Transforming Medical Education to Strengthen Clinical Care in Sub- Saharan Africa FOGARTY INTERNATIONAL CENTRE AT IAS 50th Anniversary James Hakim, MBChB, FRCP, DSc(HC) Department of Medicine, University of Zimbabwe IAS, Paris, France-25 July, 2017

Disclosure I have received consultant fees from Mylan Pharmaceuticals, Gilead and Johnson & Johnson I receive research support from NIH/Fogarty

Early Research Career-1990’s Passionate about research Lack of opportunities My professional training lacked broad training in research Undertook clinical epidemiology training under INCLEN International Clinical Epidemiology Network (INCLEN) Rockefeller Foundation Vibrant network of researchers from low-income and high-income countries “Learning” network, hands-on workshops, regular meetings around the world Training in research methodology, biostatistics, health social science, health economics, etc.

Intersection of INCLEN with Fogarty International (2000-2010) I met Jeanne McDermott A Fogarty stalwart Facilitated training opportunities, including grant writing, research courses, etc. Facilitated networking opportunities with African, US researchers Fogarty (2000-2010) Played a pivotal role in shaping my research career ICHORTA (International Clinical, Operational and Health Services Research Training Award for AIDS/TB) Research training Peer mentoring Leadership training

MEPI Program-13 Sub-Saharan African Medical Schools 2010-2015 PEPFAR/NIH Funding 6th MEPI/NEPI Symposium Nairobi 2016

MEPI Objectives Improve Education Capacity Increase output of medical Schools Improve quality of medical education Promote Regionally Relevant Research Improve Retention Ensure Sustainability Build communities of practice

MEPI Program in Sub-Saharan Africa Academic Medicine Suppl 2014 MEPI Program in Sub-Saharan Africa Empowered medical schools in sub-Saharan Africa Direct funding to medical schools in Africa North-South Collaboration South-South Collaboration Sharing of best practices Established a continent wide Forum at the end of MEPI AFREhealth (African Forum for Research and Education in health) MEPI PI COUNCIL Harare, ZIMBABWE

From MEPI To AFREhealth

Implementation of the Zimbabwe MEPI Program NECTAR IMHERZ CHRIS Visiting Professors Program Mentored Scholars Programs Research Support Community- based Education Faculty Development Information Communication Technology

Achievements of MEPI in Zimbabwe More than 150 scholars trained Improved quality of medical Education & Research Enhanced role of local Faculty leadership Engendered greater support from MOH, MOE Broadened stakeholder base Ensured sustainability of key MEPI programs

PERFECT: Promoting Excellence in Research & Faculty Enhanced Career Training An NIH/Fogarty supported award designed to train junior faculty to become accomplished independent researcher NEW

Training Programme CORE RESEARCH SKILLS Research methodology Health information literacy Bioethics Research administration Grant writing Scientific writing for publication Presentation skills ASSOCIATED SKILLS TRAINING Leadership/management/governance Bioinformatics Biosafety Intellectual property rights Technology transfer PRACTICAL TRAINING Mentorship, Mentored research projects, Electives, Attachments

DART Study The Lancet 2010;375:123-131 HPTN 052 The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV and clinical events, indicating both personal and public health benefits from such therapy. NEJM 2011;365:2618

EARNEST Study REALITY NEJM 2014;371:234 When given with a PI in 2nd therapy, NRTIs retained substantial virologic activity without evidence of increased toxicity, and there was no advantage to replacing them with RAL. Virologic control was inferior with PI monotherapy. REALITY Among HIV-infected patients with advanced immunosuppression, enhanced antimicrobial prophylaxis combined with ART resulted in reduced rates of death at both 24 weeks and 48 weeks without compromising viral suppression or increasing toxic effects.

Summary and Conclusions Fogarty played an important role in my: Early Training and mentoring Facilitated peer mentoring Fostered collaborative research and international networking Enabled acquisition of leadership skills-visioning and implementation Enabled me to assist in capacity building for research at my institution and beyond FUTURE FOR FOGARTY AND TRAINING INSTITUTIONS-Continue to Recognize Potential Provide Training Opportunities Enable Platform for Research career growth through training in Leadership and Networking skills.

Acknowledgements Roger Glass Dianne Gibb Peter Kilmarx Ian Weller J McDermott Tom Campbell Ahmed Latif M. Borok Kumarasamy Kevin de Cock Mary Basset Dianne Gibb Ian Weller Frances Cowan Mike Chirenje Nancy Padian Tsungai Chipato Mike Mbizvo Andrew Reid

Thank You For Listening