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, www.seshglobal.org):  Many key populations do not receive regular HIV testing. This project uses crowdsourcing to improve HIV testing among key populations. Crowdsourcing has a group solve a problem and then shares the solution with the public. The project initially focused on HIV testing among MSM/TG, but now has related projects on hepatitis testing, the meaning of recovery among PWID, and HIV cure. Opportunities for qualitative and quantitative research are available. Mentors: Joseph D. Tucker, MD, PhD; Kathryn Muessig, PhD; Rosanna Peeling, PhD.

Chlamydia infection in pregnancy – This UNC-Guangdong Provincial STD Control Center collaboration examines the impact of untreated Chlamydia infection on adverse pregnancy outcomes in Guangdong, China. This study also aims to reduce adverse pregnancy outcomes through screening and other intervention strategies. This project is led by the Guangdong Provincial Center for STD Prevention and Research Center. Mentors: Bin Yang, PhD; Shixing Tang, PhD; Heping Zheng, PhD; Joseph D. Tucker, MD, PhD; and Weiming Tang, 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, MD, MPH.

MSM-Competent Services Project: Many MSM have difficulty finding MSM-competent physicians who provide evidence-based services. This project will develop a pilot m-health platform to help link MSM and MSM-competent physicians. This project is in partnership with the Shenzhen Nanshan District Centers for Disease Control. Mentors: Joseph D. Tucker, MD, PhD, Zhenzhuo Luo, MS, Chongyi Wei, DrPH

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, MDer; Joseph D. Tuck, MD, PhD; Weiping Cai, MD.

Immunobiology of syphilis (IBIS) – This UNC-Guangdong Provincial STD Control Center collaboration examines the biological basis for the syphilis serofast state and related syphilis clinical management issues. The team has created a bio-repository of specimens, with the medium-term goals of enhancing diagnostics and developing a syphilis vaccine. Contact Arlene Sena, MD, MPH or Heping Zheng, 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

Option B+ Partner Engagement study: This behavioral randomized controlled trial is focused on comparing two approaches to Malawi’s Option B+ PMTCT program: the standard of care versus a partner engagement intervention with a goal of improving retention in PMTCT and ART services for HIV-infected women and infants as well as linking male partners to treatment and prevention services.  The coming year will be focused on completing enrollment and beginning follow-up.  Contact: Nora Rosenberg, PhD

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

FP-ART study: This 4-year prospective cohort study will compare the pregnancy rates among 1,420 HIV-infected women on Efavirenz who are initiating either the Jadelle implant or Depo injectable. The study began enrollment in August 2017. Contact: Jennifer Tang, MD, MSCR

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

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

KCH Lymphoma study: This is an ongoing longitudinal cohort, initiated in 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 are enrolled in a longitudinal cohort similar to the lymphoma study, with a focus on clinical and molecular predictors of outcomes. The study started in early 2017.  Contact: Satish Gopal, MD, MPH

Breast cancer cohort study: This study started in 2017, is developing 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: Tamiwe Tomoka, MBBS; Satish Gopal MD, MPH

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, MPH.

SOAR-Mental Health. This is an ongoing demonstration project with the goal of integrating depression screening and evidence-based treatment into ART care at two public health clinics in Lilongwe.  This project began in April 2017 and will continue through the end of 2018.

SHARP. This is a five-year project focused on mental health treatment capacity in Malawi and Tanzania.  We will conduct implementation science research focused on scaling up mental health treatment in non-communicable diseases clinics in Malawi; provide training courses in implementation science research, mental health interventions, and translation of research to policy; and support pilot projects focused on mental health implementation science and research-to-policy translation.

Sickle cell cohort: In 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.

TBM Kids: This trial is investigating the optimization of tuberculous meningitis (TBM) treatment in children hospitalized at Kamuzu Central Hospital with TBM. Children diagnosed with TBM at KCH either receive standard of care medications per WHO guidelines or receive a high dose rifampicin with or without levofloxacin within intensive phase of TBM treatment. Study recruitment began in June 2017. Target accrual for Lilongwe site is 30 patients and duration of follow up per patient is 18 months. Contact: Tisungane Mvalo, MBBS, FC Paed.

Malaria Vaccine Implementation Program (MVIP): Malawi is one of 3 countries in Africa in which there will be a pilot exercise on the administration of the RTS`S malaria vaccine as per recommendations from WHO.  The aims of this pilot exercise are: to assess the feasibility vaccination per proposed dose schedule, assess the impact on mortality in the clusters where the vaccine is administered and to further assess the safety of the RTS`S though hospital surveillance. This exercise is planned to take place across Malawi.  A consortium of research partners has been formed to carry out this evaluation of which UNC Project will primarily work in 2 districts (Lilongwe and Ntchisi). The UNC team will lead the evaluation of the safety assessment objective across all 8 sentinel district hospitals in Malawi. Vaccine administration and the evaluation exercise is targeted to commence in the third quarter of 2018.  Contact: Tisungane Mvalo, MBBS, FC Paed.

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

As a part of the program, a trainee may also develop a secondary data analysis of one of our many completed studies in collaboration with our faculty.

Vietnam

UNC PROJECT- VIETNAM          Site Director: Vivian Go, PhD

DDICRF trainees will primarily work out of the UNC Project-Vietnam office in Hanoi, where there are eleven full-time UNC affiliated Vietnamese nationals who speak fluent English. Vivian Go, PhD, associate professor of health behavior at UNC Gillings School of Global Public Health is the primary mentor based at UNC in Chapel Hill; she travels to Vietnam quarterly to work with site staff and assist with student project implementation. Vivian Go and Irving Hoffman stay in close contact with trainees throughout the year to ensure their mentored research training experience is a success. The in-country site director is Tran Viet Ha, MD, MSc, research assistant professor of health behavior at UNC Gillings School of Global Public Health and she has been working with UNC for more than ten years. Dr. Ha is involved in the day-to-day operations oversight and is available to trainees as a resource for navigating the project site.

Environment

The UNC Project-Vietnam office is located in Yen Hoa General Clinic building in Hanoi, Vietnam, where permanent UNC-Vietnam staff are based. The working space for UNC Vietnam contains office space for the in-country director and all permanent staff as well as the HPTN083 study site. There are two floors with fully functioning offices with air-conditioning, telephone and teleconferencing capabilities, photocopiers and hi-speed internet access via password-secured wifi. The HPTN083 study site is on the 2nd floor of the building. There are three well-equipped clinical rooms, a laboratory and a pharmacy room HPTN083 study activities. Apartments are available for trainees to rent in areas around the project office.

ICRF Students in Vietnam may work in the following areas: Contact for all: Irving Hoffman

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-exposure prophylaxis in HIV-negative men and transgender women who have sex with men.  The study site in Vietnam is in Hanoi, Vietnam, and anticipated start date will be December 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

Faculty from UNC and the University of Zambia (UNZA) have worked together since 1999, establishing a vibrant environment for full-time and visiting researchers. Our team currently oversees 13 research and training initiatives, focused on issues of HIV, women’s health, and local capacity building. These programs are funded by the US National Institutes of Health, the Bill and Melinda Gates Foundation, and various other sources. There are currently three full-time UNC faculty living in-country. We take an additional 2-4 trainees each year at the doctoral and postdoctoral levels. Contact: Ben Chi, MD, MSc

Environment

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

UNC has substantial dedicated research space and a containerized laboratory on the UTH campus. Our administrative offices are located approximately 1 kilometer from UTH. UNC currently employs 104 staff members in service of ongoing projects. Our trainees are involved in all aspects of research, with an emphasis on project management, data analysis, and results dissemination. We maintain a robust academic environment through regularly scheduled analysis meetings and connections to local researchers, including those from other US universities working in Zambia.

Possible studies

In 2018-2019, we are looking to recruit a medical student to work with our team on two studies investigating the role of HIV and its treatment on adverse birth outcomes. One study, the Zambia Preterm Birth Prevention Study is a prospective cohort assessing epidemiological and biological risk factors for preterm birth and other adverse birth outcomes. The second study, Improving Pregnancy Outcomes with Progesterone (IPOP), is a randomized trial of antenatal 17-alpha hydroxyprogesterone caproate to reduce preterm birth among HIV-infected pregnant women on antiretroviral therapy. Both studies are taking place at UNC’s study clinic housed within the University Teaching Hospital. Our ideal applicant would have previous experience in operationalizing research projects and at least basic proficiency in data analysis. Previous international experience is preferred but not required.

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