Centre for Infectious Disease Research in Zambia

Fellowship Site: Lusaka, Zambia; US Partner: University of Alabama at Birmingham

Details International Site: Centre for Infectious Disease Research in Zambia  Country: Zambia US Director: Benjamin Chi, MD, MSc bchi@cidrz.org US Institution: University of Alabama at Birmingham 2009 US Scholar: Benjamin Dorton bdorts9@yahoo.com bdorton@mcw.edu 2009 International Scholar: Jessica Mumba jesmukmul@yahoo.com 2008 US Scholars: Kristin King kristinelizabethking@gmail.com krisking@umich.edu Jennifer Hallock jlh2131@columbia.edu 2008 International Scholars: David Linyama dmlinyama@yahoo.co.uk Sally Trollip jarielle2000@yahoo.com Samson Chisele chiselesm@yahoo.co.uk Log in to read the Site Handbook!

• Service: The CIDRZ HIV prevention and treatment service units support 309 public health facilities in four of the nine provinces of Zambia. Prevention of mother-to-child HIV transmission (PMTCT) services are offered in 291 clinics and hospitals. Since the program began in 2001, 790,000 women have been counseled, with 688,000 tested and 118,000 found HIV-positive. We have provided maternal antiretroviral drug prophylaxis to 108,000 HIV-positive women. HIV care and treatment services are offered in 68 sites. Since the program began in 2004, 201,000 people have received HIV care, with 128,000 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 and 15 Zambian investigators – all based in Lusaka. To date, CIDRZ has completed 31 research projects and has another 42 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 two 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+F, CIDRZ has a fellowship program focused on service implementation called HIVCorps. Established in 2003, this program has until this year been recruiting 6-10 expatriate medical and nursing students, and recent MPH graduates for year-long attachments. In 2009-10, the program has recruited 5 expatriate fellows and 5 Zambian fellows.

Research Opportunities for Scholars and Fellows:

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, including obstetrical outcomes and contraception

Our research portfolio includes 24 individual-site and 18 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 five active clinical trials, five in the pre-implementation phase, and three 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 / Limbada)
  
• 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)
  
• Neonatal circumcision project: Evaluation of safety and acceptability of 3 neonatal circumcision techniques in Zambia (CDC, PI: E. Stringer/Bowa)

CIDRZ investigators also work closely with the Ministry of Health in the areas of outcomes research. As part of these initiatives, scholars and fellows may participate in ongoing analyses in the areas of HIV treatment, obstetrical care, and cervical cancer prevention.

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 Guesthouse,” maintained by the organization 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.

Communication:

Most expatriates rely primarily on email to communicate with friends and family back home. Internet is expensive locally, but the program makes provisions for full access through FICRS+F funding. The speed is analogous to that of dial-up services in the U.S. - sometimes slower during the workday - so capacity for videoconferencing can be limited. 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+F 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 several malls, a movie theater, 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.