Doris Duke International Clinical Research Fellowship

The Doris Duke International Clinical Research Fellowship (ICRF) is designed to encourage medical students to pursue clinical research careers by exposing them to exciting research opportunities in developing countries.  Students who are matriculated at any U.S.-based medical school are eligible for this opportunity.

Program Overview

Students who participate in the ICRF program will take a year off from medical school to conduct international clinical research under the direction of a mentor working in global health.

Each fellow will work with a mentor to formulate a specific research project, write up the protocol, and follow the protocol through the relevant approval processes. The student will then take primary responsibility for initiating and conducting the study.

The University of North Carolina at Chapel Hill places Doris Duke fellows in ChinaMalawi, Vietnam and Zambia.

Application instructions are below. Questions about the ICRF at UNC should be directed to Program Manager Kathryn Salisbury or Principal Investigator Irving Hoffman

 

Site Descriptions and Programs

China

UNC PROJECT-CHINA          Site Director: Joseph D. Tucker, MD, PhD

UNC has a long history of collaborative health research, service, and training in China.  The mission of UNC Project-China is to work collaboratively to improve the health of China and promote UNC-Chapel Hill’s presence in China. UNC faculty, students, and trainees are leading research on non-communicable diseases, HIV and STIs, maternal and child health, and other global health areas.

China has tremendous inequalities and unique capacity for public health implementation, providing a dynamic and rich environment in which to pursue mentored research through the Doris Duke program.  China’s rapid resurgence of sexually transmitted diseases creates opportunities for clinical, epidemiological, behavioral, and basic science research focused on sexual health.  Large funded projects supported by the NIH, WHO, and Gates Foundation create opportunities for students to carve out parallel mentored research.

Students interested in working with UNC Project-China must demonstrate proficiency in Mandarin (preferable) or Cantonese during an in-person interview.

ICRF China students will work in Guangzhou, Nanjing or Beijing, depending on the project. Contact Joe Tucker, MD, PhD to discuss the opportunities below.

Social entrepreneurship for sexual health (SESH):  New models of care are needed to expand HIV/syphilis screening among men who have sex with men and other most-at-risk populations.  In cooperation with local and regional community-based organizations, this project focuses on evaluation of health, social, and business metrics associated with innovative HIV and syphilis testing programs.  For example, examining how social marketing and crowdsourcing influence the success or failure of HIV testing programs.  Opportunities for qualitative and quantitative research are available. Mentors: Joseph D. Tucker, MD, PhD; Kathryn Muessig, PhD; Rosanna Peeling, PhD.

Social Science and Ethics of Curing HIV: Curing HIV is now a priority of the International AIDS Society and the US National Institutes of Health.  Clinical trials have already started in many sites, including Chapel Hill.  This research project examines the social, anthropological, ethical, and policy implications of cure HIV research.  The coming year will focus on stakeholder policy analysis to better understand the unintended implications of cure HIV research. Mentors: Stuart Rennie, PhD; Joseph D. Tucker, MD, PhD

African Migrant Health Project in Guangzhou:  There are over 100,000 African migrants in Guangzhou, but access to health services is limited by a number of cultural, linguistic, and other barriers.  Local colleagues have established a clinical service for Africans in the Xiaobei Lu area.  Building on this foundation, this project examines biomarker and behavioral aspects of this subpopulation in order to provide high quality migrant health services.  The project also examines how larger foreign policy questions and trade issues influence health and wellness. Mentors:  Joseph D. Tucker, MD, PhD; Li Ling, PhD.

Sexually Transmitted Infections: China has a resurgent syphilis epidemic and some of the highest rates of purchasing sex among urban men of anywhere in the world. The Guangdong Provincial STD Control Center plays a key role in organizing a response to STIs in Guangdong, a southern province with a high syphilis burden.  This provides unique opportunities for clinical, behavioral, epidemiological, and modeling STI research. Mentors: Ligang Yang, MD, MS; Heping Zheng, PhD; Bin Yang, MD, MS; Arlene Sena-Soberano, MD, MPH.

HIV-HCV Co-infections: The Number Eight Hospital in Guangzhou sees over 3700 HIV-infected patients and has detailed data on a cohort of HIV-HCV co-infected patients.   Clinical, behavioral, and basic science research opportunities are available. Mentors: Stanley Lemon, MD; Joseph D. Tucker, MD, PhD; Weiping Cai, MD.

Methadone Maintenance: A province-wide system of methadone maintenance clinics regularly engages over 15,000 individuals and provides opportunities for infectious disease testing, treatment, and retention among drug users.  This project led by the Sun Yat-sen Center for Migrant Health Policy explores the methadone system and its optimization. Mentors: Li Ling, PhD, Joseph D. Tucker, MD, PhD.

Malawi

UNC PROJECT – MALAWI           Site Director: Mina Hosseinipour, MD, MPH

UNC has had a presence in Malawi since 1990. UNC Project-Malawi, a collaboration between UNC and the Malawi Ministry of Health, was established in 1999 on the campus of Kamuzu Central Hospital in Lilongwe. UNC Project has grown to include more than 300 employees with research, clinical and laboratory space, and living quarters for students and visiting faculty. UNC Project’s current portfolio of activities spans clinical service delivery, public health program implementation, and clinical and operational research focused on HIV and STDs, other infectious diseases such as malaria and tuberculosis, emergency obstetrics, cancer, family planning, surgery and trauma.

ICRF Students in Malawi may work in the following areas:

Option B+ PMTCT study: This study evaluates the safety of first and second line treatments among HIV infected pregnant women and their infants. There are multiple aims related to safety, viral suppression, opportunistic infection, neurocognitive development of infants, and understanding defaulters.   This takes place in 2 clinics in Lilongwe. Contact: Mina Hosseinipour, MD, MPH

iKnow study: This is looking at finding acute HIV patients in the STI setting and arranging for partner and social contacts of these patients to determine strategies for preventing onward HIV transmission in high risk groups. Contact: Bill Miller, MD, PhD

Adolescent Health study (POWER): This pilot study will evaluate strategies to engage high risk young women (aged 15-24) in sexual and reproductive health services with a focus on HIV prevention.  This will operate in four clinics in Lilongwe. An antiretroviral therapy pre-exposure prophylaxis demonstration project may be added to this study. Contact: Nora Rosenberg, PhD

Partner Notification study: This randomized controlled trial will focus on evaluating two strategies for engaging men in HIV testing and reproductive health services with a goal of improving retention in PMTCT and ART services for women as well as linking men to care.  The coming year will be focused on completing enrollment and beginning follow-up.  Contact: Nora Rosenberg, PhD

Bubble CPAP study: This study will evaluate the efficacy of bubble CPAP for prevention of mortality in children with severe pneumonia, aged 1-59 months.  This study will take place in Salima district hospital. Contact: Eric McCollum, MD

KCH Lymphoma study: This is an ongoing longitudinal cohort, initiated in June 2013, of adults and children with pathologically confirmed lymphoproliferative disorders receiving standardized treatment under local conditions at Kamuzu Central Hospital. The study focuses on clinical presentation, treatment, and outcomes, with embedded virologic, biomarker, and genomic correlative studies, and includes a pilot clinical trial evaluating safety and efficacy of the anti-CD20 monoclonal antibody rituximab in this environment.  Contact:Satish Gopal, MD, MPH

Kaposi sarcoma cohort: Patients with KS at Lighthouse Trust and the KCH Cancer Clinic will be enrolled in a longitudinal cohort similar to the lymphoma study, with a focus on clinical and molecular predictors of outcomes. The study is anticipated to start in the 3rd quarter of 2016.  Contact: Agnes Moses, MBBS, MMED

Breast cancer cohort study: This study is anticipated to start in the 3rd quarter of 2016, and will develop a clinically annotated cohort of breast cancer cases at Kamuzu Central Hospital. It will establish a tumor block repository for future molecular and genomic characterization and collect data from patients on risk factors and post-treatment outcomes.  Contact: Clara Lee, MD.

Malawi HIV-cancer match study: Data from the Malawi National Cancer Registry are linked to HIV cohort data in a large epidemiologic study to assess cancer burden in the HIV-infected population and changes over time with availability of antiretroviral therapy. Contact: Satish Gopal, MD. Email:Satish Gopal, MD, MPH

Sickle cell cohort: In January 2015, we initiated hemoglobin electrophoresis capabilities in Lilongwe and established a longitudinal cohort of children with confirmed sickle cell disease to better understand clinical features and natural history of this disease in this environment. Contact: Kenneth Ataga, MBBS.

Depression Case Management in HIV: This two clinic pilot study will evaluate models for depression care management among HIV infected patients as a strategy to improve HIV adherence and suppression.  Contacts: Brian Pence, PhD or Mina Hosseinipour, MD, MPH

Community-facility linkage study:  A retrospective cohort study enriched by epidemiological sampling methods to characterize widely adopted community-facility linkage models and assess their impact, compared with each other and to the standard of care, on mother-infant pair care retention and other priority maternal-infant health outcomes in the context of Malawi’s Option B+ program. Anticipated start February 2017. Contact: Michael Herce, MD, MPH, MSc or Innocent Mofolo, MSc

Note, Dr. Anthony Charles oversees the trauma registry in-country.  Fellows can speak to him directly regarding surgical research topics. 

Vietnam

UNC PROJECT- VIETNAM          Site Director: Vivian Go, PhD

DDICRF Fellows will primarily work out of the UNC-project Vietnam office, where eight full-time UNC employees who are Vietnamese nationals that speak fluent English are based. Dr. Vivian Go, PhD, associate professor of health behavior at UNC Gillings School of Global Public Health will be the primary mentor and is based at UNC in Chapel Hill. Dr. Go travels to Vietnam quarterly. The project director is Dr. Ha, who has been working with UNC for more than ten years, who is also be the on-site supervisor/contact. Hanoi is a beautiful, culturally vibrant city. Apartments are available that are walking distance to the office.

Environment

The UNC-Vietnam office building is located in Hanoi, Vietnam, where the permanent UNC-Vietnam staff is based. It is a fully functioning, furnished 4-floor office building with air-conditioning, telephone and hi-speed internet access via password-secured wifi. The building contains offices and office space for the Project Director and all permanent staff. A large conference room on the fourth floor with fully functioning audio-visual equipment is available to all staff. There are also a number of extra cubicles that may be used by visiting investigators and colleagues. All staff offices are equipped with desktop or laptop computers and printers, and the building is equipped with a copier, fax machine, and scanners. The offices have several locking cabinets where project files are stored.

ICRF Students in Vietnam may work in the following areas: Contact for all: Vivian Go, PhD 

HPTN 074: Multi-site, two-arm, randomized vanguard study in Ukraine, Indonesia and Vietnam to determine the feasibility of a future trial that will assess whether an integrated intervention combining psychosocial counseling and supported referrals for antiretroviral therapy at any CD4 count and substance use treatment for HIV-positive people who inject drugs (PWID) will reduce HIV transmission to HIV-negative injection partners as compared to routine care according to national guidelines for HIV-positive PWID. There are two study sites in Thai Nguyen, Vietnam.

HPTN 083: Multi-site study in 41 sites, 7 countries, to evaluate the efficacy of the long-acting injectable agent, cabotegravir for pre-expsorue prophlyaxis in HIV-negative men and transgender women who have sex with men.  The study site in Vietnam will be Hanoi, Vietnam, and anticipated start date will be March, 2017.

HCV integration: Small qualitative study to examine the barriers to integration of HCV screening services in HIV clinics in Hanoi and/or Thai Nguyen Vietnam.

HIV positive MSM: Pilot intervention using electronic and mobile apps to engage HIV-positive MSM in the HIV continuum of care in Hanoi, Vietnam.

Hazardous Alcohol Use Among Female ART clients: Sub-study of our current comparative effectiveness trial of two evidenced-based alcohol reduction programs among ART clients, to understand the intersection of HIV and alcohol consumption unique to hazardous drinking among women.  This study would involve secondary quantitative analysis from our current dataset and qualitative data collection and analysis in the form of in-depth interviews with a sub-sample female participants enrolled in our study.

Zambia

University of Zambia School of Medicine      US-based contact: Benjamin H. Chi, MD, MSc

UNC/UNZA School of Medicine has a long history of hosting visiting trainees and faculty in support of its central mission to provide education and training in health sciences in order to address current and emerging health needs. In addition, with its strong ties to the Ministry of Health, the School of Medicine provides access to government health facilities for its collaborative research. This function is critical for mentee research at the University Teaching Hospital and surrounding primary and secondary care facilities in Lusaka. UNC fellows and faculty living in Zambia have appointments at UNZA and support its clinical, research, and training activities.  There are two full-time UNC affiliated faculty living in-country and two UNC Global Women’s Health Fellows who are board-eligible Ob/Gyns. The US-based leadership contact is Benjamin H. Chi, MD, MSc

Environment

The UNZA School of Medicine and its accredited teaching hospital, the University Teaching Hospital (UTH), comprise the principal medical training institution in Zambia for medical students, interns, and postgraduate doctors. Post-graduate physician training is available in the Departments of Anesthesia, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Surgery, and Pathology. UTH trains nurses and midwives through the Nursing School located within the hospital grounds and clinical officers (physician assistants) through their college located at Chainama Hills College Hospital in Lusaka. UTH has approximately 2,000 beds. The Cancer Diseases Hospital, built in 2007, offers the country’s only cancer treatment via medical oncologists, radiation oncologists, and surgeons. The Department of Obstetrics and Gynecology (OBS/GYN), led by Dr. Bellington Vwalika, provides in-patient and outpatient services to women in Lusaka and those referred from outlying districts and provinces.

17P study: Randomized trial of 17-alpha hydroxyprogesterone caproate to reduce preterm birth among HIV-infected pregnant women on antiretroviral therapy

Vaginal progesterone study: Feasibility and acceptability of vaginal progesterone among HIV-infected pregnant women at elevate risk for preterm birth

HIV prevention in pregnancy: Systematic review and formative mixed methods research to design a combination HIV prevention package for pregnant and breastfeeding women in Zambia and Malawi

ABLATION: Randomized trial to determine the acceptability, safety, and efficacy of a Liger Thermal Coagulator (a portable, hand-held thermo-coagulation device) for cervical cancer prevention in Zambia

DIGI-SCOPE: Validation of transvaginal colposcopy using a small, portable, and low-cost instrument with embedded digital camera

 

Application Procedure

We are currently accepting applications for the 2016-2017 fellowship year.  Please apply through the Doris Duke International Clinical Research Fellows Portal. There are full instructions and a link to the universal application. Application deadline dates will become available in the fall of 2016.

To complete your application for the UNC DDICRF, please email the following supplemental information to Kathryn Salisbury at kathryn_salisbury@med.unc.edu

  1. Rank your preference of research sites affiliated with the UNC DDICRF (China, Malawi, Vietnam and Zambia).
  2. Do you have Chinese language skills (Mandarin, Cantonese)? And is China your preferred site?

Questions? 

Please contact program coordinator Kathryn Salisbury at kathryn_salisbury@med.unc.edu