Linking HRTP Capacity Building with Zimbabwe Research Priorities: The current UB-UZ HRTP has successfully partnered with UZ to build research capacity for HIV clinical pharmacology research by developing a new program that was focused on Masters level students. The new UB-UZ HRTP application will extend this approach and include PhD and post-doctoral fellows who will become the next generation of independent researchers by 2020. During recent HRTP-sponsored workshops, the new HRTP submission was discussed and the stakeholders unanimously agreed that the theme for the next application would be to “grow the foundation for HIV clinical pharmacology research” by increasing PhD and fellowship training and linking HIV therapeutics research to maximize ARV access and patient safety, retention in care and ART adherence monitoring.
Working closely with the Higher Degrees Committee and the Medical Research Council of Zimbabwe (MRCZ), the UB-UZ HRTP has previously provided important academic and regulatory cooperation as the clinical pharmacology research program was established and further developed during the initial award period. The HRTP fellows that initiated research during the first HRTP period worked closely with the UZ Higher Degrees Committee and the national regulatory research and ethics committees to assure the appropriate level of review was completed and that clinical research was monitored closely as per NIH guidelines. The MRCZ is implemented through the Ministry of Health and Child Care and includes scientists, medical experts, lawyers, ethicists, and religious community representatives. It provides independent advice and decisions regarding research. The MRCZ is responsible for assuring responsible conduct of research, reviewing research priorities, planning research initiatives, facilitating submissions to the Institutional Review and Ethics Committee, and integrating research results with the country’s implementation priorities. We anticipate continued collaboration with the UZ Higher Degrees Committee and MRCZ as the HRTP will be proposing and conducting research.
Mutual Interest Areas with the Priorities of Zimbabwe and Co-Sponsoring NIH institutes, Centers or Offices: Priorities within Zimbabwe, as well as at UZ, continue to be focused on capacity building in basic, clinical, translational and implementation aspects of HIV clinical pharmacology research. These themes guided the recruitment of the initial HRTP trainees and focused their research projects in topic areas that were supported by academic leaders at UZ. The influence of the prior HRTP research has had an impact on both the UB and the UZ research environments. We feel this has given UB and UZ faculty a clear understanding of the benefits to contributing to LMIC research mentoring and the impact it has on all related research programs. In addition, our prior HRTP and current HRTP initiatives have important commonalities with co-sponsoring NIH institutes for this D43 RFP.
National Cancer Institute (NCI): The UB-UZ HRTP includes mentors from the Roswell Park Cancer Institute (RPCI) and will include research in HIV-related malignancy and associated clinical pharmacology challenges such as drug interactions and additive toxicity between cART and chemotherapy if decided by the MRCZ to be an emerging priority. As cancer is a high priority in Zimbabwe, and within the UZ Medical Education Partnership Initiative (MEPI), this creates a natural collaboration. The emphasis on the management of co-morbidities as a part of chronic disease is an area of emphasis within the MEPI, and has led to some collaborative projects among the prior HRTP and MEPI fellows. RPCI facilities are adjacent to the UB HRTP academic home and provides an important potential collaboration with an NCI Designated Cancer Center (See letter of support: C. Johnson: CEO/PI, RPCI). We anticipate that during this HRTP funding period we will solidify the collaboration between UZ cancer research and RPCI through joint faculty mentoring and participation in workshops at UZ.
National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH): Factors influencing patient retention and medication adherence are key factors in achieving a successful HIV Clinical Pharmacology research program. Psychiatric disorders, including depression, are reportedly on the rise in Zimbabwe over the last 10-15 years, possibly related to the economic challenges that accompany poor income, inadequate public health services and the HIV epidemic. The presence of these psychiatric factors, in turn, impacts attempts to expand ARV access and provide chronic medication management to reduce transmission and optimize treatment. This is commonly associated with unreliable medication adherence and polypharmacy related to the combined use of antidepressants and traditional medicines with psychoactive properties. The UB Research Institute on Addictions has ~25 investigators with support from NIMH, NIDA and National Institute on Alcohol Abuse and Alcoholism (NIAAA) who are interested in mentoring HRTP trainees. This will provide an excellent opportunity to integrate training and accelerate therapeutic implementation research in Zimbabwe (See letter of support, K. Leonard, PhD, Director, UB Research Institute on Addictions).
Summary: The prior UB-UZ HRTP made significant progress since implementing the program in 2008. The number of interested applicants continues to increase as evidenced by attendance at UB-UZ virtual hall videoconferences and the number of applicants at the website. The proposed new HRTP is aligned with the advances that have occurred at UZ regarding the requirement for faculty to have a PhD and the movement toward post-doctoral fellowship programs to grow sponsored research efforts. The coordination between the government of Zimbabwe, in particular the Ministry of Health and Child Care and the Ministry of Higher and Tertiary Education, Science and Technology Development has created opportunities for new collaboration and tremendous innovation will be realized through the NIH-supported capacity building programs and the other NIH-funded research in Zimbabwe. This bodes well for the goals of the new D43 HRTP and the anticipated resulting advances in HIV research and public health in Zimbabwe.