Director, HSPH Program in the Epidemiology of Infectious Diseases
For more than 25 years, Dr. Seage has conducted studies of the behavioural and biological aspects of adult and pediatric HIV transmission, natural history and treatment.
(1) Pediatric HIV Infection
Dr. Seage has been involved in studies of pediatric HIV infection, evaluating the effect of antiretroviral therapy (ART) on a variety of outcomes among children perinatally infected with HIV as well as HIV uninfected children exposed to HIV and ART in utero. In 2005 Dr. Seage was awarded $50 million for 5-yrs to establish Pediatric and HIV/AIDS Cohort Study (PHACS) Data and Operations Center. In 2010 Dr Seage successfully recompeted PHACS and HSPH was awarded an additional $85 million for another 5-year grant cycle.
As the Principal Investigator of PHACS, Dr. Seage has played a key role in establishing the overall scientific goals, the design, and conduct of the studies. Dr. Seage provides leadership for the development and ongoing implementation of all PHACS protocols and oversees all study activities at 24 clinical sites throughout continental US and Puerto Rico.
Additionally, in 2000 Dr. Seage developed and led an epidemiology methods group within the Pediatric AIDS Clinical Trials Group (PACTG) which has provided evidence that ART is as effective among children as adults, and led to strong editorial support for the use of ART among the world’s infected children, despite very limited access to these drugs.
(2) Sexual Transmission of HIV;
Dr. Seage led one of the first research teams to identify the biological and behavioral factors associated with the sexual transmission of HIV. His initial work from the Boston Partners Study (BPS) established the first estimates of the per-contact infectivity of HIV, the importance of the immune response in predicting subsequent sexual transmission of HIV, the reliability and validity of sexual behavior data, the role of nitrite inhalants as effect modifiers of unsafe sex, and the length of time between HIV infection and antibody response. Dr. Seage’s work is considered the authoritative refutation regarding the role of nitrate inhalants in the etiology of AIDS and disproved the controversial hypotheses of HIV “deniers” that nitrate inhalants caused AIDS. Dr. Seage’s work prompted the FDA to restrict the off-label use of nitrite inhalants. Additionally, Dr. Seage was the Principal Investigator and provided the scientific and administrative leadership for two other studies: Boston Young Men’s Study, and the HIVNET Vaccine Preparedness Study. In the early years of the HIV/AIDS epidemic, he played a key role in bringing epidemiologic skills and expertise to the forefront of AIDS and HIV research, translating the science into sound public health policy at the federal, state and local level.
(3) Design and Feasibility of Conducting HIV Vaccine Trials;
The success of HIV prevention interventions, including HIV vaccine trials, requires developing innovative yet feasible epidemiologic methods to identify, recruit and retain high-risk individuals. Dr. Seage developed such methods for two HIV Vaccine Preparedness Studies which enrolled over 6,400 persons at high risk for HIV infection. These studies also yielded many important findings in the field of HIV prevention trial design, including estimates of HIV incidence; innovative approaches to measure HIV risk behaviors and obtain informed consent. Dr. Seage was the Principal Investigator and Protocol Chair, providing the scientific and administrative leadership for the two Vaccine Preparedness Studies. Working with the Office of AIDS Research, the National Institute of Allergy and Infectious Diseases (NIAID) and community groups, Dr. Seage identified the key barriers to HIV vaccine trials.
(4) AIDS Surveillance and Outcomes Research, including Studies of the Cost and Cost-Effectiveness of Treating HIV Disease;
Dr. Seage directed the Massachusetts AIDS Surveillance Program for seven years and was the Principal Investigator of a series of population-based studies that estimated the medical costs and outcomes of AIDS patients. In the latter role, he identified the scientific and policy questions, designed the studies, recruited the scientific leadership teams, obtained funding, and provided oversight and scientific direction to the research. That work was extended to other disciplines, including cost and cost-effectiveness of treating HIV disease and pediatric HIV infection; evaluating HIV antibody tests; and modeling the impact of routine HIV testing.
For the past fifteen years, Dr Seage has been involved as a co-investigator of the “Cost Effectiveness of Preventing AIDS Complications Study” (CEPAC), a multidisciplinary collaboration of decision scientists, clinicians, epidemiologists and statisticians. That collaboration has yielded many contributions to the field of decision science, including initial estimates of the cost-effectiveness of preventing AIDS complications, antiretroviral therapy, adherence interventions, therapeutic vaccines, pre-exposure prophylaxis, expanded screening for HIV disease, new incidence estimates for opportunistic infections and cost. The results of CEPAC investigations have been used not only to expand ART treatment in the US and throughout the world, but also to change the very nature of routine HIV screening.
ScD, MPH, Boston University