The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

This activity is related to the University of Zambia School of Medicine (UNZA SOM) activity.

The Vanderbilt University-University of Alabama at Birmingham AIDS International Training and Research

Program (VU-UAB AITRP), led by Dr. Sten Vermund, has played an important role in the development of

research capacity in Zambia. Twenty-five Zambians have been trained at the Master of Public Health (MPH)

level at UAB since 2000, of whom all 25 are still working in Africa. Over 500 Zambians have been trained in

-country and over 40 Zambians have been trained in short-courses at UAB or Vanderbilt. The program has

been instrumental in strengthening the ability of Zambian investigators to take part in large-scale public

health evaluation, service, and research projects, take on leadership positions in initiatives such as

PEPFAR, and apply for additional research and public health service funding. VU-UAB-AITRP in-country

trainees will continue to sustain the current service, research, and training efforts, even once the AITRP

training funds are exhausted because considerable attention has been given to sustainability.

Since the program's implementation, there has been a high demand for additional primary training as well

as continuing education for those who are already trained and to continue building institutional capacity in

Zambia. Since the beginning of its collaboration with the University of Zambia (UNZA) and the University

Teaching Hospital, the VU-UAB AITRP has continued to work closely with these institutions and the

University of Alabama at Birmingham Sparkman Center for Global Health to build medical informatics

capacity, to provide biostatistics training at the UNZA, and to improve the overall climate for research with

donated journals, guest seminars, and research consultation in Zambia.

The goal of this FY 2008 activity is to build institutional and individual research capacity and sustainability in

biomedical and behavioral research focused on HIV-related research and programs in both prevention and

care. This activity has as its overarching objective the development and training of Zambian clinical

investigators to be leaders in independent investigation of relevance to PEPFAR and other vital HIV/AIDS

treatment and prevention services and programs.

The specific aims are: 1) to train a new generation of HIV/AIDS research leaders in Zambia through bi-

annual week-long workshops in Zambia that will focus on research skills, scientific writing for publication,

and proposal development; these workshops will be aimed at persons in academia, Government of the

Republic of Zambia (GRZ), and/or non-governmental organizations, who are best placed for future

leadership in research and public health; 2) to promote the initiation of new prevention research that

complements and facilitates existing international service and research endeavors between US and foreign

investigators, and builds long-term collaborative relationships among international scientists; and 3) to track

and document the long-term impact of training on Zambian trainee careers, training and research capacity

of home institutions, and impact of conducted research at institutional, regional, national, and global levels.

The FY 2008 funding will support two separate, but linked activities.

Activity One: Two short courses will be conducted in research skills and scientific writing to support

HIV/AIDS related research efforts in Zambia. The basic conceptual design of these training programs will

be both didactic and practical. Basic didactic coursework will be conducted in the morning. The afternoons

will be devoted to hands-on applications of the materials to reinforce research skills; hands-on applications

through data set manipulation, data analysis, case studies, or small group projects that are critical to skill

building. The impact of the training program on the trainees will be assessed with the help of a pre- and

post-test evaluation as well as a follow-up assessment after one year post-training. Immediate post-test

evaluation will be based on the participants' understanding of concepts as evidenced by homework,

participation and group dynamics, as well as project assignments. One-year evaluations will be based on

perceived relevance and evidence of implementation of their acquired research skills in their work setting.

Trainees will be awarded certificates of completion at the end of the workshops. The target for this training

is persons who have already been trained in core methodology through the AIDS International Training and

Research Program or a comparable training experience. We will identify persons currently working in public

health evaluation and research as well, who may have on-the-job research training but are in need of

enhanced skill-building. An experienced team from Family Health International (FHI) is working with Dr.

Vermund to ensure that the training builds on successful models. We target 20-30 trainees in each of the

two courses.

Activity Two: the Master of Medicine (MMed) program is a degree taken in parallel with post-graduate

residency training. This degree involves a research project and a full MMed thesis. In the ten-year

experience of Dr. Vermund working in Zambia, the program did not meet its didactic goals in perhaps 90%

of its graduates, as demonstrated by the poor methodology used for MMed research projects, the

sometimes trivial research questions engaged, and the inability to get MMed project published. While the

infrastructure is there to encourage research, it is inhibited by inadequate supervision and mentorship, a

lack of funds to do the work, and a failure to bridge effectively to existing research projects. We propose the

use of graduates of research training programs, such as AITRP, to be assigned as MMed mentors to

existing MMed students, establish (with partnership of several US universities working in Zambia) a seminar

series led by Zambians and facilitated by Vanderbilt and its partners, and provide support for Zambian

faculty members at the UTH/UNZA to have more effective teaching materials at their disposal. Advanced

MMed students will participate in the training represented in our first activity. Our emphasis in training will

be in monitoring and evaluation of care and treatment, quality of health care, and HIV prevention including

PMTCT and behavior change. We seek to provide relevant and sustainable research and evaluation skills

for 12-15 students annually who will develop, conduct, and publish research projects and public health

evaluation results in peer review journals. This activity will complement a similar 2008 effort to strengthen

the UNZA MPH program.

The FY 2008 funding will enable VU-UAB AITRP, in collaboration with CDC Zambia, to explore effective

ways to build human capacity in the areas of social work, physiotherapy, and community based health

workers. Increasing the capacity of workers in these areas is critical to sustaining programs in HIV/AIDS

prevention, treatment, and surveillance.

Activity Narrative: Since research and public health evaluations cover diverse themes, we consider our impact to be on the

General Population (Infants and pregnant women, Children and Adolescents of all ages), and all adults. We

know that our trainees are working with Discordant Couples, People Living with HIV/AIDS, Pregnant

Women, and Orphans and Vulnerable Children. Institutions that we expect to impact include: UTH, UNZA

School of Medicine, UNZA School of Nursing, Elizabeth Glaser Pediatric AIDS Foundation/Center for

Infectious Disease Research in Zambia (EGPAF/CIDRZ), the Zambia Exclusive Breast Feeding Study

(ZEBS) in Lusaka, and the Tropical Diseases Research Centre (TDRC) in ‘Ndola.