The Network for AIDS Research in Los Angeles (NARLA)

Ronald Mitsuyasu, UC–Los Angeles

NARLA’s mission is to support the development and evaluation of innovative strategies for the treatment and prevention of HIV in HIV-infected and at-risk individuals in greater Los Angeles. We propose:

  1. To develop and evaluate new and potentially more effective HIV treatment (e.g. hematopoietic stem cell-gene therapy) and prevention (e.g. rectal microbicides) strategies in HIV-infected and at-risk populations.
  2. To establish the Network for AIDS Research in Los Angeles (NARLA), a new collaborative group involving UCLA HIV/AIDS researchers, community HIV treatment and service providers and community research organizations.
  3. To conduct research that will include and encourage individuals from diverse communities infected or affected by HIV to participate in research of novel strategies to treat and prevent HIV infection.
  4. To train and encourage new investigators in cross-disciplinary HIV/AIDS research as it relates to improving treatment, care management and prevention in various populations in California.
  5. To conduct pilot studies via seed grant awards to investigators at all NARLA sites to perform exploratory basic, translational, clinical, epidemiological, behavioral and policy studies in areas related to the theme of the Center.

We will accomplish this through development of a strategic interactive partnership between UCLA investigators and community-based treatment and service organizations and through frequent communications, core administration and outreach services and clinical trials infrastructure at each organization. In addition, the Center will maintain a biostatistics core to serve the needs of the two proposed research projects and of the Network investigators. Fellowship awards and seed grants will foster development of new investigators and support exploratory and early developmental work on new projects that fi t the overall theme of the Center.

NARLA joins investigators at the UCLA AIDS Institute with investigators and clinicians working at 4 organizations in Los Angeles that provide services and conduct research among diverse populations of HIV infected and at-risk individuals. All 4 organizations have long and distinguished reputations for their service and/or research in the HIV/AIDS community of Los Angeles and all have close working relationships and research collaborations with UCLA AIDS investigators. These organizations include:

  • The UCLA CARE Center, an academic clinical research center and HIV clinic which provides both primary and consultative HIV care and which serves as the primary clinical research site of the UCLA AIDS Institute;
  • AIDS Project Los Angeles (APLA), a community-based, non-profi t organization dedicated to community-based research and to providing education, social support, patient advocacy and educational services to the HIV-infected and –affected communities;
  • T.H.E. (To Help Everyone) Clinic, Inc., a communitybased clinic in central LA which provides low cost health care to predominantly poorer, minority men, women and families and which has an active HIV clinic that provides medical care, social support and case management services; and
  • Friends Research Institute, Inc., a non-profi t research organization which conducts research in multiple health areas and which, in Los Angeles, has focused on marginalized and extremely high-risk populations for HIV, e.g. gay and bisexual substance users and male-to-female transgenders.

This network will enlarge the HIV research capacity in Los Angeles and California, ensure that minorities are included in clinical trials, and ensure that the research agenda addresses the needs of disenfranchised community populations. We will build infrastructure at the three non-UCLA sites to allow them to participate actively and collaboratively in the AIDS research efforts. An ongoing two-way interaction between investigators at allpartnering sites will occur through monthly phoneconferencing and quarterly face-to-face meetings to discuss research progress and to plan new initiatives. Seed grants and fellowship training awards will be available to investigators and trainees at all sites to implement new research and further the research capacity at each organization. The research projects proposed in this application will enable the partnering institutions to develop regular procedures for collaborating with UCLA HIV investigators and for participating in multi-center clinical trials. This collaboration will also increase UCLA researchers’ ability to include more subjects from diverse populations in their research and broaden the applicability of their findings to a wider group of individuals. We anticipate, as a result of this collaboration, that additional NARLA-based clinical trials of new treatment and prevention interventions for HIV will be possible.

The projects included in this proposal address two emerging and complementary areas of therapeutic and prevention interventions. Project 1 of this proposal focuses on hematopoietic stem cell-gene therapy, a new and exciting area of investigation that holds the potential for reducing or eliminating the need for continuous anti-HIV medication. UCLA is a leader in such cutting edge basic and translational research involving adult stem cells. Because we anticipate even greater interest in the uses of adult and embryonic stem cells and in gene therapy over the next few years, we need to match our basic and clinical research with advances in community understanding of these new technologies and to find ways to encourage participation in clinical trials.

Microbicides are on a fast tract as a new HIV prevention intervention. UCLA is a leader in conducting basic, translational and clinical research on anal-rectal mucosal transmission of HIV, which accounts for over half of all HIV infections in the United States. Project 2 of this proposal will address community knowledge and factors influencing acceptability of rectal microbicides in diverse populations of at-risk individuals, as measured by their willingness to sign up for a registry to participate in future clinical trials of new microbicides. This study will also develop and evaluate the optimal educational interventions to increase willingness of subjects to participate in clinical trials and to accept microbicides as a prevention tool for HIV. We believe both of these projects are timely and involve novel and unique interventions that will require systematic, culturally sensitive and non-judgmental approaches to their evaluation if they are ultimately to become accepted in the community.