University of Nairobi, Kenya

Fellowship Site: Nairobi, Kenya; US Partner: The University of Washington

The AIDS International Training and Research Program (AITRP) began in 1988 as one of the first of a new generation of research training programs sponsored by the Fogarty International Center at the National Institutes of Health. These programs provide training for scientists from institutions in low- and middle-income countries to strengthen HIV-related research and public health capacities at their institutions. The University of Washington (UW) AITRP, called the International AIDS Research and Training Program (IARTP), was established in the first year of AITRP’s existence and has collaborated with the University of Nairobi as a foreign site since that date. Over the past 20+ years, close to 100 Kenyan scientists have trained at the University of Washington, many of whom continue to work in Kenya as independent HIV/AIDS investigators in collaboration with the University of Washington. Training options include degree programs (M.P.H., M.S., Ph.D.) as well as medium- and short-term training in epidemiology, biomedical ethics, biostatistics, and basic science disciplines.

The University of Nairobi works with the following teaching hospitals and clinics of special interest:

• Ward rounds in the Departments of Surgery, Medicine, Paediatrics, and Obstetrics & Gynaecology at Kenyatta National Hospital.
• The Comprehensive Care Clinic - an adult HIV Clinic located in Kenyatta National Hospital that manages patients with HIV infection and AIDS.
• Mathare North City Council Clinic - offers maternal child health services, maternity and outpatient clinic services.
• The Couple Counseling Center in Kenyatta National Hospital - provides psycho social support to HIV discordant couples and links them to clinical care.
• Coptic Hope Center for Infectious Diseases- offers free comprehensive AIDS care and treatment.
• The High Risk Adolescent Clinic - located in Kenyatta National Hospital, this clinic provided reproductive health care for adolescent girls.

Kenya Medical Research Institute (KEMRI), the principal medical research institute in Kenya, has been a collaborating institution with the UW AITRP since 1989 when the first of 7 KEMRI researchers participated in long-term training at the UW. KEMRI operates the referral laboratory for East Africa and has a 40-bed research ward. Funding for KEMRI comes from the Kenyan government, the CDC, Walter Reed Institute, and the Japanese International Corporation Agency. Five of the 9 KEMRI research centers are currently involved in HIV/AIDS research and training and these centers work together to provide a productive research environment. A number of projects are currently being conducted in collaboration with KEMRI investigators and offer opportunities for future collaborations and training.

Kenya AIDS/STD Collaborative Research Group, established in 1980, is an international program based in the Department of Medical Microbiology at the University of Nairobi. In 1984 the group was designated a WHO Collaborating Center for Research and Training in STDs. Kenyan leadership for the Kenyan STD/AIDS project is provided by Dr. Walter Jaoko, current Chairman of the Department of Medical Microbiology. In 1985, the University of Washington became a collaborating institution through the involvement of Drs. King Holmes and Joan Kreiss. A formal inter-institutional collaborative agreement between the University of Washington and the University of Nairobi was signed in 1988 and renewed in 1995 and again in 2007. Each year the group holds a 1-week research conference in Nairobi which attracts collaborative researchers from the US, Europe, and other parts of Africa, and provides a forum for sharing research results and discussing new directions. All trainees are encouraged to attend and present their research.

University of Nairobi Institute of Tropical and Infectious Diseases (UNITID) was established in 2004 and is administered within the University of Nairobi College of Health Sciences by the School of Medicine, School of Pharmacy, School of Dental Sciences and School of Nursing Sciences. Objectives of the Institute include 1) coordination of research activities that have been carried out for over 25 years in the College of Health Sciences, 2) establishment of a unit that will serve as a reference center for scholars and senior researchers from the region and link with other research institutions with interest in tropical and infectious diseases worldwide, and 3) development of curricula and relevant courses in tropical and infectious diseases. The UNITID Director, Professor Benson Estambale, is committed to continuing research collaborations with the UW and working with the AITRP to achieve their educational objectives.

Clinical Epidemiology Unit (CEU), located at the University of Nairobi, is a branch of the International Clinical Epidemiology Network (INCLEN). INCLEN promotes training in epidemiology in East Africa and other parts of the world. The Nairobi CEU serves as a resource for trainees and also provides former Kenyan trainees opportunities to teach epidemiologic methods that are relevant at both community and regional levels. Dr. James Kiarie, Site PI of the Fogarty International Clinical Research Scholars Program, is the CEU Director and teaches epidemiology at the CEU to pre-doctoral and post-doctoral students.

Kenyatta National Hospital (KNH) is a tertiary care hospital in Nairobi which serves as the teaching hospital for the University of Nairobi medical and nursing schools. Medical students from the University of Washington and other institutions may participate in ward rounds and clinical teaching sessions in the Departments of Surgery, Medicine, Paediatrics, and Obstetrics & Gynaecology. KNH also houses several clinics that are devoted to UW collaborative research projects, including 2 large randomized clinical trials.

The UW has conducted collaborative research studies in Mombasa at the Coast General Provincial Hospital for the last 15 years. Coast Hospital is an 800-bed hospital which houses the Ganjoni Clinic. This clinic was established in 2000 and caters to HIV-1 infected women. A second ancillary clinic site established in Kilifi in 2006 now follows a large cohort of HIV-infected adults and children.

Research Opportunities:

Examples of NIH and other funded clinical research includes the following projects:

• Optimizing pediatric HIV-1 therapy
• Pediatric HIV-1 in Africa: Pathogenesis and Management
• Protective Cellular Immune Responses in HIV-1 Discordant Couples
• HAART Adherence Interventions in Africa: an RCT
• Genital HIV-1 Shedding among Women Starting Second-Line Antiretroviral Therapy
• Parallel Comparison of Tenofovir and Emtricitabine/tenofovir Pre-Exposure Prophylaxis to Prevent HIV-1 Acquisition within HIV-1 Discordant Couples
• Latent TB Detection and Implications in HIV-1 Infected Women and Their Children
• HSV-2 Suppression to Reduce Maternal Plasma, Genital and Breastmilk HIV-1 Levels
• HIV-1 Pathogenesis in Women
• Building Capacity of Infant HIV-1 Vaccine Clinical Trial Centres in Nairobi, Kenya and Fajara, The Gambia
• The Role of Antibodies in Mother to Child HIV Transmission
• Empiric Therapy of Helminth Co-Infection to Reduce HIV-1 Disease Progression
• Reproductive Health Decisions and HIV Infection Risk
• Effect of Long-Lasting Insecticide - Treated Bednets and a Point-of-Use Water Purification Devices on HIV Disease Progression in Kenya
• Impact of Cryotherapy versus Loop Electrosurgical Excision Procedure (LEEP) on Recurrence of Cervical Intraepithelial Neoplasia and HIV - 1 Cervical Shedding among HIV-positive Women
• Evaluation of the Consequences of Drug Resistant HIV-1 due to Peripartum Nevirapine

More Project Details from the NIH/CRISP database

Housing/Meals/Transportation:

The Avenue Flats is a secure, gated apartment complex which is used by many visiting students and fellows from the University of Washington. It is within walking distance of the University of Nairobi, Kenyatta National Hospital, Coptic Hospital, and other collaborative research sites. The University of Washington AITRP rents several flats for visiting U.S. students and fellows. To ensure the safety of FICRS scholars in Nairobi, they will be required to stay there. Monthly rent is between $600-$750 USD for a 2-bedroom apartment; shared accommodations are encouraged when possible. Transportation is available through matatus, buses, taxis, or personal/project vehicles. Some students and fellows who stay in Nairobi for more than a few months choose to purchase a car, which can then be sold before departure.The Kenya program has two bedroom apartments available and while this housing is not specifically designated for students it is used by University of Washington affiliated researchers and trainees, many of whom are students. The apartments are less than ½ mile walk to the training site. In addition to walking, students may travel by project vehicle.

Health Issues:

It is necessary for scholars to receive certain immunizations prior to their departure for Nairobi for diseases such as Yellow Fever, Hepatitis A, Hepatitis B, Typhoid, Meningococcus, Rabies (optional), Polio and Tetanus. The risk of malaria in Nairobi is low. However, malaria prophylaxis is recommended if any trips are planned for outside of Nairobi.

See the U.S. Centers for Disease Control and Prevention Web site and The Yellow Book: Health Information for International Travel for additional information.

The NIH/FICRS program mandates that all Scholars see a physician prior to their assignment abroad. The site will require a formal letter from your physician stating that you have received the necessary immunizations prior to the start of your fellowship (hepatitis A, hepatitis B, yellow fever, typhoid).

Safety Issues:

Kenya’s government has stabilized since the election-triggered civil unrest in early 2008. Generally, the two primary safety concerns are road safety and crime. Traffic accidents are common and pedestrians, as well as drivers/passengers, need to be aware of this and take necessary precautions. Fellows will also need to take precautions against crime, including obtaining secure housing (as described above), restricting travel at night, and avoiding certain parts of Nairobi.

See the U.S. State Department Web site for additional information.

Language Requirements Other than English:

The official language of Kenya is English and the national language is Kiswahili. A working knowledge of Kiswahili is not required to function in the program. However, it is desirable for scholars to learn as much Kiswahili as possible in order to enhance their training experience. Language training is available on the University of Nairobi campus and in the community through classes and private lessons.

What is it like to live in Kenya?

The fellowship is based in Nairobi, a cosmopolitan city with readily available access to good healthcare facilities and other amenities. The altitude is approximately 3,000 feet and temperatures are moderate year-round. There are many online resources about the history, politics, geography, culture and daily life in Kenya, and scholars are encouraged to research the country in order to prepare adequately for their stay.