Article Contents

Background
Approaches Used (Description of Programmes)
Key Accomplishments
Challenges and Opportunities
Accomplishments of Scholars and Fellows
PhD and Master’s Projects

Background

IDI research capacity building addresses the key scientific challenges of HIV treatment failure and complications from ARVs.  It also supports Uganda’s national strategic plan.  The IDI research capacity building strategy was designed based on a recommendation made by the Uganda National Health Research Organization:  to ‘create and strengthen a critical mass of human resources, capable of planning and implementing research projects that address national health needs.’

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Approaches Used (Description of Programmes)

1. Accordia Supported Programmes: Several of IDI’s research capacity building programmes were established by the Accordia Global Health Foundation with support from Gilead Sciences, Inc.  They aims to train the next generation of Ugandan scientists, selected through a highly competitive process. It has four components:

• Nelson Sewankambo Clinical Scholar Programme: In 2005, The Sewankambo Clinical Scholar Programme was created and named in honor of founding Ugandan member of the Academic Alliance and Principal of the Makerere University College of Health Sciences Professor Nelson Sewankambo.  The programme aims to train new, internationally recognized clinical investigators at Makerere University.
  
  There is outstanding clinical training available in Uganda; opportunities exist for post-graduate training (fellowships) in Uganda and elsewhere in sub-Saharan Africa.  These programmes allow faculty to participate in research programmes as senior investigators, but do not provide a mechanism for young Ugandan researchers to develop as independent investigators.  To address this need, the Sewankambo Clinical Scholar Programme was designed to be a natural extension of post-doctoral training.  Outstanding, fully trained clinicians who want to devote their careers to biomedical research, and who are less than 40 years of age, can be considered for the scholarship.  Applicants selected by the Sewankambo Selection Committee receive full funding for five years and must devote 80% of their effort to their own research and career development, while 20% is devoted to teaching activities in the College of Health Sciences.
  
  Within five years, young investigators are expected to have contributed at least five peer-reviewed papers and to have become principal investigator on at least one internationally recognized grant-funded research project.  Scholars get the opportunity to develop their own research teams, and in turn, mentor another generation of young Ugandan investigators. Investigators have access to resources to enable them conduct research, undertake clinical research training courses, and present their findings at local and international meetings.
• Ugandan Infectious Diseases Fellowship:  This programme involves three years of training in clinical infectious diseases, microbiology, diagnostic molecular biology, epidemiology, pharmacology, clinical study design, methodology and statistics that prepare participating fellows for careers in academic infectious diseases as teachers, investigators and clinical infectious disease specialists.  At the end of the training, the fellow will have achieved training equivalent to physicians in the US who are board-eligible for the American Board of Internal Medicine subsection in Infectious Diseases. 
• North American/European Exchange Fellowship: This programme promotes the development of an international medical education that addresses the complexities and challenges associated with infectious diseases and HIV/AIDS in resource-limited settings.  Moreover, the programme is designed to stimulate the next generation of medical leaders in Global Health. Trainees are linked to an international mentor from their parent institution, participate in both in-patient and out-patient clinical experience at IDI and Mulago Hospital, and collaborate with IDI staff and Academic Alliance members on at least one research project during their six month stay in Kampala. 
• Ugandan Masters in Medicine Fellowship:  This programme supports postgraduate medical students enrolled in the Masters in Internal Medicine Programme at the Makerere University College of Health Sciences to attain their degree through research and mentorship support. It provides the students a comprehensive curriculum that explores the complexities and challenges associated with infectious diseases and HIV/AIDS in Africa.
  

2. National Institutes of Health (NIH) Behavioural Research Capacity Building Programme: This programme was born out of a need to create a critical mass of well trained social and behavioral scientists whose expertise can address the wide array of challenges posed by the HIV/AIDS epidemic. It is a partnership between Makerere University, the RAND Corporation in the United States, and various health care provider organizations in Uganda. The programme’s principle purpose is to strengthen the capacity for HIV social and behavioral research among Makerere scientists and their community partners—through mentorship and participation in implementation of three pilot studies aimed at providing a training ground for building research capacity and development of pragmatic, innovative solutions to prevention and treatment challenges facing Uganda.

The programme is structured into

Senior Investigators: This group is made up of seasoned local and international researchers charged with the development and oversight of all project activities, as well as mentoring the junior researchers.

Junior Investigators: As the primary target of capacity building activities, this group of researchers is responsible for the implementation of research pilot studies. Currently, there are seven PhD-level investigators and Masters level PhD candidates participating. Each investigator is linked to two mentors; a senior investigator from Makerere and one from the RAND Corporation. The project is designed to provide them with tools, training, structural and organizational support, mentorship, and research experience.  By the end of the project, it is expected that investigators will be well positioned to successfully compete for external research funding, and to become leaders in social and behavioral HIV research, both regionally and internationally.

Graduate Students: These students are regarded as the ‘next generation’ of research scientists and serve key roles as research assistants in the implementation of the three research studies, which provides them with important exposure to research. While being mentored by the junior investigators, the students are encouraged to incorporate their project’s work into their dissertations.  There are fourteen graduate students in the programme.

The three research projects under this programme are:

Study 1: Prospective evaluation of the impact of ART on HIV risk behavior, economic output and social well-being of individual patients and their households

Study 2: Development and pilot evaluation of an intervention program designed to build the capacity of HIV clients to be agents for HIV prevention

Study 3:  Evaluating models of ART care for clinic efficiency, quality of care and cost-effectiveness

3. Fogarty International Clinical Research Scholars and Fellows Programme:  This programme is supported by the Fogarty International Centre, in collaboration with NIH.  It is currently implemented at 23 sites in Asia, Africa and the Americas. It is a one-year clinical research training experience, open to researchers at a number of levels.  The programme is based on mentored clinical research and an orientation to global health. As of July 2009, IDI was selected as an implementation site and will host its first international trainee this year, who will be paired with a Ugandan trainee.  The programme offers support for undertaking research as well as short research methods courses. Trainees enrolled in this programme have a background in medicine, osteopathy, public health, veterinary medicine, dentistry, nursing, pharmacy or optometry. This full time programme provides support for a research project, a stipend and mentorship from experienced researchers.

4. VLIR: This project is funded by the Vlaamse Interuniversitaire Raad through the University of Antwerp. The overall objective is to improve the capacity of IDI to conduct clinical research, by training clinicians/pathologists at the Institute and in Mulago. The project is doing this through the implementation of the following research projects:

• Study of the causes of in-hospital mortality among persons with HIV infection
• Study to determine the potential relationship between Human Papilloma Virus/HIV infection and esophageal squamous cell carcinoma (ESCC)
• Study on complications of tuberculosis
• Study on complications of HIV anti-retroviral treatment
• Study on genital ulcer disease as an HIV-infected cohort
  

It is anticipated that three masters and one PhD theses will be completed from this work; these trainees have all been enrolled. Two of the students are defending their theses this year.

5. INTERACT: INTERACT is an international research capacity building programme whose mission is to strengthen research and develop capacity to fight TB, malaria and HIV by strengthening the infrastructure to conduct clinical trials for the prevention and treatment of these diseases. It is funded by the European Union and the Netherlands, and the Netherlands-African Partnership for Capacity Development and Clinical Interventions Against Poverty-Related Diseases (NACCAP).

Collaborators on this programme include the Academic Medical Center for Poverty-Related Communicable Diseases; the Makerere University School of Medicine and School of Public Health; IDI; Kampala City Council; the Uganda National Tuberculosis and Leprosy Programme; and partners in Rwanda including the National University of Rwanda. Three PhD and two Masters students are enrolled through this programme.

The five-year programme is composed of three parts:

• Capacity building for clinical trials: This includes training; implementation of Good Clinical Practice; and setting up rigorous data management systems
• PhD research projects and epidemiological baseline studies which include: 
  • Implementation research: operational aspects of diagnosis and treatment of HIV infection and tuberculosis at the district level
  • Assessing impact of HAART on the reproductive health of Rwandan women
  • Incidence of and risk factors for selected adverse effects of HAART treatment in HIV-1 infected adults without a clinical suspicion of tuberculosis
  • Immune Reconstitution Inflammatory Syndrome (IRIS) and other selected adverse effects of therapy in tuberculosis/HIV co-infected patients starting HAART
  • Surveillance of HIV-1 drug resistance in HAART-treated patients and in the general population
  • Malaria treatment and intermittent preventive treatment in pregnancy, with and without HIV infection
  • Improving chemotherapy related to AIDS, tuberculosis and malaria in adults, pregnant women and children by studying the pharmacology of drugs
  • HAART in Rwandan children 0-15 years: incidence, severity, risk factors and long term outcome of adverse effect
• Improving the standard of care at participating research clinics

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Key Accomplishments

1.  Developing the Next Generation of Ugandan Leaders:   IDI has developed and fostered an environment where critical appraisal of work is made in a collaborative, comfortable, collegial manner. IDI has created a well-trained mass of experts who are leading in training and clinical research, as well as providing answers to clinical challenges, from evidence-based research completed.  Some of the successes of Sewankambo Scholars and Infectious Diseases Fellows can be found on page ##.

2. Maintaining Numerous International Linkages:  Since IDI attracts students and trainees from around the world, there is an energetic cultivation of ideas that adds to the vibrancy of research and research capacity building activities.  Ugandan and international colleagues working side-by-side help develop IDI into an international stakeholder in training, research and clinical care. The International Scientific Advisory Board (SAB) is a panel of world-renowned scientists from the US, Canada, Europe, and Africa who spend time working with IDI staff, trainees, and young scholars, guiding them in their research and practice as well as providing ongoing support and mentorship.  In addition, Ugandan and international Academic Alliance members are helping to shape IDI capacity building programmes, especially the Gilead-funded group of programmes. IDI is exploring distance learning with the University of Sydney. And increased bandwidth through a fiber optic cable will support video conferencing capabilities and enable presentation of case studies and other activities.

3. Numerous Robust PhD and Masters Projects in Various Stages of Completion: Please see page ## for a complete list.  

4. Numerous publications, as a result of capacity building activities:  Please see page ## for publications between July 2008-June 2009.

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Challenges and Opportunities

1. Protected time for PhD students: Completion of a PhD within three to four years requires full-time commitment to research.  With such commitment from the student, and with a good supervisor, a PhD could be completed within this period at Makerere University.  Currently students do not receive stipends, though, which means that they need to work—and therefore PhDs often take longer.  

2. Supervision and mentorship:  Supervisors play a critical role in the success of a student.  A limited pool of mentors and senior researchers hampers trainees’ abilities to find required expertise within Uganda. Currently, excellent supervisors are over-committed.  
Today’s PhD students are tomorrow’s mentors and supervisors.  In the future it is intended that PhD students will receive training in supervision and mentorship, and will be encouraged to supervise more junior staff during their PhD programme.

3. Advertising PhD opportunities:  While all programmes are pleased with the quality of applications received and fellows appointed, it is essential to increase networking and to maintain and disseminate up-to-date information on opportunities, in order to attract more PhD students of equal caliber.

4. Harmonization of programmes: Current and up-coming capacity building programmes provide considerable opportunities for PhD training, and some opportunities at other levels. However, harmonization of programmes in cross-cutting areas would be useful to reduce the frequency of duplicated efforts, usually involving the same partners and either the same or different people in participating institutions.

5. Support for lower cadres of trainees:  Given the pyramidal structure of capacity building (many junior level researchers need to be targeted in order to produce a few high caliber research leaders), additional input might be given to training at lower levels (e.g. Masters level) in order to clearly identify those who should be encouraged to progress.

6. Networking opportunities at lower levels:  Currently, IDI focuses training efforts on higher-level PhD and Masters student trainees. The need for training in critical appraisal and peer review has been discussed, and journal clubs and “lab meetings” are important for junior staff, to help them learn how to give and receive constructive criticism.   In addition, there is need to focus on lower-level trainees such as undergraduates and high school trainees, to expose them to research (and IDI) at an earlier stage in their education. Current efforts in this direction include hosting networking teas as well as participation in “science open days” organized by partners.

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Accomplishments of Scholars and Fellows

• Pauline Byakika (Pharmacokinetics of HIV Drugs)
  
• Ponsiano Ocama (Hepatitis B/HIV Co-Infection)
  
• Damalie Nakanjako (Suboptimal Response to Antiretroviral Therapy)
  
• Hakim Sendagire (HIV Resistance)
  
• Sabrina Kitaka (Paediatric and Adolescent HIV Prevention, Care and Treatment)
  
• David Meya (Infectious Diseases Fellow)
  
• Lydia Nakiyingi (Infectious Diseases Fellow)
  
• Alice Muwanga (Infectious Diseases Fellow)
  

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PhD and Master’s Projects

PhD Projects - Gilead:

1. Hepatitis B/HIV and liver disease in Uganda (Dr. Ponsiano Ocama)
2. Sub-optimal response to antiretroviral therapy (Dr. Damalie Nakanjako)
3. Other students developing theses topics (Henry Zakamumpa, Esther Buregeya, Alice Muwanga, Nambusi Kyegombe)
   

PhD Projects – Interact:

1. Adherence to long term treatments; TB and HIV treatments (Ibrahim Sendagire)
2. Challenges in the management of HIV/TB co-infection in resource limited settings (William Worodria)
   

PhD Project – Gilead/Interact:

1. Pharmacokinetics of ARVs and antimalarials in an African population (Dr. Pauline Byakika)

PhD Project – VLIR:

1. Body composition and bone mineral density (Fred Semitala)

Masters Project – Gilead:

1. Effect of triomune associated toxicities on virologic outcomes among HIV-1 infected adults at the Infectious Diseases Institute, Uganda (Dr. Fred Semitala - MMED)
2. Prevalence of genital ulcers, syphilis and herpes simplex 2 virus among HIV positive patients attending at Infectious Disease Institute (Dr. Edith Nyangoma – MMED)
   

Master Project – VLIR:

1. Comparison of glucose and lipid abnormalities in HIV-infected patients taking Stavudine based and Zidovudine-based regimens (Dr. Bernard Omech - MMED)

General PhD Projects:

1. ‘Obuvumu n’obusobozi’ - “Courage and Ability:” The development, piloting and evaluation of a novel intervention to empower clients attending an HIV clinic in Uganda to make informed     choices    about disclosure and become agents of change (Dr. Pooja Shorey)
2. Clinical pharmacokinetics of antiretroviral agents in HIV-infected patients in sub-Saharan Africa (Mohammed Lamorde)  
3. Improving quality of routine HIV databases using a nested research cohort (Agnes Kiragga)
4. Challenges in providing optimal antiretroviral treatment: outcomes and experience from an urban clinic in Uganda (Barbara Castelnuovo)Improved Measures of Patient-Reported Outcomes in Adults with HIV/AIDS in the Infectious Diseases Institute Cohort (Dr. Joseph Babigumira - PhD)
   

General Masters Projects:

1. Evaluation of patients’ response to HIV/AIDS treatment with HAART at the IDI (Dr. Alex Muganzi - MPH)
2. The prevalence and pattern of joint disease in HIV positive adults attending the Infectious Disease Clinic at Mulago Hospital (Dr. Mark Kaddu Mukasa - MMED)]
3. The role of liver function tests in monitoring antiretroviral-associated hepatotoxicity in patients in Mulago Hospital AIDS clinics (Dr. Robert Kalyesubula - MMED
4. The cost of seeking antiretroviral therapy at Adult Infectious Diseases Institute Mulago (Daniel Kasibante - MSc)
5. The ultra sound patterns of HIV-related parotid swellings in Uganda (Dr. Catherine Kabenge - MSc)
6. Quality of nurse led care at the Infectious Diseases Clinic, Mulago Hospital (Robinah Lukwago - MPH)Social survival strategies and challenges for people living with HIV/AIDS who access services from the Infectious Diseases Clinic, Mulago Hospital (Dorothy Kabanda - MA)
7. Sexual behaviour of patients on antiretroviral therapy in an urban HIV clinic in Uganda (Dr. Bonnie Wandera - MSc)         
8. The Uganda Human Rights Commission and the rights of people living with HIV/AIDS (Stephen Mbarushimana - MA)
9. Effect of antiretroviral therapy on the survival and CD4 count among HIV/TB co-infected patients in Kampala (Mary Nambalirwa - MSc
10. Adverse events and associated factors in TB/HIV co-infected patients on first line TB treatment in Kampala (Dr. Peter Mudiope - MSc)
11. An ICT framework for improving access to healthcare (Richard Adongu - MSc)
12. Factors associated with loss to follow up in HIV positive clients on ARVs at the Infectious Diseases clinic at Mulago Hospital (Dr. Abdulwahab Sessolo – MSc Clinical Epidemiology)
13. To determine the knowledge, attitude and practices of young people, regarding HIV positive prevention at the Infectious Diseases Institute Kampala Uganda (Dr. Agnes Nanyonjo – MPH)
14. Assessing the impact of domestic abuse on women’s ability to access and maintain HIV treatment (Olivia Lunkuse – MSc Clinical Social Work)
15. Factors Associated with Defaulting on Tuberculosis treatment Among HIV infected Patients Receiving Anti-Tuberculosis Treatment at the Infectious Disease Institute clinic- Kampala, Uganda (Dr. Sawsan Osman – MPH)
16. Barriers to adherence to clinic appointments in a free HIV care facility. (Susan Nakate – MA)
17. Factors associated with loss to follow up in HIV positive clients on ARVs in the infectious disease clinic (Dr. Sessolo Abdulwahab – MSc Clinical Epidemiology
    

General Undergraduate Projects:

1. Assessing the transitional needs of ‘young adult’ patients at the IDI (Dr. Vijay Narayan - Undergraduate)
2. The relationship between HAART and anemia in HIV patients (Charlotte Kisakye - Undergraduate)
3. Can Immunological monitoring of antiretroviral therapy be improved with the addition of simple clinical markers: Retrospective cohort study (Michael Abouyannis – Undergraduate, University of Birmingham)

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