Malawi, a Sub-Saharan African country of 15 million with HIV prevalence of 11%, has a ten year history of creative, simplified HIV programming. While a wealth of programmatic data exists and HIV research in treatment and prevention is ongoing, the next stages of research are clearly related to implementation science. How can the HIV programs be optimized to have the greatest impact on the epidemic? With finite resources, what program components should be prioritized to maximize uptake and retention along the continuum of care? To answer these questions, Malawi needs to build its foundation in implementation science as few, if any Malawian investigators are formally trained in implementation science methodology. Our Malawi HIV Implementation Research Training Program (M-HIRST) builds on 15 years of UNC- supported Fogarty-sponsored training activities that have developed a small pool of Malawian researchers with sustainable research leadership. Now, we focus on enhancing the implementation science research skills of 12 junior faculty and 150 junior investigators while also expanding the pool of qualified researchers through post-graduate training (8 investigators). Our goal is to place these talented researchers into research programs at the University of Malawi, College of Medicine (COM), the only medical school in the country. Our program is designed to maximize cost-effectiveness by utilizing existing programs and conducting the majority of activities in Malawi or South Africa. Our faculty members live in or regularly travel to Malawi, thereby reducing travel costs to the program. Our planned training program includes the following i) a Implementation scientific priorities generation workshop with key stakeholders in year 1,3, and 5 ii) provision of annual 1-2 week short courses in implementation science, clinical trial design, epidemiological research, grant- writing, iii) mentorship for trainee research and career development by UNC and COM faculty, iv) 4-6 months implementation science internships (2 annually) and v) competitive mentored research small grants programs (3-5 grants per year). Over the grant period, we expect 12 junior faculty to engage in the M-HIRST program, 15 to benefit from small grants, and 150 to participate in short courses (~30/year). To expand the pool of implementation scientists, we will train 2 PhD candidates in implementation science through our collaboration with the University of Witwatersrand, and 6 MPH/MSc candidates through the existing Malawi COM MPH course. Importantly, we will strengthen the COM Research Support Center by establishing an Implementation Science Unit within the Center, expanding a Mentor the Mentors program, and providing grants management training. The implementation Science unit will provide a framework for standardized research instruction as the post-graduate training programs expand and support the Faculty Research Track. By the end of the award, we expect to have independently funded Malawian investigators capable of leading the Malawi HIV treatment and prevention implementation science agenda.
The University of North Carolina (UNC) and the University of Malawi, College of Medicine (COM) propose to build upon 15 years of experience in HIV training activities and institutional research capacity strengthening in Malawi to focus on HIV implementation science and the development of research-focused faculty within the COM. The Malawi HIV integrated program requires critical evaluation to prioritize the components with the highest impact in maintaining the health of the population and preventing ongoing HIV transmission. Our program will develop both investigators and strengthen systems in the COM to assist the Malawi government to conduct high quality implementation science.
