One key in fighting global diseases such as malaria, HIV/AIDS and tuberculosis (TB) is strengthening high-quality research programs, particularly in places where those diseases are prevalent.

UAB’s Alexis Spokes (far left), Sibylle Kristensen and Heather White (center) teach an NIH grant writing workshop in Bamako, Mali. UAB established a training program to enhance the clinical research capabilities of institutions in poor resource countries such as Mali, Uganda and India in 2003.

UAB increased its efforts in this area when it received a five-year, $5 million grant from Fogarty International, a center of the National Institutes of Health, to establish a training program to enhance the clinical research capabilities of institutions in poor resource countries in 2003.

Now, four years later, partnering institutions in Mali, Uganda and India have shown great progress, expanding their established research centers with the help and guidance of UAB faculty and staff, says Eric Chamot, M.D., Ph.D., assistant professor in epidemiology and principal investigator for the project. Mali and India have made great strides, he says, and Uganda in particular is thriving.

“We have been working on this project for four years now, and we’ve literally trained hundreds of people in Uganda,” Chamot says. “We’ve had several trainees who came here to learn go on and have tremendous impact in the field.

“There are people who are making a difference.”

The partnering institution in Uganda is Makerere University in Kampala. (All partnering institutions are identified as International Centers for Excellence in Research). A team of UAB researchers, faculty and staff led by co-principal investigator Sibylle Kristensen, Ph.D., was charged with providing training for teams in Uganda; that included bringing some to train here at UAB from the partner sites. Kristensen’s teams had to determine elements needed to strengthen Makerere University’s capacity to do HIV/AIDS research. That included identifying the most crucial needs of the university, who needed to be trained and the kind of training needed.

“The University of Makerere was well established. In fact, many of the landmark studies about HIV/AIDS in Africa first were conducted there by Nelson Sewankambo, the dean of the School of Medicine and a pioneer in HIV/AIDS research in Africa,” Chamot says. “But their program was relying on a small number of investigators and research personnel. They needed help.”

Strategic support
The NIH has been a strong supporter of the research at Makerere University, the University of Mali in Bamako and the Tuberculosis Research Center in Chennai, India. UAB was selected to help consolidate a strategic, long-term partnership between the National Institute of Allergy and Infectious Diseases (NIAID) and the three institutions. The program has four training components: degree training at UAB for young investigators, short-term courses at UAB in clinical research methods and techniques for researchers and support staff, on-site training for research teams and distance learning via the Internet. The program also aids the institutions in competing for additional grant funding.

The NIH and other international funding agencies require strict compliance with guidelines governing clinical trials, and a large portion of the training focuses on teaching the researchers the complexity of the guidelines. “This guarantees the quality of the research work,” Chamot says.

Typical training grants are focused on young researchers expected to develop outstanding careers as researchers. Money is provided for them to pursue a doctoral degree and work with well-known U.S. researchers as mentors, Chamot says. This grant, however, wasn’t intended to focus on individuals, but, rather, institutions. It also wasn’t exclusively aimed at young scientists, but instead targets mid-level research staff and managers.

“Lab supervisors, people in charge of quality control, administrators familiar with NIH rules on grant management and nurses — because they play an important role in implementing research projects — are what our program is about,” Chamot says.

Looking ahead
Each site has key research projects planned for the coming years. New malaria vaccines are available for testing and small clinical trials already are under way in Mali. In Uganda, a large study conducted in recent years has confirmed that circumcision seems to reduce HIV transmission by almost 50 to 60 percent.

“Because of this study the NIH and the Ugandan government would like to try and implement a program, at least at the regional level, to propose circumcision as an option to adult men,” Chamot says. “This will lead to major pilot-research programs in the coming years.”

Uganda, one of the first countries in sub-Saharan Africa to experience the devastating impact of HIV/AIDS and to take action to control the epidemic, is one of the rare success stories in a region that has been ravaged by the HIV/AIDS epidemic, according to the World Health Organization.

While the rate of new infections continues to increase in most countries in sub-Saharan Africa, Uganda has succeeded in lowering its very high infection rates. Since 1993, HIV infection rates among pregnant women, a key indicator of the progress of the epidemic, have been more than halved in some areas, and infection rates among men seeking treatment for sexually transmitted infections have dropped by more than a third.

The NIH and NIAID hope the project spearheaded by Chamot and UAB, which has aided in these successes, will continue past next year when the grant expires, but whether it will or not has yet to be decided.

“The NIH desperately would like to continue, but they just don’t know where to find the money currently,” Chamot says. “They are under a much tighter budget. Hopefully the funds will come through because the successes there now are just the beginning.”