Fellowship Site Directors:
Elizabeth Reddy, MD, Duke University
Blandina Mmbaga, KCMC
Site Contact: Sarah Brittingham Muir
Site Specialties: Site Specialties: HIV/ID, maternal-child health, ethics and policy, cancer
- The KCMC-Duke Collaboration is one of Duke’s largest global health collaborations, with nearly 30-year roots and externally funded research now at $5 million/year. The program supports 50 Duke/KCMC joint personnel in Moshi, Tanzania, who conduct research in the areas of maternal and women’s health, mental health, cancer, trauma/emergency medicine, HIV testing, prevention, and care; bacterial diseases; zoonotic infections; protozoal, fungal, and viral diseases; and tuberculosis. There are 4 full-time Duke faculty, 2 infectious diseases fellows, 3 global health residents, and 3 Duke medical/postgrad students living in Moshi. Highlights include:
- 16 schools of allied health science offer additional degrees in public health, nursing, and medical records technology as well as subspecialty training in internal medicine, urology and dermato-venereology.
- Clinical and community research staff working on funded research with Duke and KCMC faculty in the clinical research and care facility with collaborators from Harvard, CDC, LSHTM, and elsewhere. The facility includes rooms for examination (10), pharmacy counseling/dispensing, nursing counseling and conference, offices, a videoconferencing facility, a data management unit, and a research pharmacy.
- 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 state-of-the-art KCMC Biotechnology Laboratory that participates in the College of American Pathology (CAP) External Quality Assurance Programs, with lab certification for NIAID clinical trial participation. The molecular virology section participates in the ACTG Virology Quality Assurance (VQA) Program and is certified by this group.
- A Community Advisory Board meets monthly and advises on proposed research projects and the interpretation of research findings.
- 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 maternal and women’s health, mental health, cancer, trauma/emergency medicine, HIV prevention, diagnosis, treatment, and care; bacterial diseases; zoonotic infectious; protozoal, fungal, viral diseases; and tuberculosis.
- Spanning more than ten years, Duke has built substantial clinical research collaborations with KCMC, and has placed medical students, residents and fellows there for training opportunities. In addition, the KCMC-Duke collaboration is focused on capacity-building with two D43 training awards; AITRP and the HIV-associated Malignancies Research Training Program. Although Duke’s research projects historically have largely focused on HIV/AIDS, ongoing research and training opportunities have expanded well beyond infectious diseases to encompass women’s reproductive health, cancer, mental health and trauma. Since becoming an international research site for the FICRS-F program, KCMC has hosted five US and foreign trainees.
About the KCMC-Duke Collaboration
THE KCMC-DUKE COLLABORATION in Moshi, Tanzania began in 1995 following an invitation from the former KCMC Executive Director, Professor John Shao, to explore joint educational and research activities. With initial support from a Minority International Research Training award, the Collaboration’s activities commenced. Since 2002, externally funded research within the Collaboration has grown dramatically, and now is nearly $2,000,000 per annum. The Collaboration participates in NIH-sponsored networks such as the AIDS Clinical Trials Group (ACTG), Infant, Maternal, Pediatric and Adolescent AIDS Clinical Trials (IMPMCT), the Center for HIV/AIDS Vaccine Immunology (CHAVI), and the Center for AIDS Research (CFAR). Duke and KCMC investigators represent a diversity of Departments and Schools, and the research focus has expanded greatly from an initial emphasis on HIV/AIDS to include other infectious diseases, maternal and women’s health, and mental health. The Collaboration has been academically productive, and has published 30 original scientific contributions with many more in development. The major focus of these publications has been clinically and locally relevant investigations of PEPFAR-related topics such as HIV testing strategies, clinical manifestations of HIV disease, etiology of febrile illness, tuberculosis, antiretroviral treatment strategies and adherence, women’s health -especially cervical cancer screening and prevention of mother to child transmission, and mental health. There are currently four full-time Duke faculty living in Moshi, in addition to 2 infectious diseases fellows, 3 global health residents, and 3 medical or postgraduate students.
Capacity building has been an explicit priority of the Collaboration. Realizing this goal has been strongly supported by the many research grants to Collaboration investigators, and the AIDS International Training Research Program (AITRP) award from the Fogarty International Center. To date, three Tanzanians have received four Masters degrees with AITRP support. In addition, there are currently 2 Masters and 2 PhD candidates receiving AITRP support. A PEPFAR supplement to AITRP has provided support for the training of a Tanzanian Masters of Nursing candidate enrolled at the Duke University School of Nursing, and biannual training of Tanzanian laboratory technologists at KCMC. In addition, fifteen US medical or postgraduate students have spent one year engaged in research within the Collaboration since 2002, and most of them have partnered with a Tanzanian “twin” to enhance the impact of their experiences. The twinning process has been supported more formally by the designation of the Collaboration as a site for Fogarty International Clinical Scholars. Collaboration members play important roles in teaching in the KCM College curriculum, on the wards at KCMC, and in weekly activities such as journal club and clinical conferences. Service delivery, often in the context of implementation science projects, has been an integral part of the Collaboration’s activities. To date, for instance, over 13,000 people have been tested for HIV through our affiliations with community-based organizations, mobile-testing campaigns in rural areas, and home-based outreach.
The KCMC-Duke Collaboration has a formidable existing research portfolio which addresses a breadth of topics with substantial relevance to public health and policy in Tanzania and MEPI including HIV/AIDS, tuberculosis, other communicable diseases, maternal and women’s health, mental health, chronic non-communicable disease and health systems. The KCM College Department of Community Health also offers outstanding opportunities to engage students, trainees and faculty in mentored research projects. Between the KCMC-Duke Collaboration and the Department of Community Health, there is a substantial “clinical research laboratory” available to address topics of great relevance to PEPFAR and public health in Tanzania. In addition, the Collaboration has a record of providing research training for Tanzanian investigators, and therefore understands the needs and opportunities for supporting the development of these investigators.
Kilimanjaro Christian Medical Centre (KCMC) is located on a 480-acre campus in Moshi Town, 8 kilometers from town center at the base of Mount Kilimanjaro. KCMC is one of four referral hospitals in Tanzania, and has more than 500 inpatient beds and a catchment area which is home to 16,000,000 persons. The KCMC complex also houses a free standing research facility known as the KCMC Biotechnology Laboratory, a central library, administrative offices, dormitories, and housing for international visitors. KCMC was established in 1971 as a Zonal Referral Consult Hospital for the northern regions of Tanzania (Arusha, Dodoma, Kilimanjaro, Singida and Tanga). It is operated by the Good Samaritan Foundation, an ecumenical non-governmental organization. Kilimanjaro Christian Medical College incorporates 16 schools of allied health sciences and offers additional degrees in public health, nursing, and medical records technology as well as advanced subspecialty training in internal medicine, urology and dermato-vemereology.
KCMC is the principal clinical facility used for medical and postgraduate education within KCM College, and also hosts numerous continuing medical education activities. KCMC receives PEPFAR support from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) for the care of HIV-infected persons in the region. EGPAF, in combination with Duke University and CDC-Tanzania, funded construction of the KCMC Child Centered Family Care Centre (CCFCC) in 2007, creating a state of the art facility for providing care and supporting research with HIV-infected families.
Kilimanjaro Christian Medical College (KCM College) is a constituent component of Tumaini University, the largest university in Tanzania. KCM College offers a robust academic environment, with 16 different health-related degrees and approximately 1100 students, making it the second largest medical training entity in Tanzania. KCM College graduated its first 15 doctors in 2002, and in 2009 the entering class size was 122, reflecting an unprecedented expansion in a brief period of time. Over the next 10 years KCM College plans to maintain its medical school class at approximately 120. KCM College hosts 3 Faculties (Medicine, Nursing and Rehabilitation Medicine) and 3 Directorates (Allied Health Sciences Schools, Postgraduate Studies and Research and Consultancies). KCM College offers postgraduate specialty training (Masters in Medicine) in medicine, pediatrics, obstetrics and gynecology, surgery, orthopedic surgery, otolaryngology, ophthalmology and dermatovenereology, and Master’s degree programs in Public Health and Clinical Research.
- KCMC has a diversity of collaborative research projects including HIV testing, care for HIV-infected adolescents, care for HIV-infected pregnant women, causes of febrile illness and deaths, zoonoses, emergency medicine, mental health, and cancer.
- We have three Duke faculty members on site at KCMC who can assist in providing mentorship to fellows. In additions, there are regular weekly academic conferences and a journal club.
- KCMC is affiliated with the Kilimanjaro Christian Medical University College, which offers 16 health-related degrees including a school of medicine and post-graduate training in 9 specialties. It creates a robust academic environment in which all leaners may interact and teach each other.
The Duke-KCMC collaboration is housed within the Child-Centered Family Care Centre (CCFCC), which was completed in 2007 and jointly funded by the Elizabeth Glaser Pediatric AIDS Foundation, CDCTanzania and Duke University. The offices of the Duke-KCMC collaboration investigators and staff are housed on the second floor of the Outpatient Department (OPD). The Pediatric and Adult Infectious Diseases Clinics are held in an immediately adjacent newly constructed space which is dedicated to the care of families living with HIV infection. The clinical care and research programs are closely integrated in this space, facilitating the referral of patients for evaluation as research subjects and the referral of subjects for clinical care. There are 10 examination rooms, a pharmacy counseling and dispensing room, nursing counseling and conference rooms, a videoconferencing facility, and a waiting room in the clinic space. Office space includes two large offices for investigators, one large room which accommodates 6 staff members, two intermediate offices which accommodate 2-3 administrative staff each, one intermediate office for the Site Coordinator and her regulatory assistant, one large office for students and trainees, 3 small offices for study coordinators, the Data Management Unit, the Research Pharmacy, the large conference room and videoconferencing facility, and an information technology support room. Metal filing cabinets are used to keep all regulatory binders, study documents and charts, and shadow charts secure. All of this space is further secured by a single entrance which is covered with a floor to ceiling grate and locked. Each office also has locking doors. Security staff guard the Medical Centre twenty four hours/day. KCMC-DUMC and a very limited number of other staff have keys to the grate and offices, and all keys are tracked in a key accountability log.
The state-of-the-art KCMC Biotechnology Laboratory is available for support of clinical studies, and is located approximately 500 meters from the KCMC wards and the CCFCC. This laboratory was developed under the leadership of Dr. Crump, and is staffed by the Laboratory Supervisor Caroline Chevallier, MT and seven technologists. Specimens arriving at the laboratory are logged in at the front desk with the date, time, project and name of the person delivering the specimen. The hematology specialty area has 2 Abbott Cell Dyne 3500 hematology analyzers. The chemistry specialty area has 2 Cobas Integra analyzers. The serology specialty area has a Bio-Rad Elisa reader and washer. The microbiology specialty area contains a BioMeriuex BacT/ALERT 3D continuously monitored blood culture instrument with a 240 well expansion unit for performing routine blood cultures, mycobacterial blood culture, and liquid culture of nonblood specimens for mycobacteria. In addition, there is a NuAire dual chamber water jacket CO2 incubator,Olympus BX 41 plain and fluorescent microscopes, and NuAire Class IIA biological safety hood. These instruments are housed in a biological safety level 3 area. Each of these specialty areas participates in College of American Pathology (CAP) External Quality Assurance (EQA) programs, and has been site visited and approved by NIH site monitors. CD4+ lymphocyte absolute number and percentage are measured with aFACSCalibur flow cytometer in the immunology specialty area. As a back-up to the FACSCalibur machine, a FASCan machine is available in the Kilimanjaro Reproductive Health Program Laboratory. Becton Dickinson has a Nairobi office, and supplies monoclonal antibodies to KCMC regularly. The FACSCalibur and FACScan flow cytometers participate in the UKNEQAS QA/QC program. There is an Abbott M2000 real time PCR machine and specimen processor in the molecular virology specialty area which can measure HIV RNA from multiple subtypes down to 50 copies/mL. This specialty area participates in the ACTG Virology Quality Assurance (VQA) Program, and is certified by this group.
Twenty computers are hosted on a local area network with 10 printers, and internet connections are made through a dedicated satellite connection for the collaboration. All computers are password protected, and access is limited to collaboration staff. All computers are supported by UPS devices to prevent the loss of data, and a back-up generator is available for power outages. Data management for ISAAC, CHAT and CFAR studies is supported by Verity teleforms scanning. Two high speed scanners are located on-site with a Hewlett Packard ProLiant ML350 server. All computers are password-protected, and access to the teleform system is restricted to the Data Manager and CRS Leader. Remote data entry is provided for the ACTG and IMPAACT network study subjects
- Two collaboration vehicles are available to support investigators and staff; the first is a Toyota Hilux truck which is owned by KCMC and DUMC, the second is a Toyota Land Cruiser hard top purchased for KCMC through the ISAAC project. The collaboration driver will transport staff as needed to project-related destinations, and an explicit vehicle use policy guides proper use and vehicle accountability.
- A Community Advisory Board meets monthly and advises on proposed research projects and the interpretation of research findings.
1D43TW01013801 (Alfred Kien Mteta PI)
Strengthening of Research Capacity for Junior Faculty in Tanzania
The Medical Education Partnership Initiative-Tanzania (MEPI-T) will build upon accomplishments from the first funding cycle, focusing on development of robust research skills in select junior faculty, and strengthening the institutional environment and culture for research to ensure the long-term success of its faculty. MEPI-T represents a partnership between the Kilimanjaro Christian Medical University College (KCMU College) in Moshi and the Catholic University of Health and Allied Sciences (CUHAS) in Mwanza.
4D43TW009595-04 (John Bartlett PI)
Research Training Program for Low- And Middle-Income Country Institutions
Responding to Tanzanian national priorities for optimizing the care of persons living with HIV infection, Duke University and the Kilimanjaro Christian Medical Centre (KCMC) will develop a Sociobehavioral Sciences (SBS) Research Core at KCMC focused on HIV/AIDS care.
1R01AI121378-01 (John Crump PI)
Investigating Febrile Deaths in Tanzania (INDITe)
The objective of ‘Investigating Febrile Deaths in Tanzania (INDITe)’ is to identify actionable patient management and health system interventions that could avert fatal outcomes among patients with severe Febrile illness in low-resource areas.
1R21AI124344-01 (Blandina Mmbaga, Melissa Watt co-PIs)
Postpartum HIV Care Engagement in the Context of Option B+ in Tanzania
The goal of the proposed study is to examine the implementation of Option B+ in three sites in the Kilimanjaro Region of Tanzania, to understand factors at both the facility and patient levels that support or obstruct women’s engagement with HIV care following childbirth, and to identify opportunities to support the successful implementation of Option B+.
1K01TW010000-01A1 (Catherine Staton PI)
Addressing High Risk Alcohol Use Amongst Injury Patients in an Emergency Department in Tanzania
This career development award will allow for the cultural adaptation, validation, and pilot testing of a brief negotiational interview for alcohol use. To do so, the project will 1) describe the current knowledge and perceptions about alcohol use in Tanzania, 2) adapt an evidence-based intervention to the Tanzanian setting and, 3) pilot this intervention in preparation of a large-scale trial.
5K01TW009985-02 (Dorothy Dow PI)
Integrating Mental Health into a HIV Clinic to Improve Outcomes in Tanzanian Youth
Dr. Dow proposes to integrate both a HIV educational curriculum and an intensive cognitive behavioral therapy (CBT) and life skills training program called SPARCS, into the HIV teen clinic. This project is anticipated to improve both mental and physical health of HIV-positive adolescents in Tanzania and open a dialogue of discussion around mental health difficulties in this setting.
Medical Education Partnership Initiative (MEPI)
The Duke University School of Medicine (DUSOM) and the Kilimanjaro Christian Medical College (KCM College) will partner to strengthen medical education in Tanzania, training a new generation of physicians with the knowledge, commitment and modern tools to become leaders in academics, research and policy.
R01-MH106388 (Ostermann, Thielman)
Does Preference-based HIV Testing Increase Uptake in High Risk Populations?
This study uses Discrete Choice Experiments to quantify HIV testing preferences among two high-risk populations in the Kilimanjaro Region, identify preferred testing options, and evaluate, in a pragmatic randomized controlled trial, the effect of a preference-based HIV counseling and testing (PB-HCT) intervention on testing uptake.
Positive Outcomes for Children Orphaned by AIDS
The objective of this 5 country, 9 year, longitudinal study of orphaned and abandoned children is to examine the influence of orphan placement characteristics, caregiver characteristics, and culture, on various outcomes. The first 4 years focused on associations with: 1) behavior and emotional adjustment; 2) learning and achievement; 3) post-traumatic stress disorder and depression; and 4) health status, including health related quality of life. The next 5 years will focus on the above characteristics that are associated with educational achievement, labor force participation, civic engagement, risk behaviors, marital formation and child bearing. 3,500 orphaned and abandoned children and their caregivers in Cambodia, India, Ethiopia, Kenya and Tanzania are involved in the study.
Coping with HIV/AIDS in Tanzania
The objective of this study is to understand the factors influencing adherence in less wealthy nations as ART expands in order to slow down the spread of medication-resistant virus. We will follow 750 newly diagnosed HIV + persons, 500 previously diagnosed HIV + persons and 750 HIV – persons. Baseline data will be used to examine associations between psychosocial (including trauma, mental health symptomatology, coping strategies and life events), socio-demographic, economic factors and health status, adherence to ART, and health promotion and high risk activities.
The Impact and Social Ecology of Bacterial Zoonoses in Northern Tanzania: Understanding Transmission Patterns among humans, livestock, and wildlife hosts
This project will integrate several disciplinary approaches, including social behavioral studies, human febrile illness surveillance, and linked human-animal epidemiological studies, to generate data for incorporation into models of human disease risk. These models, together with an understanding of community risk perception and knowledge, will allow us to identify appropriate strategies for disease control and prevention.
Developing Research Capacity in Africa for Studies On HIV-Associated Malignancies (HAMTRP)
The Kilimanjaro Christian Medical Centre (KCMC) and Duke University Medical Center (DUMC) will partner to further develop research capacity in HIV infection and associated complications, including neoplasms such as cervical cancer, Kaposi’s sarcoma, lymphoma and squamous cell carcinoma of the conjunctiva
1K23AI116869-01A1 (Matthew Rubach PI)
Viral Zoonoses and Severe Febrile Illness in Northern Tanzania
The objective of this proposal is to deploy standard as well as innovative diagnostic tools in order to investigate what proportion of severe febrile illness (SFI) in northern Tanzania is attributable to emerging zoonotic viral pathogens.
1R01CA193380-01 (Nirmala Ramanujam PI)
Culturally Appropriate Screening and Diagnosis of Cervical Cancer in East Africa
The goal of this Academic-Industry Partnership is for PI, Dr. Nimmi Ramanujam to work in partnership with Zenalux Biomedical to bring a two-pronged cervical cancer culturally relevant screening program that will facilitate scaling of population wide screening and sustainability of see and treat programs in East Africa by using visual inspection with acetic acid (VIA) to screen the general female population at a primary health care setting, and VIA followed by cryotherapy or Loop Electrosurgical Procedure (LEEP) at secondary (district and regional hospitals) and tertiary hospitals.
Expatriate investigators and staff are commonly housed in the KCMC Doctor’s Compound, located about one kilometer (a 10-15 minute walk) from the current research offices. The Compound has internet access to facilitate communications. There is around the clock security in the Compound to ensure personal and equipment safety.
Matthew Rubach, MD
Steven Sumner, MD
Sky Vanderburg, MD
John Stanifer, MD, MSc
Dorothy Dow, MD, MSc-GH
Shama Cash-Goldwasser, MD
David Goodman, MD, MPH
Brian Meier, MD, MA
Zachary Tabb, BS