Judith N. Wasserheit

Global Health; Adolescent sexual & reproductive health, STD prevention & control, HIV vaccine trials.
Dr. WasserheitÂ's research focuses on clinical and epidemiological aspects of sexually transmitted diseases (STDs), including HIV infection, with particular emphasis on their relationship to the reproductive health of women and adolescents at both the individual and the population levels. An internist, infectious disease expert and epidemiologist, Dr. Wasserheit is the Director of the NIAID-supported HIV Vaccine Trials Network. This network of almost 30 field trial sites on five continents was established as an international platform to conduct phase I-III clinical trials of HIV vaccine candidates.

Research interests include:
Dr. Wasserheit conducted one of the first systematic reviews of the interrelationship between sexually transmitted infections (STIs) and HIV, and developed the concept of `epidemiologic synergy' between these infections that continues to define the field. Her work was also among the first to highlight the importance of epidemic phase in research, prevention and control of STIs, including HIV infection, as well as in the synergy among these infections. Dr. Wasserheit has played a central role in clinical trials of HIV vaccines and her ongoing work in this area includes investigation of the impact of HSV-2 infection on response to the Merck Adenovirus type 5 HIV-1 trivalent vaccine with colleagues in the HIV Vaccine Trials Network. In collaboration with Drs. Abu-Raddad, Barnabas, and other colleagues, she has also examined the impact of adherence on the outcome of HIV clinical trials and is continuing to explore other factors that affect the validity and reliability of randomized controlled trials. Recent ecological analyses conducted with Drs. Barnabas, Abu-Raddad, Longini, Kublin and investigators at 24 sites around the world have demonstrated significantly regional difference in mean HIV viral loads adjusted for CD4 counts, gender and pregnancy, with highest levels observed at African sites.

- Intervention trials to prevent HIV, STDs and pregnancy among adolescents. dolescents, particularly adolescent girls, are among the highest risk populations for HIV infection and other STDs, as well as for unintended pregnancy. Schools offer a unique opportunity to improve adolescent sexual and reproductive health, yet to date, there is little evidence for the efficacy of school-based interventions. Persistent questions include the optimal timing, frequency, duration, and delivery channel for school-based interventions, as well as the need for complementary interventions with parents or other community members. With colleagues at the University of Washington School of Medicine, research efforts focus on the design and evaluation of a multi-level intervention combining a school-based curriculum with enhanced access to clinical services and a program to assist parents or parent surrogates in developing skills to help teens minimized risk of STDs, HIV infection, and pregnancy.

- STD-HIV interactions-Numerous prospective observational studies from multiple countries have demonstrated at least a 2-5 fold increased risk of HIV transmission among individuals infected with other STDs. HIV, in turn, may alter the natural history and response to standard therapy of some STDs, specifically genital ulcers and HPV infections, resulting in a unique type of "epidemiological synergy between HIV and several of these other infections. Three community randomized controlled trials (CRCT) have now been conducted in sub-Saharan Africa by other research groups to examine the impact of various approaches to STD treatment on HIV incidence. Results have ranged from a 40% reduction to no significant change in HIV incidence. These differences appear to be due to differences in levels of risk behaviors, STDs and HIV epidemic phase. Ongoing work examines the epidemiologic, and biologic mechanisms that underpin the synergy between HIV infection and other STDs, the role of trichomoniasis and BV in HIV transmission, and the importance of factors such as HIV epidemic phase, STD symptom status and STD treatment approach in the success of STD interventions for HIV prevention.

- Epidemic phase - Observational data suggests that STD/HIV epidemics move through predictable phases characterized by changing subpopulation distributions and driven by a combination of evolving changes in the pathogens, the hosts, and the prevention and treatment programs that are implemented. Current research focuses on methods to determine epidemic phase and to permit health officials to tailor interventions to the locally relevant epidemic phase.