1. DGIS -ITG IMT A. von HUMBOLDT (IMTAvH) Lima, Peru Institutional strengthening & collaboration

2. Lima & UPCH Lima, massive rural immigration in 1970-1980: 2 10 M Universidad Peruana Cayetano Heredia National General Hospital (4th line) Northern Lima, 3 million inhabitants

3. UNIVERSIDAD PERUANA CAYETANO HEREDIA Facultades Facultad de Medicina Alberto Hurtado Facultad de Ciencias y Filisofía Facultad de Estomatología Facultad de Veterinaria y Zootecnia Facultad de Educación Facultad de Enfermería Facultad de Salud Pública y Administración Carlos Vidal Layseca Facultad de Psicología - Private University, founded 1962 - 8 Facs, 6.500 students - Hospital: 420 beds, training in 28 medical specialities, 900 students - 3 Research Institutes, including IMT AvH

4. IMTAvH (1968) Clinics for Tropical and Infectious Diseases 150 consultations /day, 36 beds, 9 infectiologists, 3 dermatologists 7 labs 9 courses, pre- & post-graduate incl. Gorgas Course

6. IMTAvH- ITG 1987 Spin-off from DGIS/IMTA cooperation with Bolivia joint research project EC-STD (INCO) Leishmaniases 1988 Collaboration for Mycobacterioses Françoise Portaels / Humberto Guerra 1987 Collaboration for Mycoses Danielle Swinne / Betty Bustamante 1989 Memorandum of Understanding (MoU) 1996 Collaboration in Malnutrition (P. Kolsteren) joint EC-INCO project Antwerp -Lima - Cochabamba 1996 MoU expanded + Nutrition, Public Health, STD 1998 Framework Programme DGIS-ITG-IMTAvH "International Strenthening & Collaboration"

7. COLLABORATION 5 topics12 partners4 ITMA departments Leishmaniases *Jorge Arevalo Parasitology cut., muco-cut. Alejandro Llanos- Cuentas, MD *Jean-Claude Dujardin, D Sc Mycobacterioses Humberto Guerra, MD Microbiology TB, MDR-TB, Buruli Françoise Portaels, D Sc Mycoses Betty Bustamante, MD Clinical Sciences & Sporotrichosis Danielle Swinne, D Sc Institute of Public Health Brussels Malnutrition Iris Pecho Public Health Micronutrients, Anna Prada co-infections Patrick Kolsteren Clinical Research Eduardo Gotuzzo Clinical Sciences (since 2000)Tine Verdonck HIV/TB, skin ulcer * Coordination: 2 local coordinators (JA/Lima, JDC/Antwerp) + 1 promotor (DLR/Antwerp)

8. SYNERGY BETWEEN TOPICS Clinical epidemiology of HIV/TB and skin ulcer Molecular tools for diagnosis and epidemiology INSTITUTIONAL STRENGTHENING Human Resources: tech training, M Sc, PhD Centralized equipment for cryobanking & molecular biology Computerized management of reference collections: clinical specimens, pathogens, sera Distance Learning: CD- ROM Trop. Med. cfr Erwin Van den Ende

9. DGIS INPUT, BUDGETARY

10. BREAKDOWN 2000 BUDGET 12 M 4

11. QUALITY CONTROL 2001 Administrative management: 2 nd back-up site visit (LS + JVL) External evaluation: 1 Lat-Am + 1 EU experts 2002 New 5-yr Master Plan to be identified by IMTAvH institutional priorities QC indicators sustainability DGIS PROGRAMME Strengthens institutional sustainability reference and teaching capacity competitivity in research fund raising: EC-INCO, WHO/TDR, NIH…

12. Major achievements (equipment) Improvement of basic laboratory facilities Common facilities for sample storage (-70°C) Bio-Safety Common laboratory facilities for molecular biology

13. Major achievements (training) Clinical research: 2 MDs Leishmania: 2 PhD, 4 MSc, 2 MSc Mycology: 1 MSc Mycobacteriology: 5 Medical students, 1 MSc Nutrition: 2 experts, multidisciplinary team Common activities: management biological samples

14. Major achievements (science) Clinical research: TB: many patients with MDR, frequent co-infection PCP- TB Skin ulcer (differential diagnosis): predictive value of clinical and epidemiological information; mostly due to Leishmania, PCR without biopsy (scrap) Translation of CD-Rom on Tropical Medicine in spanish (+/- 75% achieved)

15. Major achievements (science) Leishmania: PCR identification of Leishmania species directly in biopsies (first in the world): prognosis and epidemiological surveillance Development of methodologies for analysis of differential gene expression (virulence, drug resistance) Opening of a research line on the influence of vit A on disease progress

16. Major achievements (science) Mycobacteriology: Implementation of phage-based methodology for identification of Mycobact. infection and determination of drug-resistance Detection of resistance to second line drugs in the general population of TB patients and in patients with MDR-TB (16% kanamycin, 10% ofloxacin) Detection of autochtonous cases of Buruli ulcer

17. Mycology: possibility to be regional/national reference centre initiation of studies on molecular epidemiology of fungi Nutrition: 71% anemia < 5 years: despite good quality of iron- enriched bread, this is not provided to children; search for alternative strategies. Effect of nutritional supplements on parasitoses Major achievements (science)

18. Output (publications) Leishmania: 1 PhD thesis, 1 MSc thesis, 3 papers Mycology: 3 papers Mycobacteriology: 1 manual, 1 paper, 5 abstracts in proceedings Nutrition: reports, papers in the pipeline Clinical research: 1 paper in preparation

19. Output (projects) Leishmania: 2 TDR, 1 INCO-Dev (Drug resistance), 1 QOL (epidemiological surveillance) Mycology: 2 clinical trials Mycobacteriology: 1 INCO-Dev (concerted action), 1 submission to TDR Nutrition: 1 INCO-Dev, 1 USAID Clinical research: 2 submissions to TDR

20. Synergy Clinical research Tropical and Infectious diseases Leishmaniases Mycoses Mycobacterioses HIV/AIDS Molecular diagnosis and epidemiology Ref. Sample collection Role of nutritional status

21. Prospects Clinical trials Reference centre for molecular diagnosis and epidemiology of pathogens (inter- regional course) Immunology (starting from HTLV/Strongyloides)? …(Cysticercose, neuro-)

22. DGIS Institutional strengthening Stability, continuity, pilot studies for competitivity in research projects (EC-INCO, WHO-TDR, NIH..)