Weill Bugando Medical Centre
Fellowship Site Directors:
Daniel Fitzgerald, MD,
Robert Peck, MD
Site Specialties: HIV/AIDS, Clinical Trials, Chronic Diseases
The goal of the Weill Cornell program in Tanzania is to support research, medical education, and clinical services in the city of Mwanza, Tanzania. Research is conducted in collaboration with the National Institute of Medical Research (NIMR), an internationally recognized center conducting epidemiologic studies and clinical trials on HIV, sexually transmitted infections, schistosomiasis, and chronic diseases. Cornell-NIMR research training focuses on interactions between HIV and schistosomiasis and on chronic diseases. Medical education and clinical services are provided with the Weill Bugando Medical College and teaching hospital. The medical college has collaborated with Cornell since its inception in 2006 and graduated its first students in 2010. Dr Daniel Fitzgerald and Dr Warren Johnson co-direct the Cornell Tanzania program with two on site Cornell faculty (Dr Jen Downs, Dr Robert Peck). Weill Cornell research training is supported through a Fogarty AITRP program (TW00018; PI WD Johnson) and global health research training grant (AI098627; PI Fitzgerald).
Training opportunities exist for the following programs:
Hypertension in HIV-infected Tanzanians: Time Course and Pathogenesis: A prospective longitudinal study will document the time course and predictors of incident hypertension in HIV-infected Tanzanian adults. This will advance our understanding of the pathogenesis of hypertension and identify potential targets for interventions. This project will prospectively determine the incidence and predictors of hypertension in a cohort study of 500 recently diagnosed HIV-infected adults and 300 matched HIV-negative controls during 4 years of follow-up. It will also determine the association and temporal relationship between albuminuria and incident hypertension in HIV-infected adults after ART initiation in a nested case-control study.
Schistosomiasis, Mucosal Immunity, and HIV Susceptibility: A prospective study to determine causation between schistosomiasis and HIV infection will be conducted. The study is supported by the Wellcome Trust and the Global Fund against AIDS, TB, and Malaria. This study will determine the odds ratio of HIV infection in adults with chronic S. haematobium infection compared to controls without schistosomiasis through the conduct of a case-control study nested within an established cohort of 30,000 people in rural Tanzania. The established cohort is supported by the Wellcome Trust and the Global Fund against AIDS, TB, and Malaria. This study will also determine the effect of S. haematobium infection on the gene expression and frequency of immune cells, including CD4+ Th17 cells, in the cervical mucosa brushings, biopsies, and in the peripheral blood of HIV-seronegative women. The women will be recruited from villages endemic for S. haematobium
Trials of Vaginal Microbicides in Mwanza, Tanzania: This project funded by the European and Developing Countries Clinical Trials Partnership (EDCTP) has the goal of preparing clinical sites and strengthening capacity for future microbicide trials in Tanzania. NIMR study team members have established two study clinic sites in mining communities and highway regions and have begun recruitment of 1000 HIV-negative women who are commercial sex workers documented to be at high risk for incident HIV. The project seeks to determine HIV seroincidence and to describe and quantify intravaginal practices (cleansing, inserting materials, lubricating, drying) taking place among Tanzanian women in the region that may be increasing the risk of HIV acquisition.
One year outcomes among children and adults discharged from Bugando Medical Centre in Mwanza, Tanzania: This is an observational cohort study of 1000 consecutive children and 1000 consecutive adults who were admitted to the wards of the Weill Bugando Medical Centre and were enrolled after informed consent. The primary objective of this study is to determine the 12-month outcomes of children and adults admitted to Bugando Medical Centre in Mwanza, Tanzania.
Hypertension and Inflammation among African Adults: Hypertension is increasingly common in Africa but the mechanisms of hypertension in this population are poorly understood. In this cross-sectional study, we propose use stored serum samples from the East Africa Chronic Disease Study to study the relationship between hypertension and inflammation in East African adults. Adults who had moderate-severe hypertension at the time of study enrollment will be included in the study together with control subjects who had normal blood pressure. Using the stored serum samples, we will measure the levels of pro-inflammatory cytokines and compare cytokine levels between adults with and without hypertension. If inflammation is associated with hypertension in our population, this may be a target for prevention and/or treatment.
Schistosomiasis and HIV in Men in Tanzania: This is a cross-sectional study in which adult men living in villages in which schistosomiasis is endemic (prevalence of 30-80%) will receive screening for schistosomiasis and other parasitic infections, syphilis, and HIV. Men will be asked to provide written informed consent to participate. They will be asked to respond to a brief questionnaire regarding their behavioral and sexual risk factors and clinical symptoms and then will provide blood, urine, and stool samples. The goal will be to determine the odds ratio for HIV infection in men with schistosomiasis, as compared to men without schistosomiasis.
EboVac: Developing a vaccine for Ebola: A Phase 1 trial of a Prophylactic Ebola Vaccine using an Heterologous Prime-Boost Regimen. This trial is conducted at the Mwanza Intervention Trials Unit (MITU) at NIMR in Mwanza, Tanzania. This trial is supported by the European Commission.
H3Africa: Burden, spectrum and aetiology of type II diabetes in sub-Saharan Africa: The goal of this project is to facilitate a contemporary research approach to the study of genomics and environmental determinants of type II diabetes mellitus with the goal of improving the health of African populations. This project will also look at the prevalence and distribution of diabetic retinopathy and study the environmental and genetic determinants of diabetic retinopathy. This study is supported by the Wellcome Trust.
STRIVE for Prevention: Addressing the Structural Drivers of HIV Research Programme Consortium (RPC): The goal of this project is to provide evidence on the best ways to understand and tackle key structural drivers of HIV risk and vulnerability, thereby reducing poverty and health disparities and enhancing and sustaining the impact of proven HIV prevention strategies. The project will assess whether it is feasible, acceptable, and safe to offer oral PrEP as part of a combination HIV prevention package that addresses GBV, stigma and HIV in adolescent girls and young women aged 16-24 years. In Part 1 of the study, participants who consent for screening will be counselled and tested for HIV and asked about experiences of GBV and stigma. In Part II of the study, HIV negative participants interested in using PrEP will be invited to enrol into a prospective cohort study. This project is supported by the United Kingdom’s Department for International Development (DFID).
Adaptation and evaluation of IMAGE project in Tanzania (MAISHA project): The overall goal of the current study is to design and implement two cluster randomised controlled trials to: 1) assess the impact of a combined microfinance and gender training intervention for women (Component A); and 2) assess the impact of a participatory gender training programme for women and their partners (Component B). Both trials will assess whether the interventions have a significant impact on women’s experience of physical and/or sexual intimate partner violence in the past 12 months, as well as other gender-empowerment, economic, and health related outcomes. In addition, a complementary qualitative research study will be conducted to learn more about the factors that contribute to women’s vulnerability to violence, to better understand how the different intervention models impact on the lives of intervention participants and their families, and how different forms of intervention may reduce this risk. A process evaluation to assess fidelity of the interventions and an economic evaluation will run alongside the two trials.
Improving the health systems response to chronic disease in Africa: Funded by the Medical Research Council in the UK, this project will address the information gap on the burden of CDs at both population and health service levels, and population beliefs that may influence treatment seeking behaviour for CDs need to be investigated. All these data are to be used to design an effective intervention package aiming to improve the health care system for the prevention and treatment of CDs. Our project aims to address these needs and study the effectiveness and cost-effectiveness of such an intervention package under ‘real-life’ conditions in Tanzania and Uganda.
The prevalence of HIV and syphilis, and non-communicable diseases, and associated factors among fishing communities in northwestern Tanzania: Objectives: Funded by the International AIDS Vaccine Initiative, this project includes the following specific objectives: 1). To determine the prevalence of HIV and syphilis infections among fisherfolk in selected fishing communities on the Tanzanian side of Lake Victoria; 2) To determine factors associated with HIV and syphilis infections in the study population; 3) To determine the prevalence of selected NCDs, including hypertension, diabetes and renal diseases; 4) To determine factors associated with selected NCDs, including hypertension, diabetes and renal diseases; 5) To determine coverage of improved drinking water sources, sanitation and hygiene (WASH) in households located in selected fishing communities along the shores of Lake Victoria; 6) Based on findings of this study, to develop interventions and seek funding to implement them in the communities where this study will be implemented.
A Dose Reduction Immunobridging and Safety Study of Two HPV vaccines in Tanzanian girls (DORIS Trial): Funded by the Medical Research Council of the UK, the objective of this project is to demonstrate non-inferiority of immune responses induced by 1 dose of HPV vaccine when compared with 3 doses of the same vaccine by evaluating HPV 16/18-specific seropositivity, antibody avidity and memory B cell responses at month (M) 36.
Research on a hand hygiene intervention to optimise helminthic infections control: The overall aim of the Mikono Safi trial, which means “clean hands” in Kiswahili, is to assess the effectiveness of a behaviour change intervention, including promotion of handwashing with soap (HWWS), among school-aged children in the Kagera Region of North-Western Tanzania in reducing both the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections. This project will design a scalable and affordable school-based behaviour change intervention to promote hand washing with water and soap at key times during the day among school-aged children in North Western Tanzania. It will assess the effectiveness of this intervention in changing hand washing behaviour and in maintaining reductions in the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections among school-aged children following a deworming programme. This project is funded by the UK Department of International Development.
Medical College & Hospital:
Weill Bugando Medical College is Tanzania’s only medical school in western Tanzania. The medical college was opened in 2003 and is located on a 52 acre campus on Bugando Hill in the city of Mwanza. The college was renamed in 2007 in honor of benefactors Joan and Sanford Weill, becoming the Weill Bugando Medical College, which now provides training for almost 400 medical students and 50 students in four Master of Medicine post-graduate programs (internal medicine, obstetrics and gynecology, surgery, pediatrics). The medical college has 60,000 square feet of teaching space including 2 large auditoriums, 12 classrooms, an anatomy dissection theatre, a teaching laboratory, faculty offices, and administrative space. Weill Bugando has a medical library that is approximately 5,000 square feet. The library has 6 staff members including chief librarian Mr. Yanga Machuma. The library currently has approximately 6,000 medical textbooks and 12 computer terminals with internet access. Weill Bugando also has access to over 7000 journals and PubMed via the World Health Organization’s HINARI program. Weill Bugando has living quarters and accommodations for faculty, residents, and students. There are 42 apartments on campus for senior faculty (12 three-bedroom, 24 two-bedroom, and 8 one-bedroom). There is also a guest house with 6 bedrooms for visiting faculty and trainees from WCMC.
The Bugando Hospital is the consultant and teaching hospital for the western zones of the United Republic of Tanzania. Situated along the shores of Lake Victoria in Mwanza City, it is a 900-bed referral hospital that oversees medical care for approximately 15 million people living in the zone. It is a referral centre for tertiary specialist care for six regions, including Mwanza, Mara, Kagera, Shinyanga, Tabora, and Kigoma. The hospital and its on-campus clinics receive over 250,000 patient visits per year, with over 43,000 admissions per year. Additionally, Bugando has a very active outpatient HIV clinic that is the referral clinic for the entire Lake Zone.
Bugando has eight buildings (A-H) interconnected with covered walkways. The main building is 11 stories; the first floor is dedicated to out-patient clinics. The second floor is administrative offices. The upper floors house patient wards with 900 beds. The basement houses 6 operating theatres. A 14,000 square foot clinical laboratory was recently renovated and relocated to a large wing of the hospital with support of the Abbott Fund, which has also renovated and improved several other critical laboratories in rural hospitals the Lake Zone region. The Abbott Fund also continues to support scholarships for Bugando’s laboratory technician students, assuring a supply of talented laboratory technicians to staff the Bugando and rural laboratories.The 24-hour/day hospital laboratory has sections for hematology, chemistry, serology, blood transfusion, parasitology, and microbiology. It houses the national tuberculosis laboratory for the region, and has capacity to perform multidrug resistant tuberculosis sensitivity testing. The laboratory has standard operating procedures for all assays and adheres to good clinical and laboratory practices.
NIMR Facilities: The Tanzanian National Institute for Medical Research (NIMR), a governmental research laboratory with over 50 research scientists has conducted medical research in the Mwanza region for 30 years. NIMR scientists regularly participate in field work and community-based studies, including large epidemiological studies and clinical trials.
The NIMR campus has three buildings. The first and oldest building is approximately 15,000 square feet and houses office and laboratory space for research scientists, statisticians, field workers, and parasitologists. The second building is the 4000 square-foot laboratory, as further described below. NIMR’s newest building was opened in July 2009, and is over 20,500 square feet. This building houses the core departments of Information and Communication Technology, Data Management and Analysis, Administration and Finance, and Laboratory Services. In addition, the building provides 35 offices for researchers and project teams, an entire wing for storage of clinical specimens and field data, conference hall facilities for 125 participants, a smaller training room that can accommodate about 40 people, and meeting rooms for up to 20 people. NIMR hosted its first international conference, entitled, “HIV Prevention—Where Now?” in July 2009.
NIMR has developed three dedicated research clinics in the Mwanza region that are closely linked with rural health centers, each of which is under the clinical oversight of Bugando Hospital. These are now being used for conduct of the Phase IIIb randomized clinical trial of the GlaxoSmithKline Human Papillomavirus vaccine and for the conduct of chronic disease research such as hypertension and diabetes. The research clinics have the capacity for data storage, processing and storage of biological samples, clinical examinations, HIV testing and counseling, pharmacies, study supply storage, reception/waiting areas for study participants, and working rooms for study coordinators. In collaboration with local health workers, these clinics also provide general physical and pelvic examinations, cervical cancer screening and referrals, family planning, pregnancy testing and referrals to antenatal clinics, screening and treatment for sexually-transmitted infections, testing and treatment for malaria, and referrals for HIV care.
The newly-built laboratory at NIMR was completed in 2003 with support from the Medical Research Council (United Kingdom) and the London School of Hygiene and Tropical Medicine (LSHTM). The facility has over 4000 square feet with eight air-conditioned rooms and dedicated rooms for hematology (full blood counts and CD4 differential counts by flow cytometry), biochemistry (full blood chemistry), serology (HIV, syphilis, Herpes simplex virus type 2), and molecular biology. The molecular biology section has the capacity to amplify DNA for Chlamydia trachomatis and Neisseria gonorrhoeae, to conduct monoclonal antibody-based ELISA tests, and to determine microorganism loads by real time PCR. It is equipped with two ABI thermocyclers, microcentrifuges, an ELISA reader, and a light cycler for real-time PCR. The lab also has two dedicated freezer rooms and one refrigerator room with a 44 KVA generator that has an automatic switch for power back-up to the laboratory.
In addition, the laboratory is equipped with a Laboratory Information Management System (LIMS) for receipt, processing, and tracking of samples. Each section of the laboratory has its own computer terminal and bar-code scanner. All samples have bar-code labels, which are essential for the laboratory to maintain the chain of custody.
The NIMR laboratory is capable of high-quality testing of up to 2000 samples per week with short turn-around time to support NIMR’s large epidemiological studies. The laboratory’s quality assurance is verified by Contract Laboratory Service (South Africa), the Centers for Disease Control (United States), the UK Quality Control for Molecular Diagnosis (United Kingdom), the AFREQUAS CD4+ Lymphocyte Proficiency Programme (South Africa), and the Royal College of Pathologists (Australia). Agreement between the NIMR laboratory and reference laboratories has been close to 100%.
The NIMR Data Management and Analysis Department was established approximately 15 years ago, and in recent years has grown exponentially in proportion to the need created by the increasing volume of trials taking place at NIMR. In 2007, the Department was given an entire wing in NIMR’s newest building. The vision of the department is to participate actively in all phases of research project development. This includes design of data collection tools, tracking of participant recruitment and follow-up, converting data from paper to electronic form, and statistical analysis of data.
The department’s new data management system, DMSys, is compliant with Good Clinical Practice (GCP) and US Food and Drug Administration (FDA) regulations. Staff in the department have been trained in the system’s use, and it has successfully been used to manage data for NIMR’s large clinical cohorts and epidemiologic studies. In the past year, the department has begun to implement the use of electronic devices for field data collection, which increases data processing capacity and minimizes transcription errors.
The Data Management and Analysis Department consists of a senior data manager, a medical statistician, three junior data managers, a data archivist, and a team of eight data entry clerks. In addition, Dr. Jim Todd is a senior statistician and a faculty member at the London School of Hygiene and Tropical Medicine who is stationed full-time at NIMR. He plays a major role in statistical analysis of data and in mentoring junior staff with the goal of building capacity in this area.
The newest building on the NIMR campus was opened in July 2009. In addition to the conference and training facilities, meeting rooms, and storage space described above, the building also has 35 offices, which can accommodate researchers, data managers and data entry staff, and statisticians. These offices are equipped with work stations that have internet access. All offices have access to a printer and copier as well.
NIMR has received numerous grants from sponsors including the Wellcome Trust, the European and Developing Countries Clinical Trials Partnership (EDCTP), the United Kingdom Department for International Development (DFID), and the United Kingdom Medical Research Council (MRC). The potential for ongoing collaboration with scientists at all levels within this organization is vast. Current research projects at NIMR include:
The Tanzama Project
This is a 15 year longitudinal community based HIV surveillance program in rural villages in the Kissessa region of Mwanza, with a population of 30,000. The study is supported by the Wellcome Trust and the Global Fund against AIDS, TB, and Malaria. Every six months, study teams conduct community based demographic, medical, and sero-surveys in rural villages. Outcomes include HIV seroincidnce and risk factors for infection, natural history of HIV disease, vertical HIV transmission rates, and the impact of new HIV prevention and therapeutic interventions. Data are stored at a data management center in Mwanza and analyzed with the assistance of on-site demographers and statisticians. This is one of the longest HIV community based surveillance programs in Africa. Dr Fitzgerald is collaborating with NIMR to introduce a nested case-control study within the Tanzama Project to examine the effect of S. haematobium infection on HIV incidence in women of reproductive age.(Se Research Strategy section for details)
Phase IIIb, Double-Blind, Randomized, Controlled, Multicenter Study to Assess the Immunogenicity and Safety of GlaxoSmithKline Biologicals HPV-16/18 L1AS04 Vaccine Administered Intramuscularly According to a Three-Dose Schedule in Healthy Female Subjects
Also known as the GSK HPV-021 trial, this project funded by GlaxoSmithKline is evaluating antibody responses against HPV-16 and HPV-18 at month 7 in participants who are 10-14 years of age and 15-25 years of age. Subjects are healthy girls and young women from schools, colleges, and family planning clinics in the Mwanza town, randomized 2:1 to receive placebo or vaccine.
Uptake and Cost-Effectiveness Rapid Syphilis Testing in Antenatal Care and the Feasibility of its Integration into Prevention of Mother-to-Child Transmission of HIV Programs in Tanzania
This study is supported by the Bill and Melinda Gates Foundation through the World Health Organization Special Program for Research and Training in Tropical Diseases. Dr Fitzgerald is a co-investigator with participation in Haiti and Tanzania. The project will determine feasibility of increasing access to antenatal syphilis screening using a same-day testing and treatment strategy. The study will also explore cost-effectiveness of introducing quality-assured rapid syphilis screening into existing Prevention of Mother to Child Transmission and other antenatal services
K24 AI098627 Fitzgerald (PI)
2012 – 2017
Global Health Research and Training in HIV and Tuberculosis
The major goal of this grant is to provide training and mentoring in HIV and tuberculosis patient-oriented research for postdoctoral fellows.
K23 AI110238 Downs (PI)
2014 – 2019
Schistosomiasis, Mucosal Immunity, and HIV Susceptibility
The goal of this grant is to provide mentored research training to Dr. Jennifer Downs who will conduct studies on the effects of schistosomiasis on mucosal immunity and susceptibility to HIV infection.
K01 TW010281 Peck (PI)
2015 – 2020
Hypertension in HIV-Infected Tanzanians: Time Course and Pathogenesis
The goal of this grant is to provide mentored research training to Dr. Robert Peck through the conduct of studies on HIV, chronic inflammation, and hypertension in cohorts of HIV infected and uninfected adults in Tanzania
Community Based Surveillance for Chronic Diseases
This is a community based field study to determine the epidemiology of chronic diseases in Tanzania funded by The Medical Research Council. The PI is Saidi Kapiga and collaborators include Dr Robert Peck (WCMC).The major chronic diseases studied are hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney diseases, and depression. 600 randomly selected adults will be enrolled from 5 different locations, (2 sites in the city, and 3 sites in rural areas).
Research Training Facilities: The NIMR center in Mwanza works closely with Weill Bugando Medical College and is dedicated to training young investigators and to building research capacity in the Mwanza region. NIMR has 30 senior investigators and a team of experienced laboratory technicians, data managers, and field workers. NIMR has had long-standing ties to the London School of Tropical Medicine and Hygiene. Dr. Fitzgerald has collaborated with NIMR researchers since 2006 with publications on natural history studies of HIV (AIDS, 2006), point-of-care syphilis diagnostics (STI, 2006) and HIV and schistosomiasis (Am J Trop Med Hyg, 2011). Collaborators include Dr. Saidi Kapiga, Mr. John Changalucha, and Dr. Jim Todd.