Kim Mwamelo, MPH '17, leads the TDI graduation procession at Dartmouth's 2017 Commencement ceremony.
Tuberculosis remains a leading cause of death among persons living with HIV (PLWH) in Tanzania. In 2019, of the 27,000 adult and child deaths among PLWH in Tanzania, an estimated 12,000, or 44%, were TB-related. Epidemiologic and operational research to improve prevention and treatment of both adult and pediatric HIV-TB is a defined national priority, and was confirmed as the largest training gap in our pre-proposal needs assessment, but there is no specifically designated and staffed institute to plan, coordinate and conduct such research. The objective of MIDI is to provide the training to develop a premier clinical and operational research infectious disease institute at Muhimibili University of Health and Allied Sciences (MUHAS), with a first focus on advancing research in HIV-TB. MUHAS leadership, the Tanzanian National Tuberculosis and Leprosy Programme (NTLP), National HIV/AIDS Control Programme (NACP) and former Fogarty trainees have all contributed to planning the new institute.
The program will consolidate the expertise of past Fogarty trainees with a new focused plan to train the requisite MUHAS faculty to affiliate with MIDI. The institute is based in a newly renovated office space in the Centre for Health Professions Education (CHPE) building on the MUHAS campus. The initial faculty core at MUHAS (Director, Associate Director) will be augmented by the addition of trainees who will complete the following degrees determined to be necessary for providing the necessary research expertise for the institute: 3 PhD candidates in biostatistics and/or epidemiology, 1 in biomedical data sciences, and 2 junior faculty with focused grant-writing training.
Additional short and medium term training in HIV-TB updates, HIV-TB monitoring and evaluation, and data analysis using R programming for infectious disease research, and HIV-TB research methods will be provided for investigators. Pilot grant funding will be available for HIV-TB research projects and investigators will coordinate efforts through regular research seminars at MUHAS linked by teleconference to Dartmouth and BU. Short-term training will also be offered to NTLP and NACP leaderhip and researchers to link MIDI and Minstry of Health research efforts and skills. Defined performance measures focused on development of independent HIV-TB research capacity have been developed and will be monitored.
A targeted candidate pool will be recruited from junior faculty and trainees at MUHAS, prior Dartmouth-BU-MUHAS/Fogarty alumni, and public presentations and focused advertising. Performance sites for research will include adult and pediatric DarDar Programs, NTLP clinical sites, and active MUHAS clinical research sites. MIDI faculty have extensive experience in HIV-TB research, actively funded research projects, and wide experience training and mentoring junior colleagues. A senior Training Advisory Committee provides expert consultation to the program. After 5 years, MIDI will have set HIV-TB research priorities for Tanzania and have secured independent funding for research on these priorities.
The overall goal of the Dartmouth/MUHAS Research Ethics Training and Program Development for Tanzania (DMRET) is to expand existing expertise in research bioethics among all individuals engaged in the research enterprise at Muhimbili University of Health and Allied Sciences (MUHAS) and throughout Tanzania and the entire east sub-Saharan Africa region. The program has progressed from an absence of any program or individuals trained in Research Bioethics to an increasingly robust entity that includes a successful training program with several cohorts of Master in Bioethics (MBE) graduates and a vital Department of Bioethics and Professionalism at MUHAS. Program graduates have now entered the workforce and created a large community of ethics professionals at institutions across the country, who contribute to an expanding research enterprise. The program faculty now provide teaching across the institution, serving as the main source of bioethics training for all MUHAS students, and they are expanding their expertise through their own PhD education and a number of active collaborations with other programs. These developments are both an impetus for, and in many respects a result of, a strong region-specific program in Research Bioethics. Over the next five years we will expand and strengthen ethics scholarship at MUHAS, and across Tanzania and the region.
The specific aims are to:
The overall goal of this collaborative training program was to strengthen and expand the capacity of Muhimbili University of Health and Allied Sciences (MUHAS) to better manage their portfolio of existing and future research grants. Dartmouth and the University of California San Francisco (UCSF) assisted MUHAS by providing training and mentorship to its new Office of Sponsored Programs (OSP) through intensive residency internships at Dartmouth and USCF, in-country short-term training programs and distance learning.
The specific aims were to:
Fogarty Africa Consortium on Tuberculosis (FACT) was created in 2010 as a collaboration between the Dartmouth-BU AITRP (Tanzania) and the Georgia-Case Western Reserve AITRP (Uganda). The goal of FACT is to connect current and former Fogarty trainees from East Africa in a south-south research network and to develop priorities for clinical, epidemiologic and programmatic tuberculosis research in the region.
The first annual one day research meeting was held in Dar es Salaam in 2010 and the second annual meeting in 2011 in Kampala. The program included research lectures, study design discussions and a poster session. Annual meetings alternate between Dar and Kampala, and since 2012 has expanded to include other East African Fogarty trainees.
The overall goal of our project was to establish new and strengthen existing expertise in IRB management and training among research scientists, faculty, health care providers and other professionals at MUHAS and throughout Tanzania. Building on Dartmouth’s long-standing collaboration with the MUHAS Research Ethics Committee (REC), this grant allowed us to assist the REC to the next step in development. Further, Dartmouth has established research and training collaborations in Tanzania on which to build innovative IRB support programs.
The specific aims were to:
Although the grant has concluded, Dartmouth continues to support the trainings of MUHAS REC and MUHAS faculty regarding bioethics issues through two annual, onsite training programs that are supported by the DMRET grant.
The Dartmouth-Boston University HIV training research collaboration was established in 2003 with support through HIV training grants from the Fogarty International Center at the National Institutes for Health to provide advanced HIV and tuberculosis research training to physicians, scientists and other health care professionals from Tanzania.
The principal collaborating partner in Tanzania has been the Muhmibili University of Health and Allied Sciences (MUHAS), and additional collaborations have been established with the National Institute for Medical Research and the Ministry of Health. Geisel School of Medicine at Dartmouth, The Dartmouth Institute, and the Boston University School of Public Health offer masters and doctoral level degree training in basic science research, epidemiology, health sciences research, and pharmacology.
In Tanzania the Dartmouth-BU Fogarty program sponsors selected advanced degree programs at MUHAS and offers 1-3 day conferences and workshops on issues on HIV and tuberculosis. Short term training in a variety of HIV- and TB-related topics is also offered. A south-south research collaboration known as the Fogarty Africa Consortium on Tuberculosis (FACT) was established in 2010 in collaboration with the Georgia-Case Western Reserve AITRP in Uganda.