research Program Evaluation Task Force."

For the prevention of HIV infection and AIDS, understanding of the biobehavioral aspects of disease is critical. The AITRP should therefore be expanded, as noted above, to include conditions that are associated biologically and behaviorally with HIV infection and AIDS. In addition to the ability to conduct interdisciplinary research, it is important that research institutions in developing countries, where resources are limited, to have scientific capabilities across several disciplines. Promising areas of multidisciplinary research and research training include biomedical studies (e.g., host genetics, mother-child transmission), behavioral research (e.g., determinants of risk behaviors, care-seeking behaviors), intervention studies (e.g., behavioral interventions to reduce risk, prevent heterosexual transmission), and evaluation of treatment modalities (clinical trials).

Proper data management and analysis also are important to ensure that research data are accurate, informative, and useful. Investigators and institutions in developing countries will not have achieved complete research independence until they have developed the capacity to collect, and manage and analyze data sets in their own countries. To conduct successful research, expertise must be acquired in developing protocols, developing and applying data collection instruments and data management systems, and monitoring quality control.

In order for this approach to be successful, grantees must be able to provide high quality training and, therefore, to demonstrate a high degree of scientific expertise across disciplines. Accomplishments since the beginning of the epidemic indicate that such levels of scientific expertise exist for all fields to be included in the AITRP. Prospective applicants should be encouraged to form consortia or other forms of collaboration in order to provide the best possible level of scientific merit in the areas included in their applications. These collaborations should reflect the best science available, rather than friendships, parallel departments in an institution, etc.

Recommendation 1:

The focus of research training in the AITRP should be multidisciplinary. It must include training in one or more areas in each of the two broad fields of biomedical and behavioral research, in addition to an essential core component of data management and analysis. Biomedical research areas may include basic science, clinical science, epidemiology, and vaccine research. Behavioral research areas may include the social sciences, economics, policy issues, etc. Data management and analysis includes protocol development, biostatistics, data collection procedures, and quality control.

Recommendation 2:

The research focus of the AITRP should remain HIV/AIDS. It can include specific HIV-related conditions, namely opportunistic infections, STDs, TB, and HIV-associated reproductive health issues.

II. BALANCE OF TRAINING

As FIC reports in its AITRP Progress Report Year 07 (July 1996), the AITRP is the largest global research training program for HIV/AIDS. Evidence indicates that the program has had a significant impact on epidemiology training and postdoctoral research related to HIV/AIDS. Because of the AITRP and other programs, a large cadre of individuals with basic epidemiology skills is now available worldwide. Significant research studies also have been initiated by AITRP trainees.

As already noted, the next phase of the AITRP will emphasize the development of independent researchers and sustainable research enterprises in developing countries and the establishment of multidisciplinary, collaborative research partnerships. To meet these goals, the AITRP must be refocused to emphasize long-term, advanced training conducted in the United States, and reentry support for trainees returning to their home countries. Some short-term training will continue to be needed in certain well-defined areas as, for example, to acquire expertise in specific techniques, such as laboratory skills, survey design, or study-specific biostatistical analyses, but more general short-term training is already supported by other entities. All training efforts should be carefully designed to meet specific research purposes; information sharing and sensitization to the problems of HIV/AIDS are no longer relevant in the current stage of the pandemic. Reflecting this research focus, the nature and quality of training should be emphasized, not the number of individuals trained.

Within these guidelines, the training program will need to remain flexible to accommodate in-country needs. Areas of training should relate to NIH's research interests and reflect current and emerging research priorities.

Reentry grant support, previously recommended in the Report of the NIH AIDS Research Program Evaluation Task Force of the Office of AIDS Research Advisory Council and the panel which met in October 1991 to review the AITRP prior to solicitation for the second round of 5-year funding, is essential to sustainability. As FIC works with OAR to develop implementation plans for the recommendations contained in the OAR report, specific attention should be given to implementing both small and large reentry grants. Because the AITRP's resources are limited and should be targeted to specific research training needs, other funding sources could be enlisted to help support the large reentry grants. The panel encourages FIC to search creatively for reentry funds from other NIH components, non-NIH sources, and host and other governments. In this process, FIC should remain flexible to new collaborative arrangements and could assist in organizing and administering the peer review of applications for reentry awards.

Recommendation 3:

Greater emphasis should be given in the future to U.S.-based, long-term (more than 1 year) training leading to an advanced degree or postdoctoral training. Long-term training should include degrees in any relevant HIV prevention research field.

Short-term training, both in-country or U.S.-based, should continue but should only be used for specific technical training needs, such as specific laboratory procedures. Short-term courses or workshops that are only for the purpose of general orientation to HIV/AIDS and networking should be discouraged as a component of training.

Recommendation 4:

As is the case now, small re-entry grants should be available for returning trainees. These should be small (less than $25,000) and "one-time-only awards" made through the FIC participating centers. For trainees completing long-term degree and postdoctoral training, larger re-entry grants should be available. These grants could be multiyear support up to $100,000, awarded on a competitive basis, not through the FIC participating centers or the current FIC budget, but through an NIH process. This would not preclude trainees from applying for an R-01.

III. REGIONAL APPROACHES AND GEOGRAPHIC CONCERNS

AITRP programs tend to be funded in countries that have existing research infrastructure and/or historically established links to U.S. research institutions. As a consequence, the geographic distribution of programs and relative investment among programs are not balanced. While a goal of global distribution is laudable, it is not possible for the AITRP to establish programs in all countries with significant HIV epidemic burden. Many other national and international agencies are supporting research and research training on HIV/AIDS in developing countries. Because of this support, FIC should not feel compelled to sponsor an AITRP effort in every country of the world. The review panel views parity on a geographical, political, or HIV prevalence basis as arbitrary and a potential impediment to success of the training and research mission of the AITRP. On the other hand, it is important, to strive for sustained efforts within individual countries, where scientific considerations warrant.

Good regional representation for the AITRP and coordination with other related programs within a country are desirable. Limited extension of AITRP efforts from an established country program to neighboring countries also is desirable where there is good scientific rationale and extension is carefully planned. Such an extension should include training within the established or new country but may also include sponsored short- or long-term training in the United States as described above in sections I and II.

The formation of regional networks with formal agendas unique to an area is viewed, however, as an unnecessary addition which detracts from the flexibility and responsiveness of the AITRP's current organization. Similar to the emphasis on long-term instead of short-term training, regional approaches and geographic interests should emphasize depth instead of breadth and quality instead of quantity during the next phase of the AITRP.

Recommendation 5:

The AITRP should not be required to establish programs in all countries with significant HIV incidence or prevalence. Nor should the AITRP be required to index investments against global or regional HIV prevalence. Rather, sustained success of the research and training mission within a country should be the priority. Any expansion to additional countries should be predicated on the likelihood of sustained success and should be done on a competitive basis.

Recommendation 6:

Any extension of AITRP efforts from an established country program to neighboring countries should be carefully planned. The establishment of formal regional networks is discouraged.

IV. COLLABORATION AND COORDINATION

FIC has encouraged collaboration and coordination of AITRP activities with similar programs supported by other organizations. These efforts need to be strengthened and expanded to include organizations supporting research in the behavioral and social sciences and in biostatistics and data management. Opportunities exist for cooperating in HIV/AIDS research with other U.S. Government agencies, private foundations, and bilateral, international, and multilateral organizations. FIC should explore collaboration with UNAIDS. Bilateral cooperation with other countries active in HIV/AIDS research and training, such as Japan and the countries of the European Union, also could be fruitful. Collaboration and coordination among AITRP projects and with other organizations and countries would enable FIC to leverage its funds, minimize redundant support in-country, and target the AITRP to specific needs.

Recommendation 7:

Coordination and collaboration with other government agencies (e.g., CDC, USAID) and with bilateral, international, and multilateral organizations is strongly encouraged. And, much stronger collaborations should be forged between FIC and NIDA and NIMH in parallel with the recommended shift in focus on behavioral research. Collaboration and coordination also should be sought with the Rockefeller INCLEN program.

Better coordination and collaboration should occur between the participating AITRP programs and institutions, especially when operating within the same country (e.g., Brazil). The organization and coordination of activities among sites should be a responsibility of FIC. Joint coordination meetings should be held during international meetings.

V. ACCESS TO THE AITRP

To launch the next phase of the AITRP, FIC will be announcing the recompetition for AITRP awards during FY 1997. This recompetition will result in a third cycle of 5-year AITRP awards. To accomplish the changes envisaged in the program, it is desirable that the FIC make the program widely available to U.S. investigators with research and research training expertise in HIV and HIV-related conditions. The AITRP has not been well advertised or accessible to the broad range of investigators receiving support from the NIH for research on HIV/AIDS. Yet, indicative of the AITRP's success is the increasing number of institutions and investigators interested in applying to the program.

Increased access to the AITRP for U.S. AIDS investigators not currently involved with the FIC is desirable. FIC's AIDS-FIRCA program is one successful example of such increased access. Nonetheless, the panel encourages additional measures to provide funding opportunities for training to a wider range of HIV/AIDS investigators based on a competitive process.

Three specific problems are: the restriction of AITRP administrative supplements to already-funded AITRP investigators; the award of all AITRP grants for the same 5-year period, which closes the program to other investigators and potentially novel approaches for 5 years; and FIC's award of administrative supplements to AITRP investigators, without competitive review, to establish additional U.S. training sites. Increased competition and flexibility in the program could be achieved by making the program more visible (e.g., announcing it through the Internet), creating a supplemental AITRP award available to all NIH grantees to support HIV/AIDS research and research training, and inviting applications at different times during the 5-year period. The competitive process should be monitored closely to ensure open competition for all.

Recommendation 8:

The AITRP should be made more visible to the broad scope of U.S. investigators who have peer-reviewed NIH AIDS funding, and a mechanism should be created so that these investigators can compete for supplemental AITRP training funds for appropriate candidates and projects. In addition, FIC should consider staggering the funding cycle for program grants in order to achieve greater flexibility. For in-country institutions not currently linked to the AITRP, access should be limited as recommended in the goals for AITRP regionalization (see recommendation #5 above).

VI. SPECIAL REVIEW PROCEDURES

To maintain the flexibility that is characteristic of the AITRP and so critical to its success, the institutions receiving AITRP awards should have sole responsibility for selecting trainees and research projects on which trainees work. Grantee institutions should have established internal review committees and procedures to accomplish these functions. Although FIC and other NIH and Council reviews are necessary for the award of additional funds for supplementary projects, FIC review of projects to be conducted under the initial AITRP grant is strongly discouraged.

FIC and NIH's role in selecting trainees and grantees should be limited to reviewing an institution's criteria and review procedures as stated in the institution's application for award. This practice is already used at the NIH for reviewing some investigator-initiated research project grants and program project grants. While such procedures currently are generally and informally in place for most AITRP grantee institutions, FIC should formalize them by making them part of the application and the initial and second-level review process. FIC's criteria for scoring an institution's review procedures should be stated clearly in the Request for Applications (RFA).

Recommendation 9:

The AITRP grant applications should specify (a) criteria for the selection of trainees by a committee composed of investigators participating at the parent institution(s) in the program and (b) a mechanism for internal peer review of applications to support relevant research projects with budgets not exceeding $25,000.

The criteria and mechanisms for selection of trainees and research projects should be reviewed at the NIH at the time the grant proposals are reviewed competitively. After funding, these criteria and mechanisms should be instituted as described and no further outside review carried out at the FIC or elsewhere at the NIH during the funding period of the grant.

VII. DISSEMINATION OF INFORMATION

The AITRP is generating significant research and training results which are not always widely disseminated by participating institutions, trainees, or the FIC. These results should be accessible to the public and research community and, when appropriate, applied to prevention of HIV/AIDS in developing countries. Distribution of this valuable information to all HIV/AIDS researchers and trainees, clinicians, and public health professionals implementing prevention programs, as well as the public, is an important responsibility of the participating institutions and FIC. This activity, however, could significantly increase the workload and cost of any one organization and thus should be shared.

Various mechanisms could be used to foster dissemination of information and transfer of research results into practice. Newsletters could be exchanged among all AITRP trainees and grantees so that all regions can benefit from knowledge gained through FIC-sponsored programs. Annual meetings could be held for grantees and trainees within a country for presenting research findings and sharing information. Such meetings would serve a dual purpose in countries with multiple FIC programs by facilitating collaboration among trainees, as well as exchange of information among both grantees and trainees. An FIC World Wide Web site could be used for notification of research projects; through this site, titles of all new papers and abstracts of FIC-sponsored research could be disseminated rapidly and investigators could communicate informally.

A very important problem and major difficulty for foreign investigators is the lack of, or poor, access to the worldwide research literature on HIV/AIDS and related conditions. To foster independent and sustainable research in developing countries, and to enhance collaborations and partnerships between U.S. and foreign investigators, access to this literature must be improved.

Recommendation 10:

FIC should endeavor to ensure that research results are accessible and to facilitate translation of results into practice by (a) exchanging newsletters among grantees, (b) sponsoring in-country meetings for all trainees in a country, and (c) establishing a World Wide Web site for dissemination of new information and for less formal exchange of information among sites. In addition, FIC should require grantees to (a) provide for in-country dissemination of research results and (b) develop mechanisms to facilitate access of their foreign collaborators to current published literature. The AITRP grant applications should include specific plans for in-country dissemination of research results for local prevention of HIV infection, and these efforts should be part of regular progress reports.

VIII. TRACKING TRAINEES

The FIC has documented the accomplishments of the AITRP for the past 8 years. The data that have been collected and reported consist largely of the number of training courses and trainees and countries involved; the number of grantees and trainees from different countries and regions; the number and titles of grantees and trainees' research publications; the percentage of NIH publications on HIV/AIDS authored or coauthored by AITRP grantees and trainees; the percentage of presentations by grantees and trainee at international conferences on AIDS; and growth in funding. These outcome measures, although informative, do not adequately convey specific benefits of AITRP training. Also, the reporting of trainees' publications does not reflect the research support of other funding sources or the trainees' true contribution to the research effort. More meaningful criteria for assessing the AITRP's outcomes and contributions need to be identified. The AITRP is now entering its ninth year, and documentation of meaningful results should be possible.

The importance of conducting a thorough assessment of the AITRP's contribution cannot be overemphasized and, for this reason, the panel added this topic to its list of review questions. As the AITRP enters the third 5-year cycle, the number of trainees and grantees and similar quantity measures are no longer relevant and should be replaced by measures of the quality of the program. The new measures should document results that are specific to the AITRP and that relate directly to the program's mission and five goals (see recommendation #1).

With the new emphasis on fostering independent and sustainable research capacities, measures will be needed to track the development of grantees and trainees over longer periods (e.g., 10 years). With the shift to advanced, long-term training, measures will be needed to track the outcomes of this training for every grantee over this period. Also, with the new emphasis on relating AITRP training to specific research needs, the outcomes of training should be measured in terms of the impact on research. Long-term data will enable the FIC, for example, to assess AITRP grantees' participation in building their countries' research infrastructure. All these data will be important for evaluating the AITRP's success at the end of the next 5-year cycle. Each institution participating in the AITRP should be required to provide the data and to indicate its process for obtaining the data in its grant application. FIC should specify the need to develop tracking data and indicate the data desired on the AITRP application form. It should be noted that the indicators of success may not be the same for developing countries and the United States.

The FIC's Progress ReportYear 07 for the AITRP is a compendium of much detailed information. This wealth of data, however, is not easily accessible. Concise summary data are needed to convey the AITRP's accomplishments and impact to multiple audiences. These data should include the number of trainees still in training by year of entry into the program, the number of trainees who return to their home countries, the number and position of former trainees working on AIDS-related activities in their home countries and in other countries, and the number and position of trainees who have dropped out of AIDS-related activities.

Recommendation 11:

FIC should develop a tracking system for followup of the AITRP's long-term trainees. For long-term trainees, data should be collected annually for 10 years and include date and year from entry into training, employment position, principal investigator grant support, and first-author publications. The data also would include trainees lost to followup.

For the AITRP's short-term training courses, data should be collected on the number and nature of courses offered. For those who receive individualized short-term training, the data collected should link the type of training offered with specific research outcomes.

To facilitate review of the entire program, the FIC should develop summary tables of the tracking data identified above for both short- and long-term trainees.