China-UNC; PI Myron Cohen, MD

Fellowship Site: China-Nanjing-UNC

The FICRS program is located at the China Center for Disease Control (China CDC) National Center for STD Control (NCSTD) in Nanjing, Jiangsu Province, near Shanghai. NCSTD is the nation's leading center for the prevention and control of STDs. NCSTD acts as a technically operating institution to be responsible for national STD control programs. This organization oversees the prevention and treatment of sexually transmitted infections in China and provides the technical supports and capacity-building for regional and local activities. The center is part of the Chinese Academy of Medical Sciences (CAMS) and a part of the China CDC (Beijing). The center is also affiliated with Peking Union Medical College (PUMC, the medical school of Tsinghua [Qinghua] University), one of China’s premiere medical universities and the university initiated eight-year medical program in China. Equipped with extensive clinical, research and teaching facilities, the NCSTD trains both masters and PhD students focused on STD epidemiology, laboratory diagnostics and clinical research.

NCSTD is an organization with a history as rich and inspiring as modern China itself. NCSTD (formerly called the Central Institute of Dermatology and Venereology) was established as a clinical and public health institute under the Ministry of Health in 1954 and become a branch of the Chinese Academy of Medical Sciences and Peking Union Medical College in 1957. The organization played a central role in the national eradication of syphilis and other STDS in the early 1960s, and of leprosy in the late 20th Century through collective efforts with several generations of national and international experts, including the late Dr. George Hatem, a University of North Carolina graduate and a friend of Mao Zedong.

NCSTD has extensive experience with international collaboration and multi-disciplinary research, and is a World Health Organization Collaborating Center for the Prevention and Control of Sexually Transmitted Infections. NCSTD receives research funding from the US National Institutes of Health (NIH), the World Health Organization, and many other international and national organizations.

The co-sponsor of FICRS in China is the University of North Carolina at Chapel Hill (UNC) Institute for Global Health and Infectious Disease. Dr. Myron Cohen, the Director of the Center, has worked extensively in China. UNC faculty are internationally recognized for their work on STDs and HIV, making the collaboration between NCSTD and UNC a perfect fit. UNC serves as a home for an NIH STI Cooperative Research Center, an NIH STD Clinical Trials Unit, an NIH Center for AIDS Research, and NIH AIDS Clinical Trials Unit, and an NIH Center for HIV-AIDS Vaccine Immunology (CHAVI), an NIH Global Health Frameworks Program and many other domestic and international research activities in infectious diseases.

NCSTD hosts clinical STD and dermatology physicians from across China, and provides rigorous training for more than 50 graduate students annually for medical and research careers. In addition to conducting dermatology and STD research, the Institute runs large inpatient and outpatient clinics and is involved in policy and guidelines development.

Research Opportunities:

NIH-funded clinical research includes the following projects:

• UNC AITRP - The UNC AITRP funds training for researchers in the area of HIV/AIDS prevention to conduct multi-disciplinary behavioral and biomedical research and to strengthen the research capacity of institutions to address the AIDS epidemic. (5 D43 TW01039-08).
• Community Popular Opinion Leaders (C-POL)-based HIV/STD prevention program. (3V10 MHO61513:04S1).
• China Integrated Programs for Research on AIDS (China CIPRA). (U19 AI51915-02).
• Partnership for Social Science Research on HIV/AIDS in China (NIH NICHD R24 HD056670-01)
• Studies on acute and established HIV infections and syphilis infection among patients attending STD clinics in Guangxi China (FHI FCO 84402)
• Studies on introduction of rapid syphilis tests into antenatal care and outreach services of high risk groups in China. (WHO OD/TS-08-00088)
• Molecular epidemiological study of azithromycin-resistance in Treponema pallidum in China. (CID 0806)

The Nanjing NCSTD has its brother center, National Center for Leprosy Control (NCLEP), under the same management structure. NCLEP is responsible for the detection and control of leprosy, which remains active in parts of China, especially rural villages in Guizhou province. Our trainees have the opportunity to travel to these villages to visit with patients and take part in medical and public health activities. Although not related to HIV/STD research, many trainees find this a highlight of their Nanjing experience.

NIH/FICRS trainees have worked on the forefront of NCSTD's efforts on documenting and combating the return and exponential rise of STDs in China amidst the country's growing HIV/AIDS epidemic. Equally compelling are the climbing rates of syphilis and congenital syphilis, which have grave implications for China's One Child Policy. Epidemiological, laboratory, behavioral and policy research and strategies are being undertaken by NCSTD to address the synergism of STDs and HIV in China.

In addition to carrying out individual and teamed research projects, Fellows are strongly encouraged to participate at the Institute's inpatient rounds, outpatient STD and dermatology clinics, and travel with the Institute's plastic surgeons to leprosy communities. These activities supply the Fellow with a well-rounded and in-depth understanding of disease burden and health care in China.

Papers from NCSTD-UNC Trainees:

Tucker JD, Henderson GE, Wang TF, Huang Y, Parish W, Pan S, Chen XS, Cohen MS. "Surplus men, sex work, and the spread of HIV in China." AIDS 19: 539-547, 2005.

Lin CC, Gao X, Chen XS, Chen Q, Cohen MS. "China's Syphilis Epidemic: A Systematic Review of Seroprevalence Studies." Sexually Transmitted Diseases. July 2006. 33 (7).

Wong SP, Yin YP, Gao X, Wei WH, Shi MQ, Huang PY, Wang H, Chen Q, Liu M, Tucker JD, Chen XS, Cohen MS. Risk of syphilis in STI clinic patients: a cross-sectional study of 11,500 cases in Guangxi, China. Sexually Transmitted Infections. 2007; 83(5):351-6

Chen ZQ, Zhang GC, Gong XD, Lin C, GAO X, Liang GJ, Yue XL, Chen XC, Cohen MS. "Syphilis returns to China: Results of the national surveillance program from the Chinese Center for STD Control, Nanjing, China" (Lancet, in press).

Chen XS, Yin YP, Tucker JD, Gao X, Cheng F, Wang TF, Wang HC, Huang PY, Cohen MS. Detection of acute and established HIV infections in sexually transmitted disease clinics in Guangxi, China: implications for screening and prevention of HIV infection. Journal of Infectious Diseases. 2007; 196(11):1654-61.

Yin YP, Chen XS, Wang HC, Shi MQ, Wei WH, Zhu BY, Yu YH, Tucker JD, Cohen MS. Detection of acute HIV infections among sexually transmitted disease clinic patients: practice in Guangxi Autonomous Region in China. Sexually Transmitted Infections. 2008 (in press).

Additional Suggested Reading:

Cohen MS, Henderson GE, Hamilton H, Aiello P, Zheng H, Brandt A. "Eradication of syphilis in China—Lessons for the 20th century?" Journal of Infectious Disease. 174: S223-230, 1996.

Cohen MS, Ping G, Fox K, Henderson G. "Sexually transmitted diseases in the People's Republic of China in Y2K: Back to the future." Sex Transmitted Diseases. 27(3):143-5, 2000.

Ministry of Health, People's Republic of China, Joint United Nations Programme on HIV/AIDS, World Health Organization. 2005 "Update on the HIV/AIDS Epidemic and Response in China." January 2006.

Housing/Meals/Transportation:

Trainees can choose to live in housing provided by the Institute or off-campus (for approximately $250/month). The Institute is located near the base of Purple Mountain, a popular destination for Chinese climbers and hikers. The site provides a bicycle for transportation and is conveniently located on major public transportation lines to Nanjing's city center (a 15-minute bus ride away). A typical housing arrangement at the Hopkins-Nanjing Center in the city center costs approximately $600/month and includes wireless internet access, a small kitchen and digital television. This is within walking distance of the main campus of Nanjing University, and the NCSTD is easily accessible by bicycle, bus, subway or taxi.

Health Issues:

For any health related issues, scholars have access to an international SOS clinic in Nanjing as well as a variety of large, affordable general and specialty Chinese-run hospitals. Additional medical care options are available in Shanghai. Trainees may also obtain an individual med-evac insurance policy that covers helicopter evacuation in the event of medical emergency.

Immunizations (CDC guidelines): Hepatitis A, Hepatitis B, typhoid, Japanese Encephalitis. Trainees are also advised to take malaria prophylaxis (atovaquone/proguanil) while in rural Guangxi province.

See the U.S. Centers for Disease Control Web site and The Yellow Book: Health Information for International Travel.

The NIH/FICRS program mandates that all Scholars see a physician prior to their assignment abroad.

Safety Issues:

Nanjing is a safe city both by national and international standards. The NCSTD site is guarded 24 hours a day. It is also within minutes of two local police stations. The trainees is required to report to local police station for temporal residence. Most housing options are located within 24-hour gated communities. Trainees can move about the city unescorted day or night, and no incidents of crime reported by US or foreign scholars. Trainees may address any concerns at the US consulate in Shanghai (less than two hours by train). Public attitudes towards American citizens are currently positive, and Chinese citizens generally go out of their way to help foreign visitors.

See the U.S. State Department Web site for information.

Language Requirements Other than English:

Chinese (Mandarin). We require trainees to have fundamental language training and expect them to undergo additional language training at Nanjing University.

Advanced language training is a key part of the UNC-Nanjing Fogarty International Clinical Research Scholars (FICRS) Program. To that end, we have developed a collaborative relationship with Nanjing University, where our trainees can take advanced courses in Chinese. Our trainees utilize the resources of the Hopkins-Nanjing Center for Chinese and American Studies (http://www.sais-jhu.edu/Nanjing/), which is jointly administered by Nanjing University and The Johns Hopkins University Paul H. Nitze School of Advanced International Studies (SAIS). SAIS hosts a number of public lectures and training sessions in Nanjing available to FICRS Scholars and Fellows.

What is it like to live in China?

China is one of the world's greatest civilizations, rich with more than 5,000 years of history. As the world's fourth largest country and the home to 53 ethnic minorities, China is abundant with places to explore. Fellows will have the unique opportunity to experience China's many deep cultural traditions, such as the Moon Festival and Lunar New Year, and at the same time, take part in the dramatic social, economic, and political changes of modern China.