Uganda-CWRU Research Collaboration 20th Anniversary Celebration

Yesterday I had a fortunate opportunity to get a broader sense of the important history and work occurring at my research site, a once in a decade opportunity in fact.  On Monday and Tuesday, scientific meetings were held at the Hotel Africana in celebration of the 20 years Case Western Reserve University has been in partnership with Makerere University/Mulago hospital. I was able to attend yesterday’s events.

 

Everyone affiliated with the collaboration was invited to yesterday’s events – literally everyone – including janitorial staff for the Case/Mulago offices. I think in a way I had unknowingly taken for granted this collaboration until I learned its uniqueness according to those who presented, last of which was the Vice President of Uganda. For example, you’ll see Dr. Christine Sizemore’s (chief of the Tuberculosis and other Mycobacterial Diseases Section in the NIAID Division of Microbiology and Infectious Diseases) name in my “NIH training” posts since she gave a tuberculosis lecture in Bethesda in July. I had the chance to meet her again yesterday after her presentation about the collaboration from an NIH perspective. She told me afterwards as we were walking that the Uganda-CWRU TBRU (Tuberculosis Research Unit) collaboration is one of the most unique in Africa for the NIH. She said the Ugandan leadership in general has been a gold standard. Whereas at many other NIH-funded research sites internationally the US researchers lead the majority of the research work, Uganda is a shining distinction in that the Ugandan researchers are exceptionally trained (they receive training here and in the US) and lead the majority of the research in the collaboration.

 

I had not realized this. I just assumed what was happening here, the type of partnership, hierarchies, and delineations of US/Ugandan divisions of responsibility, was the same elsewhere. Apparently, that is not the case. Dr. William MacKenzie from the US Centers for Disease Control (CDC) further emphasized the uniqueness and success of the Uganda TBRU. It is one of only 4 international sites funded by the CDC for the TBTC (Tb Trials Consortium) and one of 2 in Africa period. One of the US researchers presenting called it the “most efficient Tb research site internationally” with 90% of patients enrolled in one particular study being enrolled correctly to protocol and with Ugandan research participants accounting for 47% of the study patients from this multi-site international trial. That particular speaker summarized the Ugandan collaboration this way, “Good science, good clinical care.”

 

We heard presentations from a number of Ugandan professors and researchers as well as researchers from the USA.

Dr. Alphonse Okwera presenting

Dr. Alphonse Okwera presenting

 The speakers were not just from the biological sciences either. We had 3 presenters talk about the twenty years of social and behavioral studies in light of the collaboration’s funding of social science work surrounding HIV issues. One of the US researchers present at the formation of the collaboration, for example, researched Ugandan attitudes towards vaccinations in preparation for an AIDS vaccine trial. Combining social impacts and assessments of research is important to the collaboration.

 

 

 

 

The intersections of cancer, HIV, and Tb were discussed much yesterday. As HIV becomes more chronically managed here, issues of HIV-related malignancies become more and more relevant. Discussions of research mapping the intersections between infectious disease and oncology highlighted new directions in research. Implementation research is still needed for delivering quality HIV and Tb treatment to all, but the future will be in chronic disease research, as it currently is in the USA right now.

 

A number of well known researchers were present or referenced throughout the day. One of the speakers scheduled Dr. Peter Mugyeni, stood on the President Bush’s left when the PEPfAR bill was signed originally. One speaker referred to Dr. Sten Vermund, one of the directors of the program that brings my colleagues and me to our respective Fogarty sites around the world this year. The last speaker of the day was the Vice-President of Uganda, Dr. Gilbert Bukenya who was surrounded by security detail and all.

Uganda vice-president Bukenya

Uganda vice-president Bukenya

He emphasized the importance of the collaboration in light of its history which he was a part of from the outset. (The VP was a former dean and professor at Makerere University School of Medicine.) There was a lot of to-be-expected “patting oneself on the back” in the celebration, and as the day went on, it was clearly appropriate, to say the least, given the challenges, risks, and extremely hard work of the Ugandans and Americans over the past 2 decades. When the collaboration started back in the late 1980s Uganda was not in an ideal state politically or in terms of infrastructure – the collaboration was a risk, but one that has ultimately benefited study participants/patients, health care capacity building and research training for Ugandans, and the furthering of scientific knowledge, especially in Tb and HIV.

Ndere troupe performing in between speeches

Ndere troupe performing in between speeches

 

I have to say that the glue that holds the collaboration’s success together, from what I could tell from people’s comments and my short time here, is the Fogarty AITRP (AIDS International Training and Research Program) and state of the art laboratory facilities available through the NIH funding. To date this program has allowed 53 Ugandans to train at CWRU for masters and doctoral level programs in immunology, anthropology, epidemiology, microbiology, and virology. Fifty of the 53 have returned to Uganda. The relationship between the high caliber of research and those leading it, most who were part of the AITRIP training, could not have been clearer. My mentor, Dr. Chris Whalen, has been an instrumental and crucial part of that program. Today I learned that the risks have paid off thus far in the dividends of capacity building and quality research. This collaboration has “trained the trainer” and because of it, its productivity and sustainability (provided international funding continues) is strong. One of the Ugandan researchers call for more AITRP funding received resounding affirmations from the audience. The collaboration has resulted in AITRP trained individuals co-authoring over 389 peer-reviewed journal articles, 115 of which had AITRP trained Ugandans as first authors. There is always a tug of war actually and conceptually between clinical emphasis and research emphasis when working in resource-constrained settings. Yet, the research here has translated into better patient care at the very least.

 

What does this all mean? Well to me, capacity-building means more Ugandans caring for Ugandans with the state-of-the art arsenal of knowledge to do so in a resource-constrained environment. It means local approaches to research design and implementation and more of a truer sense of “collaboration.” And it turns challenges parental arguments from high-income countries that low-income countries cannot undertake such endeavors. Additional implementation methods of transparency and accountability further solidify this project’s success.

 

Uganda’s advancement during the past 20 years was noted in the same way. Twenty years ago the discussions were about “no care which to access” to present discussions of securing “access to care” for all Ugandans. I think the most important of the public recognition made on several occasions thanking the patients/participants. At the end of the day, for all the successes and markers of success, the event was patient-centered.

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