Zambia-UAB; PI Ben Chi, MD, MSc

Fellowship Site: Zambia-Lusaka

The Centre for Infectious Disease Research in Zambia (CIDRZ) is a non-profit organization affiliated with the University of Alabama at Birmingham (UAB). A large organization of nearly 600 employees, CIDRZ is a major government partner for HIV service expansion and clinical research in Zambia.

• Service: The CIDRZ HIV prevention and treatment service units support 274 public health facilities in four of the nine provinces of Zambia. Prevention of mother-to-child HIV transmission (PMTCT) services are offered in 253 clinics and hospitals. Since the program began in 2001, 570,000 women have been counseled, with 480,000 tested and 90,000 found HIV-positive. We have provided maternal antiretroviral drug prophylaxis to 81,000 HIV-positive women. The PMTCT team has trained 2,069 nurses and midwives to date. HIV care and treatment services are offered in 58 sites. We have trained 2,376 health care workers and counselors in HIV care: 1,222 in HIV clinical management, 654 in pediatric HIV clinical management, and 500 in adherence counseling. Since the program began in 2004, 145,000 people have received HIV care, with 92,000 starting antiretroviral therapy. Our related service activities include a comprehensive cervical cancer screening program that has screened 20,000 women, and an integrated TB/HIV program that offers HIV testing to TB patients and TB screening for all HIV patients.
• Research: The CIDRZ research group includes seven UAB faculty members living in Zambia. To date, CIDRZ has completed 16 research projects and has another 27 projects ongoing or in start-up phase. Core research support services are provided by a central research operations group. This group includes units dedicated to study regulation (including a full-time IRB liaison), training, data management, and quality control / quality assurance. The data analysis unit includes four biostatisticians residing in Zambia. The research group meets weekly with study coordinators and the CIDRZ clinical team to discuss ongoing and prospective studies.
• Training:Alongside NIH/FICRS, CIDRZ has an internship program focused on HIV service implementation called HIVCorps. Established in 2003, this program recruits 6-10 medical students, nursing students, and recent MPH graduates for year-long attachments.

Research Opportunities:

The core competencies for CIDRZ research are:

(1) prevention of mother-to-child HIV transmission

(2) general HIV prevention

(3) HIV microbicidal prevention

(4) optimization of HIV treatment

(5) TB and HIV co-infection

(6) cervical cancer prevention

(7) maternal-child health

More recently, we have begun in-depth research in the area of contraception as it relates to HIV disease progression. Our research portfolio includes 17 individual-site and seven multi-center studies, funded through agencies such as the National Institutes of Health, Centers for Disease Control and Prevention, Elizabeth Glaser Pediatric AIDS Foundation, Doris Duke Charitable Foundation, and Gates Foundation.

The UAB-CIDRZ Clinical Trial Unit (CTU) – based in Lusaka, Zambia – participates in four DAIDS-sponsored networks: HIV Prevention Trials Network (HPTN), AIDS Clinical Trials Group (ACTG), International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT), and Microbicides Trials Network (MTN). Within these networks, our unit currently has four active clinical trials, two in the pre-implementation phase, and seven in the early planning / site selection stage. Selected research training opportunities:

• CEMART: Observational cohort study of 200 HIV-infected adults to evaluate causes for early mortality following HAART initiation (CDC, PI: Stringer / Lakhi)
  
• HAART & regression of cervical dysplasia: Evaluation of HAART on cervical dysplasia regression among 1,800 HIV-infected women (NIH/NCI, PI: Parham / Mwanahamuntu)
  
• Routine ART for PMTCT in Kafue District: Cluster-randomized trial to determine population effectiveness of routine ART for PMTCT in rural Zambia (Doris Duke, PI: Chi / Chintu)
  
• Contraception and HIV disease progression: Randomized clinical trial of 60 participants investigating potential mechanism for rapid HIV disease progression among users of hormonal contraception (UAB, Pi: E. Stringer)
  
• Non-virologic methods to diagnose pediatric ART eligibility: Cross-sectional study of 3300 mother-child pairs to develop an algorithm for determining HIV infection and ART eligibility in settings where virologic testing for HIV is unavailable (EGPAF, PI: Chi / Chintu)
  
• Optimal algorithms for diagnosis of smear-negative TB: Validation of WHO algorithms for diagnosing smear-negative TB in settings with limited diagnostic capabilities (CDC, PI: Reid / Kancheya)

Additional research conducted at the site may include the following projects: Electronic database of HIV-infected women accessing cervical cancer screening Evaluation of HAART on cervical dysplasia regression among HIV-infected women Evaluation of markers of post-cryotherapy wound healing in HIV-positive women.

Housing/Meals/Transportation:

There are many suitable expatriate housing options available in Lusaka, although some can be expensive. Based on availability, new arrivals are allowed to live for up to four weeks at the “CIDRZ flats,” a group of apartments maintained by CIDRZ for new arrivals and short-term consultants. A discounted rate is provided to new trainees over this period. Following this initial period, trainees have rented apartments ranging between $800 - $1500 per month in the past; most opt to share housing with roommates to reduce the per person costs. Some, but not all, of our scholars in the past have lived within walking distance from the central CIDRZ offices. Those who do not live within walking distance typically use taxi service or purchase a vehicle locally. CIDRZ has numerous trainees each year, and our administrative staff can assist by putting new arrivals in contact with reputable real estate companies locally.

Most expatriates rely primarily on email to communicate with friends and family back home. Personal internet access at CIDRZ is limited during normal work hours, although public access stations are available. Internet access, however, is available during nights and weekends for all employees at the CIDRZ offices. There are a growing number of internet cafes in Lusaka and access through local cell phone providers is also popular option. All scholars/fellows are provided with a cellular phone on arrival and this can be reached from the U.S. at no local charge. Internet telephony (e.g. Skype) and call-back services are other common modes of voice communication.

Health Issues:

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

Basic health care is available. One local clinic, called Corpmed is listed on some Blue Cross and Blue Shields plans as a foreign institution. We recommend evacuation insurance in case of emergency.

The NIH/FICRS program mandates that all Scholars see a physician prior to their assignment abroad. Proof of required vaccinations is required prior to the start of the Scholar's training period (polio booster, typhoid, rabies, hepatitis A and B, meningitis vaccine and tetanus). The 2006 national malaria survey and our clinical experience indicate there is very little malaria in Lusaka. Many long-term expatriates do not take prophylaxis, although there are risks. CIDRZ does recommend prophylaxis if traveling outside Lusaka (e.g. to game parks) and most formulations (including Larium and Malarone) are available over-the-counter at Lusaka pharmacies.

Safety Issues:

See the US State Department Web site for information. Overall, Zambia is a safe country and has had no major political upheavals since it peacefully declared independence from the United Kingdom in 1964. Crime rates in Lusaka are very low compared to other large African cities such as Johannesburg and Nairobi. When incidents do occur, they are typically non-violent in nature. Over the past several years, there have been a few incidents involving trainees, but most could have been avoided had a few general rules been followed (e.g. avoid walking alone at night, take taxis late in the evening). CIDRZ conducts orientation sessions for newcomers to brief them on safety issues and recommends that they register with the US embassy while in country.

Language Requirements Other than English:

English is the official language of Zambia and is used for all professional communications. Those proficient in English should not have any difficulty working and living in Zambia. Zambia has 72 local languages, which vary by region of the country. Some knowledge of the local language can be helpful in clinical settings, but staff members capable of translating are generally available in health care settings. As part of the HIVCorps Internship and Fogarty ICRS orientation, Nyanja lessons (one of two commonly spoken local languages in Lusaka) are provided twice weekly for three months. Those who wish to continue these lessons are encouraged to do so.

What is it like to live in Zambia?

Living in Zambia is very pleasant. Visitors are generally surprised at the number of amenities available, particularly in the capital city Lusaka. Zambians are very welcoming, particularly if guests respect cultural norms and learn some of the local language. Dress is relatively conservative, and shorts and short skirts are not recommended. There is a large and vibrant expatriate community. Normal safety precautions apply, but there is a generally high level of personal safety. The weather is pleasant and moderate, with rains from December to March, a temperate winter in June and July, and a hot season in October and November. Lusaka has two malls, a movie theater, a bowling alley, and dozens of restaurants. Americans will find prices for manufactured goods somewhat high, as most items are imported into the country. Prices for local items such as fruits, vegetables, dairy, and meat are reasonable and the quality and variety are very good.