Dartmouth’s Global Health Initiative’s efforts in Tanzania are built upon a solid foundation established through a partnership between Dartmouth medical researchers and the Muhimbili University of Health Sciences in Dar es Salaam. The name derives from a combining of Dartmouth and Dar es Salaam, and is evocative of the Swahili word dada, which means sister.

The DARDAR programs consist of three components:

• AERAS Tuberculosis Vaccine Trial Sites Network: The AERAS Global TB Vaccine Foundation's mission is to develop new tuberculosis vaccines and ensure that they are distributed effectively and efficiently. This mission is accomplished by taking promising research and early development TB vaccine candidates through preclinical regulatory requirements and Phase I, II and III clinical trials. As a member of the AERAS Tuberculosis Vaccine Trial Sites Network, The DarDar Consortium is collaborating with AERAS to provide epidemiologic and other data on HIV-associated tuberculosis from the study cohort in Dar es Salaam, Tanzania to support future clinical trials of other vaccine candidates.

• Hearing impairment in HIV-infected and HIV/TB-coinfected individuals in Tanzania: Hearing loss is a major public health issue throughout the world. Children and adults who develop hearing loss either from HIV exposure or other causes face a lifetime of difficulty. In an effort to address this public health issue, this study brings together three established Dartmouth resources to examine hearing loss among HIV-infected patients in Tanzania: 1) the DarDar Health Study, 2) the DarDar pediatric clinic, and 3) a laptop computer-based, hearing testing system developed by DMS in collaboration with the National Aeronautics and Space Administration for use on the International Space Station. Using this system, the researchers will determine the frequency of abnormal central and peripheral hearing test results in a cross-sectional prevalence study in Tanzania. An additional goal will be to improve the existing hearing testing system to create a portable, easy-to-use, rugged, multipurpose device optimized for resource-poor countries and suitable for both adult and pediatric hearing evaluations. Among other objectives, collectively, these studies will: (1) provide the first comprehensive data on hearing loss among HIV-infected persons living in a resource poor setting, (2) permit the development of guidelines for monitoring high-risk subjects and intervening with appropriate treatment and hearing augmentation, and (3) provide a comprehensive hearing assessment system that could be employed throughout resource-poor and resource-rich countries.

• Nutrition Studies among HIV-infected women in Tanzania: In resource-poor regions of the world where HIV is endemic, especially countries in sub-Saharan Africa, nutrition plays a critical role in HIV disease. Nutrition affects the health of HIV-infected women and children, and may influence the risk of mother-to-infant transmission of HIV through breast milk. Additionally, nutrition influences the risk of tuberculosis (TB) and TB disease severity. Our hypotheses are that administration of a culturally acceptable protein calorie supplementations is a practical, sustainable and effective strategy to: 1) decrease HIV viral load in plasma and breast milk of breast feeding women, enhance passively transferred immune mediators in breast milk, and improve HIV outcomes in women and their breast-fed infants and, 2) decrease HIV viral load, enhance TB-specific T-cell immunity, and improve outcomes in women with HIV and active TB. Our two specific aims are to show that these strategies are effective in randomized clinical trials. Drawing on the 7 year DARDAR collaboration between Dartmouth and Muhimbili University College of Health Sciences in Tanzania we will conduct 3 nutritional studies among HIV-infected women in Dar es Salaam. Findings from these studies are expected to have a major impact on policies for nutritionally vulnerable HIV sub-populations.

• DARDAR Pediatric Program (DDP): Through an award from the Foundation for the Treatment of Children with AIDS, we have established a comprehensive family centered pediatric HIV care and treatment clinic serving patients since May 2006, and now housed in a newly constructed clinic. The program provides HIV testing, counseling and treatment, screening for tuberculosis, and outreach to target orphans and vulnerable populations. More than 600 children have been screened at the clinic with about 300 children who have tested positive for HIV enrolled in care and treatment.

• Dartmouth-Boston University AIDS International Training and Research Program (AITRP) ~ 2003 – 2007: A five year comprehensive degree and non-degree training program for Tanzania scientists and health care professionals aimed at strengthening research capacity in HIV and tuberculosis at MUHAS. Funded by a Fogarty International Center/NIH grant, the program currently has three Tanzanian Professionals enrolled in doctoral programs at Dartmouth and Boston University. Two MPH degrees have been awarded to Tanzanians and one is in progress. In addition, several training programs in Tanzania have been conducted.  A 5-year (2008 – 2013) renewal application was submitted in August 2007 to further expand HIV research training between the three institutions.

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• DARDAR Health Study ~ 2001 – 2009: An NIH/NIAID Phase III randomized, controlled trial of  an investigational vaccine designed to reduce death from HIV associated tuberculosis. A staff of 26 health professionals are conducting the study in a specially-constructed clinic and the study is currently following 2000 patients who  are receiving care for recurrent illnesses. The study was completed in 2009.