Tanzania-Duke; PI G. Ralph Corey, MD

Fellowship Site: Tanzania-Moshi

The Kilimanjaro Christian Medical Centre (KCMC) is located in Moshi, Tanzania at the base of Mount Kilimanjaro. KCMC was conceived in response to the government’s request for non-governmental organizations to establish a national teaching hospital in the northern regions of Tanzania. The Good Samaritan Foundation opened KCMC in 1971. Soon after opening, KCMC was taken over by the Tanzanian Ministry of Health, and the hospital continues under their auspices today. KCMC is one of four referral hospitals for Tanzania, and has a catchment area of almost 15,000,000 persons, the largest of any referral hospital in Tanzania. KCMC currently has 457 inpatient beds with an average occupancy of 116%. In 2006, KCMC recorded more than 20,500 admissions, 3,000 births, and over 110,000 outpatient visits.

The KCMC-Duke Collaboration is one of Duke’s largest global health collaborations. The program supports approximately 50 personnel in Moshi, Tanzania, who conduct research studies in the areas of HIV prevention, diagnosis, treatment, and care; bacterial diseases; protozoal, fungal, viral diseases; and tuberculosis. Examples of ongoing research activities include network studies of the Adult AIDS Clinical Trials Group (ACTG), the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT), Centers for HIV/AIDS Vaccine Immunology (CHAVI), and International Studies on AIDS Associated Co-infections (ISAAC). Ongoing research is focused on  predictors of drug adherence and virologic failure among pediatric patients receiving antiretroviral therapy; the etiology of fever among adults and children in northern Tanzania; optimal tuberculosis diagnostic strategies; field studies of a dry blood spot method for HIV-1 RNA measurement; strategies for optimizing the effectiveness of HIV testing in rural and urban communities, and psychosocial adaptation and clinical events among a large cohort of  persons living with HIV in the Kilimanjaro Region  In addition to having a large clinical and community research staff, the Collaboration program includes extensive research support capacity in the areas of administration, regulatory affairs, transportation, data management, and laboratory. The Collaboration supports hematology, chemistry, immunology, microbiology, and molecular microbiology laboratory sections in the KCMC Biotechnology Laboratory.

Research Opportunities:

NIH-funded clinical research includes the following projects:

• Cohort Studies of Etiology of Febrile Illness Among Hospitalized HIV-Infected and HIV-Uninfected Patients Admitted to Adult Medical Service in Tanzania
• Effect of an Intensified Patient-specific TB Diagnostic Strategy on Treatment Decisions by Physicians Caring for Adults and Children with Suspected Pulmonary TB in the Kilimanjaro Region of Northern Tanzania
• Acceptability, behavior modification, and cost-effectiveness of associated with mobile HIV voluntary counseling and testing in the Kilimanjaro Region of Tanzania
• Coping with HIV/AIDS in Tanzania
• Epigenetic alterations in imprinted genes and cervical cancer in HIV+ and HIV- patients
• Studies of Ocular Surface Squamous Neoplasia
• HIV Prevalence in Psychiatric Patients
• Improving HAART Adherence and HIV outcomes in Depressed HIV Clinic Patients in Tanzania

Additional research:   

• Non-Typhi Salmonella Bacteremia Studies at Kilimanjaro Christian Medical Centre and Mawenzi Regional Hospital
• A Phase IV Pilot Study of Lopinavir/Ritonavir Monotherapy in Antiretroviral Naive HIV-Infected Subjects
• Field Studies of a Dry Blood Spot Nucleic Amplification Method for Infant HIV Diagnosis and for HIV-1 RNA Concentration Determination
• Evaluation of Safety and Pharmacokinetics of Co-administered Anti-TB and Antiretroviral Medications in Tanzanian Children Co-infected with Mycobacterium Tuberculosis and HIV
• Prospective Evaluation of the Cost Effective and Safe Implementation of Minimally Invasive Gynecologic Surgery Technologies in a Low Resource Setting.
• Emergency Obstetrics and Neonatal Resuscitation Teaching Protocols Adaptation in the Kilimanjaro Region; Study of adverse maternal and neonatal outcomes.
• Development of a Novel, Inexpensive Device for the Management of Post-Partum Hemorrhage in Remote Settings.
• HIV Voluntary Counseling and Testing (VCT)-PLUS: Enhancing VCT to Improve Case Finding and Access to Care in Tanzania

Housing/Meals/Transportation:

Safe, affordable, gated housing is available on the KCMC Doctors Compound which is located approximately 500 meters from KCMC. A base on the KCMC Doctors’ Compound allows Scholars to interact and benefit from the presence of Duke Faculty and other foreign trainees who reside within this community.  The houses have electricity and running water, and most of them have a phone that you can receive phone calls on. They have Western flush toilets and showers with hoses, and kitchens with ovens and stoves. There is a living room and a dining room, and several bedrooms. Bedding is provided for you, and the house is fully furnished. 

Health Issues:

The NIH/FICRS program mandates that all trainees see a physician prior to their assignment abroad. See the U.S. Centers for Disease Control Web site and The Yellow Book: Health Information for International Travel.

Malaria is uncommon in Moshi and many trainees elect not to take prophylaxis. Antimalarial treatment with artemenisin-based co-formulations is immediately available when needed for empirical treatment. The water supply is from a local well, but most foreigners elect to boil drinking water as a precautionary measure. Gastroenteritis does occur, but is usually self-limited. All staff members have regular PPD testing to monitor for TB exposures. All trainees are carefully counseled about the need for safer sex precautions. Immediate medical care is available through the 2 Duke Faculty members on-site, and through KCMC when necessary. If more sophisticated care is needed, trainees can be airlifted to Dar es Salaam or Nairobi via Flying Doctors, or to the United States by air ambulance.

Safety Issues:

Although not without risk, the risk of crime in Moshi is relatively small. Most trainees live within the KCMC Doctor’s Compound, which is walking distance (500 yards) from KCMC and guarded continuously. Motor traffic accidents are common, but fortunately none of our trainees have been involved.  Trainees are carefully instructed to be cautious while traveling, especially at night. Most trainees carry the names of several trustworthy taxi drivers in their mobile phones to assist with unexpected transportation needs.

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

Language Requirements Other than English:

Although Kiswahili is the national language of Tanzania, English is the official language of KCMC, KCM College, and the KCMC-Duke Collaboration. While basic Kiswahili is useful for interactions with patients and for functioning in the community, it is by no means essential for successful conduct of research. Scholars are encouraged to study Kiswahili prior to travel to Tanzania and to continue their studies after arrival with or without the assistance of a Kiswahili language tutor. Kiswahili language tutors are readily available in Moshi at affordable per hour rates.

What is it like to live in Tanzania?

Moshi, Tanzania is a small city of approximately 300,000 residents.  With its international teaching hospital, grassroots organizations, and extensive network of faith-based groups, among many other programs, Moshi provides a perfect opportunity to meld academic study with international practice.  Moshi is located at the base of Mt Kilimanjaro in the north of Tanzania, close to the Kenyan border. A popular tourist destination, people come from all over the world to safari through Ngorongoro Crater, the Serengeti National Park, as well as to climb Kilimanjaro. The friendly and welcoming community makes long stays easier, while the proximity to Dar es Salaam, Arusha, and Zanzibar make for quick getaways. Moshi also has a small, but stable expatriate community with whom you can find friendship and support.