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 the ICRF.

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 Malawi, Zambia, and China.

Application instructions are below. Questions about the ICRF at UNC should be directed to program coordinator Kirsten Leysieffer, kirsten_leysieffer@med.unc.edu.

Site Descriptions and Programs

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 research portfolio includes HIV and STD research, other infectious diseases such as malaria and tuberculosis, cancer, obstetric fistula, family planning, surgery, burns, and trauma.

ICRF students in Malawi may work in the following areas:

Treatment of HIV: The Malawi ART program, initiated in 2004, has now evolved to provide more comprehensive integrated services including family planning, cervical cancer screening, tuberculosis screening and treatment, pre-ART, isoniazid preventive therapy, mental health management, and other prevention programs. Fellows may develop projects focused on outpatient program evaluation of existing services or models of integration within the program. Additionally, we are conducting a phase 3, randomized clinical trial evaluating the optimal treatment of HIV associated cryptococcal meningitis as well as developing strategies for optimizing inpatient care.
Mentors: Mina Hosseinipour, MD, MPH; Sam Phiri, PhD, Cecilia Kanyama, MBBS.

Universal ART for pregnant and breastfeeding women: Together with the Malawi Ministry of Health, UNC Project is rolling out universal ART for all pregnant and breastfeeding women. The monitoring and evaluation team addresses operational issues related to the rollout of PMTCT and ART activities and best practices for the integration of additional services, including tuberculosis screening, malaria control, family planning and laboratory services. Research activities will include evaluation of novel programs including point of care testing, implementation of cell phone based data collection, modification of ART eligibility guidelines, couple recruitment and retention strategies such as cell phone reminders, and family planning integration.   We are conducting a cluster randomized clinical trial evaluating support strategies for improving uptake and retention in the program.
Mentors: Mina Hosseinipour, MD, MPH; Innocent Mofolo, MSc

New technologies for HIV and TB Diagnosis: Many companies are working on point of care assays to better diagnose and monitor HIV infection and tuberculosis. UNC Project has been working with more sensitive diagnostic testing capacity, but it is unclear how these tests should be integrated into the TB and HIV programs. Research activities will include development of optimal screening algorithms.
Mentors: Irving Hoffman, PA, MPH; Mina Hosseinipour, MD, MPH; Peter Gilligan, PhD; Debbie Kamwendo, MS; Bill Miller, MD, MPH; Charles van der Horst, MD

Sexually Transmitted Infections: The STI clinic at UNC Project is the setting for many treatment and prevention trials, most focused on the interaction between HIV and STIs and also acute HIV. Since 2005, the STI clinic has had a robust, real-time database that tracks individual clinical, demographic and behavioral factors.
Mentors:  Irving Hoffman, PA, MPH; Bill Miller, MD, PhD, MPH

Cancer: UNC Project has created a cancer and pathology registry that allows analysis of a wide range of cancers.  Students have previously conducted research on esophageal, head&neck, and breast cancer.  We have also begun cancer chemotherapy trials in Kaposi’s Sarcoma and Lymphoma.
Mentors:  Satish Gopal, MD, MPH; Agnes Moses, MD; Clara Lee, MD, MPH.

Family Planning: UNC investigators have completed studies evaluating the feasibility and acceptability of immediate postpartum intrauterine device placement and interactions between HIV, antiretrovirals and hormonal contraception. They are also completing a 1-year prospective cohort study evaluating the family planning knowledge, attitudes, and practices of 600 postpartum women; a needs assessment of family planning providers at 14 Lilongwe District Health Centres; and an operational research project to integrate a package of family planning interventions into the President’s Safe Motherhood Initiative. Research activities will involve assistance with a roll-out of immediate postpartum IUD insertion across Malawi and evaluation of the effect of a combined community- and facility-based educational intervention on postpartum contraceptive uptake.
Mentors:  Jennifer Tang, MD, Gretchen Stuart, MD

Obstetric Fistula: The Freedom from Fistula Foundation operates a full-time fistula unit in Lilongwe, called the Fistula Care Centre. UNC has instituted a comprehensive obstetric fistula database to examine characteristics associated with development of fistula and successful surgical repair. Ongoing studies include a cross-sectional study evaluating the ultrasonographic and hormonal characteristics of women with fistula and their relationship to poor reproductive outcomes and amenorrhea. Research activities will include management and analysis of the fistula database, as well as management of a prospective cohort study to assess for changes in quality-of-life and depression before and after fistula repair.
Mentor: Jeff Wilkinson, MD

Trauma/Burns/Surgery: The initial hospital-based trauma registry that started in 2008 is still ongoing.  Additional projects address burn outcomes and wound management techniques, and common general surgery conditions including sigmoid volvulus, acute abdomen, surgical management of cancer, and pediatric surgery. UNC faculty and residents also assist with a general surgery residency program for Malawians (COSECSA) and provide care for surgical patients.
Mentors: Anthony Charles, MD, MPH; Carol Shores, MD, PhD; Jonathan Samuel, MD, MPH

For more information about UNC Project-Malawi, click here.

Zambia

Site Director: Benjamin Chi, MD

The Centre for Infectious Disease Research in Zambia (CIDRZ) is an independent Zambian non-profit organization and a key collaborator to the Zambian Ministry of Health. Currently, six UNC faculty live and work full-time at CIDRZ, including those in the departments of obstetrics and gynecology and medicine. The organization’s scope of work comprises the implementation of large public health programs, rigorous evaluations of program effectiveness, and the conduct of locally relevant clinical trials. We have core competencies in: (1) HIV prevention, including mother-to-child HIV transmission, (2) HIV care and treatment, (3) child health, (4) women’s health, and (5) tuberculosis.

These are the potential topical areas for the coming year:

Prevention of mother-to-child transmission of HIV (PMTCT): UNC-CIDRZ investigators are internationally recognized for their work in PMTCT and we have conducted numerous epidemiological studies, public health impact evaluations, and randomized clinical trials. In the coming year, we will implement two NIH-funded projects in the field: (1) a cluster-randomized trial of the point-of-care SAMBA platform for early infant diagnosis of HIV, and (2) a validation of a community survey methodology to assess population PMTCT program impact.
Mentors: Ben Chi, MD, MSc; Mwangelwa Mubiana-Mbewe, MBChB; Jeff Stringer, MD; Carla Chibwesha, MD, MSc

Cervical cancer prevention:  In collaboration with the Ministry of Health, University of Zambia, and the Centers for Disease Control and Prevention, CIDRZ has helped to establish one of the largest cervical cancer prevention programs in the region. With more than 80,000 women screened since 2005, our program relies heavily on resource-appropriate approaches – including “see-to-treat” methods and nurse provider models – to increase access nationwide.
Mentors: Groesbeck Parham, MD; Mulindi Mwanahamuntu, MD; Carla Chibwesha, MD, MSc; Sharon Kapambwe, MD

Pediatric diarrhea surveillance: Through funding from the Bill and Melinda Gates Foundation, we are conducting community and facility-based assessments throughout Lusaka Province to determine (i) trends in pediatric diarrhea-related morbidity and mortality, (ii) epidemiology of enteric pathogens, (iii) rotavirus vaccine effectiveness, and (iv) cost-effectiveness of a comprehensive public health initiative to reduce diarrhea-related mortality supported by the Ministry of Health, Absolute Return for Kids, Glaxo-Smith Kline, and CIDRZ.
Mentors: Roma Chilengi, MD; Brad Guffey, MD; Jeff Stringer, MD

Tuberculosis-HIV co-infection: CIDRZ has extensive clinical and research expertise dedicated to improving the screening, diagnosis and management of TB in HIV-infected patients.  With PEPFAR/CDC support, we work in over 250 clinics in Eastern, Lusaka, Southern, and Western provinces to promote integrated services. We have developed a robust portfolio of clinical and implementation science studies and are currently conducting trials funded by the NIH, CDC, and World Health Organization.
Mentors: Stewart Reid, MD, MPH; Nzali Kancheya, MD; German Henostroza, MD; Annika Kruuner, MD

Primary health care: Funded by the Doris Duke Charitable Foundation, the BHOMA initiative (Better Health Outcomes through Mentoring and Assessment) aims to improve primary health care through standardized medical care, on-going clinical mentorship, and intensive community engagement. We have implemented a rigorous evaluation plan to evaluate services across the rural districts of Chongwe, Kafue, and Luangwa.
Mentors: Roma Chilengi, MD; Jeff Stringer, MD

Epidemiologic research using large observational databases:  In collaboration with the Ministry of Health, CIDRZ maintains large programmatic databases in the areas of HIV care and treatment (280,000+ patients), cervical cancer screening (58,000+ patients), and obstetrical care (250,000+ patients). This has been an important resource for local and international investigators and is supported on-site by an analysis team comprised of one PhD biostatistician and two Masters-level analysts. We are an active participant in the IeDEA collaboration (International Epidemiologic Databases to Evaluate AIDS) and have successfully conducted analyses with data pooled both regionally and globally.
Mentors: Ben Chi, MD; Patrick Musonda, PhD; Jeff Stringer, MD

For more information about CIDRZ, click here.

China

Site Director: Joseph D. Tucker, MD, MA

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.

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, MA; 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, MA.

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, MA; 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, MD.

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, MA; 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, MA.

For more about UNC Project-China, click here.

Application Procedure

We are currently accepting applications for our 2014-2015 Fellowship.  Please apply through the Doris Duke International Clinical Research Fellows Portal, where there are full instructions and a link to the universal application. Applications are due January 14, 2014.

To complete your application for the UNC DDICRF, please email the following supplemental information to Kirsten Leysieffer at kirsten_leysieffer@med.unc.edu.

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

Questions

For questions about the ICRF at UNC, please contact program coordinator Kirsten Leysieffer at kirsten_leysieffer@med.unc.edu.