Tackling the Toughest Public Health Problems
DSMHI faculty and trainees (from medical students to residents to junior and senior faculty) are engaged in research involving disadvantaged communities in Boston, Peru, Haiti, and Russia. Their goal is to address ranking health problems disproportionately afflicting those marginalized by poverty, racism, and gender inequality. In some sites, especially in rural Haiti, health care infrastructures are weak or absent -- DSMHI members have worked with local partners (primarily Partners In Health (PIH) ) to make modern medical care available to those who would otherwise not receive it.

Research Expands Knowledge
"Operational research" underway in these regions will yield lessons on how best to serve populations saddled with excess morbidity and mortality due to AIDS, tuberculosis, malaria, typhoid, sexually transmitted diseases, and complications of pregnancy and childbirth. In rural central Haiti, for example, DSMHI and PIH staff have launched innovative biosocial research efforts designed to understand and control each of these health problems.

AIDS Treatment, A World Model
Among the most significant of these efforts has been DSMHI-supported research on AIDS prevention and care. Central Haiti is the site of the world's first community-based AIDS care program, piloted by PIH-Haiti. The "HIV Equity Initiative" is considered a model pilot project with imoprtant applications to other resource-poor settings in sub-Saharan Africa and beyond. In addition to offering integrated AIDS prevention and care for a population living in dire poverty, the "HIV Equity Project" has initiated a dozen operational research projects designed to improve program performance and develop models of care useful in other resource-poor settings. To combat TB in Peru and Russia, as noted, DSMHI staff are currently involved in scaling-up "DOTS-Plus" treatment projects nationwide or oblastwide; extensive training programs are to be launched in each of these sites.

Fighting New Diseases
These research and training efforts provide valuable insight into increasing the scope of complex health interventions, as well as for improving patient outcomes. For AIDS and TB, these issues include: 

• enhancing adherence through community-based care;
• side-effect management;
• optimal clinical regimens;
• improved diagnostics;
• and the use of electronic medical records.

In each of its projects, the DSMHI hopes to develop, implement, and assess the efficacy of "CHIPS"-- complex health interventions in poor settings. The Division is convinced that such models are relevant not only to AIDS and drug-resistant tuberculosis and malaria, but also to other chronic diseases for which effective therapies already exist. As we move forward, we hope to leverage our successful experience combating these diseases to fight other widespread health problems in poor regions, including:

• maternal mortality,
• diabetes,
• coronary artery disease,
• hypertension,
• renal insufficiency, and
• mental illnesses.

Through its work, the Division also tackles the broader issues surrounding health inequality, including research ethics, and the cost effectiveness and sustainability of treatment models.

In the coming years, the DSMHI will seek not only to reinforce research and training efforts in the heavily burdened regions in which we now work, but also to develop innovative programs in "social cardiology," pediatrics, oncology, surgery, and radiology.