University of Zambia & Centre for Infectious Disease Research in Zambia
Fellowship Site Directors:
Douglas Heimburger, MD, MS, Vanderbilt University
Paul Kelly, MD, Honorary Lecturer at UNZA SOM
Benjamin Chi, MD, MSc, CIDRZ
Site Specialties:HIV/ID, nutrition, maternal-child health, cancer
Zambia Site Highlights:
- The Medical Care Division of UTH is comprised of 8 medical specialist departments: Medicine, Obstetrics and Gynecology, Surgery, Pediatrics, Radiology, Pathology, Anesthesia, and Dentistry. Other UTH/UNZA SOM resources include the Community Medicine and Virology. UTH (Dr. Paul Kelly’s gastroenterology research unit and others) have hosted multiple US and Zambian FICRS-F trainees.
- UTH has a Southern Africa Consortium for Research Excellence (SACORE) Wellcome Trust grant to expand research infrastructure (e.g., establish a Clinical Research Center) and provide opportunities for African researchers to develop their own research ideas using PhD and post-doctoral fellowships.
- An UNZA NIH MEPI grant (Y. Mulla, PI, SHV, co-PI), and a MEPI Linked Award to CIDRZ (B. Chi, PI), to expand and improve medical education at UNZA/UTH.
- Nutritional Support for African Adults Starting Antiretroviral Therapy, a large clinical trial supported by the European and Developing Countries Clinical Trials Partnership (S. Filteau, P. Kelly, D. Heimburger).
- At CIDRZ, 7 Lusaka-based faculty members from Vanderbilt and UAB, 16 Zambian investigators and numerous additional collaborators from UNZA/UTH and the Zambian Ministry of Health. All modern research needs are accommodated, including multiple NIAID networks supporting trials in Lusaka (IMPAACT, ACTG, HPTN, and MTN).
- The CIDRZ Central Laboratory at Kalingalinga Health Center is among the busiest and most sophisticated laboratories in the region, serving 300,000 patients enrolled in the CIDRZ-supported PEPFAR Program as well as other patients. The lab has doubled its output every 24 months. The CIDRZ Tuberculosis Lab has the capacity to perform 6,000-7,000 liquid and solid cultures per year.
UNZA falls under the Ministry of Education, headed by a Cabinet Minister with a Deputy Minister and a Permanent Secretary. The University Chancellor is appointed by the President of Zambia and serves as the Chairman of the UNZA Senate. UNZA School of Medicine (SOM) works closely with the University Teaching Hospital and has strong partnership links with the Lusaka District Health Board. UNZA SOM has recently established a Research Support Centre to support research projects in terms of logistics and financial management. This has been done with assistance from a major NIH grant, the Medical Education Partnership Initiative (MEPI, YF Mulla, PI; Sten H. Vermund, co-PI at Vanderbilt University), which is enabling major enhancements to medical education at UNZA. There is an emerging focus on development of promising Zambian researchers which is creating an enabling intellectual environment for world-class research in the School of Medicine. Vanderbilt University has contributed substantially to this effort for years through its AIDS International Training and Research Program grant (AITRP, Sten H. Vermund, PI).
UNZA SOM is also a part of the Wellcome Trust-funded Southern Africa Consortium for Research Excellence (SACORE) initiative, which aims to transform research capacity in a consortium of southern African medical schools. Dr. Kelly who will serve as the international GHF site director is the Deputy Director of SACORE. Of direct relevance to this proposal, SACORE is funding doctoral and post-doctoral fellows who will be working in this and other labs in the School of Medicine, who will help create an enabling environment.
The School of Medicine has long been host to visiting research groups. All of the major research groups currently active in UNZASOM have hosted visiting trainee researchers from the USA (notably Fogarty fellows), from the UK (Wellcome Trust training and intermediate fellows), and from other European countries. Fogarty fellows usually undertake their own research project for up to a year, often in a pairing arrangement so that a local junior academic benefits from the collaboration. Wellcome Trust fellows stay for longer (2-3 years), but often flexibly so that their time is divided between host and visited country. Research projects undertaken are usually clinical research. Past projects include: abdominal tuberculosis, gastric and esophageal cancer, and vascular effects of anti-retroviral therapy.
The University Teaching Hospital (UTH) is the only secondary level health facility in Lusaka and Zambia’s only tertiary care hospital. UNZA SOM is located on the same site and the two are closely related. The Medical Care Division of UTH is comprised of eight medical specialist departments: Medicine, Obstetrics and Gynecology, Surgery, Pediatrics, Radiology, Pathology, Anesthesia, and Dentistry. Other UTH/UNZA SOM resources include the Department of Community Medicine and a virology laboratory.
Department of Community Medicine (Dr. Charles Michelo, Director) includes expertise in public health, epidemiology, and biostatistics. The department includes a Director, Associate Professor, two Senior Lecturers, two Lecturers, one staff development Fellow, and approximately 40 undergraduate students and twelve Masters of Public Health students.
Department of Internal Medicine (Dr. S. Lakhi, Clinical Head) provides referral care in general medicine and a number of subspecialties, including busy clinics for endocrinology, cardiology, gastroenterology, nephrology, and infectious diseases. The department has a large outpatient clinic and inpatient wards with 350 beds. It is staffed by 83 health providers, including seven professors and consultants, 40 nurses, and approximately 35 residents and interns. Medical students rotate constantly through the Department.
Department of Obstetrics and Gynecology (Dr. V. Bellington Vwalika, Chair) provides all referral obstetrical care to the city of Lusaka and environs, and delivers approximately 17,000 babies per year. Clinical services include maternity care, medical gynecology, surgical gynecology, gynecologic oncology, and family planning. The Department is housed in 11 wards and has a total of 464 beds: 250 beds in obstetrics, 89 beds in gynecology, and 125 baby cots. In total, more than 100 patients are admitted to the obstetrics and gynecology service daily.
Department of Pediatrics (Dr. C. Kankasa, Clinical Head) provides specialized referral care for pediatric HIV treatment and conducts related research. Services are currently provided in a 400-bed facility housing a community health outreach facility, nutrition training unit, clinical laboratory, clinical instruction facility, and a computer laboratory. The CDC is also constructing a new “Center of Excellence” for pediatric HIV care and treatment for the department.
UTH Clinical Research Facility: This facility has been recently established in a new building, from funds from NUSTART and a separate EDCTP-funded study led by Dr. Peter Mwaba and in collaboration with the LSHTM. In addition to waiting room, consultation rooms, offices, and data storage space, the facility houses a body composition suite with equipment for air displacement plethysmography, bioelectrical impedance, deuterium dilution and classical anthropometry.
NUSTART, IP.2009.33011.004 (Filteau, PI)
Nutritional support for African adults starting antiretroviral therapy (NUSTART)
087537 (Kumwenda, PI)
Randomized controlled trial investigating whether provision of a vitamin and mineral-rich food can improve survival of African adults starting antiretroviral therapy for HIV
Southern Africa Consortium for Research Excellence
One of the 7 successful African Institutions Research Capacity Awards, to develop research capacity in Zambia, Zimbabwe and Malawi.
ZEPACT (Goma, PI)
ZEPACT is a CDC/PEPFAR sponsored grant intended to expand the training of multiple cadres of HIV providers in Zambia. UNZA SOM leads a coalition of the University of Maryland, UAB, and CIDRZ to develop and enhance training programs for HIV specialists at the Medical Officer, Clinical Officer, Nurse Provider, and community health worker levels in order to broaden Zambia’s capacity to respond to the HIV crisis.
One of our sister research groups makes a very pleasant house available in Kabulonga (3 miles from UTH) at a cost of $300 per month. We expect, and obtain, privilieged access to facilities within UTH. Where these are inadequate, several acceoptable private hospitals offer good services. Where there are weaknesses (intensive care, lab diagnostics, radiology) for certain problems, there are world class facilities in Johannesburg. Health insurance is therefore recommended, and it should include evacuation coverage.
The Centre for Infectious Disease Research in Lusaka, Zambia is a leader in research in a number of areas, including HIV/AIDS, tuberculosis, malaria, maternal-child health care and studies, and more. CIDRZ has completed over 40 research projects, and is active in many major network students including the NIH AIDS Clinical Trials Group Network, HIV Prevention Trials Network, Microbicide Trials Network, and International Maternal Pediatric Adolescent AIDS Clinical Trials Group.
The research, training, and service productivity at CIDRZ is made possible by the scope of infrastructure developed in Lusaka. A diverse group of faculty researchers, including Lusaka-based individuals from U.S. institutions, Zambian investigators, and continuous collaboration from other researchers from a wide swath of U.S. institutions ensures that quality research productivity remains consistent. Physical resources, including the CIDRZ Central Laboratory at Kalingalinga Health Center, also ensure that CIDRZ services meet high standards and tremendous demand. The CIDRZ Central Lab hosts numerous NIH-funded projects and meets accompanying rigorous accreditation standards. The resources of CIDRZ also extend to a great number of public health facilities throughout Zambia, offering HIV prevention and treatment across multiple provinces. A recently added dedicated analysis unit with a PhD-level biostatistician and two Masters-level analysts are also a considerable resource for global health clinical research endeavors.
In addition to participating in clinical trials, CIDRZ has a well-established history of participation in major training grants, such as the AIDS International Training and Research Program and the Fogarty International Clinical Research Scholars and Fellows program. These programs have provided training and mentorship for 55 individuals, both US Nationals and Zambians. CIDRZ was an original site in the FICR Scholar program and became a Fellows site as well when the post-doctoral component of the program was established. Additional training programs include ASPIRE with the University of California, San Francsico, the Summer Institute with the University of Alabama, Birmingham, and CIDRZ’s own HIVCorps. In all, CIDRZ has participated in the training of nearly 200 individuals since 2002.
Microbicide Trials Network (Hillier, PI)
Selected Projects Include:
- Seroconverter protocol for women who seroconvert during microbicide trials (MTN 015)
- Phase 2B safety and effectiveness of vaginal matrix ring with Dapivirine for the prevention of HIV-1 infection in women (MTN 020)
HIV Prevention Trials Network (HPTN) (Vermund, PI)
Selected Projects Include:
- Preparing for international prevention trials involving HIV-infected individuals in care settings (HPTN 063)
AIDS Clinical Trials Group Network (ACTG) (Kuritzkes, PI)
Selected Projects Include:
- International Trial of Modified Directly Observed Therapy versus Self-Administered Therapy for Participants with First Virologic Failure on a Non-Nucleoside Reverse Transcriptase Inhibitor-Containing Antiretroviral Regime (ACTG 5234)
- REMEMBER: Reducing Early Mortality and Early Morbidity by Empiric Tuberculosis Treatment Regimens (ACTG 5274)
- A Randomized, Phase II Trial to Compare an HPV Test-and-Treat Strategy to a Cytology-based Strategy for Prevention of CIN 2+ in HIV-infected Women (ACTG 5282)
- Controlled comparison of two moxifloxacin containing treatment shortening regimens in pulmonary tuberculosis with the standard regimen (ACTG 5304)
International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Group (Jackson, PI)
Selected Projects Include:
- Dual randomized controlled trials of PI- vs. NNRTI-containing HAART in nevirapine exposed and unexposed infants (IMPAACT 1060)
- Observational pilot P1060 sub study comparing differences in malaria and parasitemia by real time quantitative PCR in HIV-infected infants and children on PI-based HAART versus NNRTI-based HAART (IMPAACT 1068)
- EFV in children with TB co-infection (IMPAACT 1070)
- Prospective trial of safety and efficacy of rotavirus vaccine in HIV-infected and uninfected/exposed infants (IMPAACT 1072)
- PROMISE: Promoting Mother and Infant Survival Everywhere (IMPAACT 1077)
- A Randomized Clinical Trial to Assess the Safety and Efficacy of Isoniazid Preventive Therapy Initiated in the Antepartum to Reduce TB Incidence among HIV-Infected Women and Mortality among their Infants in High TB Incidence Settings (IMPAACT 1078)
- Maternal and infant monitoring for evidence of toxicity related to tenofovir exposure: the bone and the kidney health substudy of the IMPAACT P1077 PROMISE study (IMPAACT 1084)
There are many suitable expatriate housing options available in Lusaka, although some can be expensive. Based on availability, new arrivals are allowed to live for up to four weeks at the CIDRZ Guesthouse, maintained by the organization for new arrivals and short-term consultants. A discounted rate is provided to new trainees over this period. Following this initial period, trainees have rented apartments ranging between $800 – $1500 per month in the past; most opt to share housing with roommates to reduce the per person costs. Some, but not all, of our previous scholars have lived within walking distance from the central CIDRZ offices. Those who do not live within walking distance typically use taxi service or purchase a vehicle locally. CIDRZ has numerous trainees each year, and our administrative staff can assist by putting new arrivals in contact with reputable real estate companies locally.
Most expatriates rely primarily on email to communicate with friends and family back home. Internet is expensive locally, but the program makes provisions for full access through GHF funding. The speed is analogous to that of dial-up services in the U.S. – sometimes slower during the workday – so capacity for videoconferencing can be limited. All scholars/fellows are provided with a cellular phone on arrival and this can be reached from the U.S. at no local charge. Internet telephony (e.g. Skype) and call-back services are other common modes of voice communication.
See the U.S. Centers for Disease Control Web site and The Yellow Book: Health Information for International Travel. Basic health care is available. One local clinic, called Corpmed is listed on some Blue Cross and Blue Shields plans as a foreign institution. We recommend evacuation insurance in case of emergency. The 2006 national malaria survey and our clinical experience indicate there is very little malaria in Lusaka. Many long-term expatriates do not take prophylaxis, although there are risks. CIDRZ does recommend prophylaxis if traveling outside Lusaka (e.g. to game parks) and most formulations (including Larium and Malarone) are available over-the-counter at Lusaka pharmacies.
See the US State Department Web site for information. Overall, Zambia is a safe country and has had no major political upheavals since it peacefully declared independence from the United Kingdom in 1964. Crime rates in Lusaka are very low compared to other large African cities such as Johannesburg and Nairobi. When incidents do occur, they are typically non-violent in nature. Over the past several years, there have been a few incidents involving trainees, but most could have been avoided had a few general rules been followed (e.g. avoid walking alone at night, take taxis late in the evening). CIDRZ conducts orientation sessions for newcomers to brief them on safety issues and recommends that they register with the US embassy while in country.
Language Requirements Other than English:
English is the official language of Zambia and is used for all professional communications. Those proficient in English should not have any difficulty working and living in Zambia. Zambia has 72 local languages, which vary by region of the country. Some knowledge of the local language can be helpful in clinical settings, but staff members capable of translating are generally available in health care settings. As part of the HIVCorps Fellowship and Fogarty GHF orientation, Nyanja lessons (one of two commonly spoken local languages in Lusaka) will be provided twice weekly for three months. Those who wish to continue these lessons are encouraged to do so.