Trials and tribulations of an African-led research and capacity development programme: the case for EDCTP investments

We describe the initiation and establishment of The University of Zambia – University College London Medical School (UNZA-UCLMS) Research and Training Project, an entirely African scientist-led, south–north partnership. In its 16 year existence, the project, by successfully obtaining competitive grant funding, has transformed itself into one of Africa’s most productive African-led R obtaining continued competitive or donor grant funding support; and serious investment by the African governments involved. The recent 255 million Euros EDCTP investment in sub-Saharan Africa through south–north partnerships is expected to enhance existing African-led R obtener un apoyo financiero continuo, competitivo o proveniente de donaciones; y una inversión seria por parte de los gobiernos Africanos involucrados. Se espera que la reciente inversión de 255 millones de Euros de la EDCTP en África sub-Sahariana a través de las cooperaciones sur-norte fortalezca los programas existentes de I+D liderados por africanos. Los gobiernos africanos deberán estar a la altura del reto. Since the 1950s, as African countries became independent from colonial domination, they embarked on developing their own medical schools and training programmes. The fact, that several African institutions had not been able to develop their medical and scientific Research and Development (R Deacon 2000; Clarke 2007). Because of poor economies, African governments were unable to invest adequately in sustaining local R Luo et al. 1994; Mathewson et al. 1994, 1995; Oshitani et al. 1994) formed the foundation for the subsequent joint R while a few of these remained abroad after qualification, others returned to work in Zambia – for example, Peter Mwaba, who did a PhD at UCLMS came back to Zambia, and later succeeded Chintu as UNZA-UCLMS Project director in 2004. He was the second African scientist to be awarded the Albert Chalmers Medal by the Royal Society of Tropical Medicine and Hygiene. For establishing R Pletschette Chintu et al. 2002; Kasolo et al. 2002) and used by WHO-IMCI and regional African paediatricians to highlight the difficulties of making accurate respiratory diagnoses in HIV-infected children and to alert WHO to the important and growing issue of paediatric TB, an issue neglected in the past. A thought-provoking article (Costello Training of all grades of medical, administrative and technical staff; Building of clinical trials, laboratory science and database expertise; Building of project-specific research infrastructure, including an infectious diseases research facility; Research publications in high impact factor journals: R Establishing productive regional south–south and south–north networking of R Developing high profile advocacy for TB for funders and politicians. Translational clinical, epidemiological, basic science, clinical trials and operational studies of TB, TB/HIV and respiratory diseases in both adults and children have been performed under the UNZA-UCLMS Project, and several are underway. The basic principles involved in developing the research projects are to deal with locally relevant health problems responsible for high morbidity and mortality in Zambian adults and children. All potential R and on Co-trimoxazole prophylaxis in: HIV-infected adults with TB, HIV-infected children and HIV-infected post-natal women. The results of these clinical trials have yielded major policy relevant outputs (Mwinga et al. 2002; Chintu et al. 2004; Nunn et al. 2008). WHO-TDR recently funded a clinical trial on the optimal timing of highly active antiretroviral therapy (HAART) in HIV-infected Zambian adults being treated for TB through this project. During the duration of the UNZA-UCLMS Project, 104 articles were published in peer-reviewed international journals; Zambian scientists are lead authors of 48 of them. Six articles were published in the Lancet, of which five have African lead authors (Mwinga et al. 2002; Mwaba et al. 2003a,b; Chintu et al. 2004; Onyebujoh et al. 2006). A further five Lancet papers were published by our Zambia project staff as part of their advocacy activities (Chintu Zumla Chintu Chintu Onyebujoh et al. 2006). Our project’s research outputs have been used by the WHO to change policy and management of TB treatment, and TB/HIV antibiotic prophylaxis recommendations (Chintu et al. 1993a,b, 2004; Luo et al. 1994; Nunn et al. 2008). Advocacy articles by project staff for TB, TB/HIV and diseases of poverty have appeared in medical journals (Zumla et al. 1999, 2009; Chintu Grange et al. 2009) as well as health magazines, newspapers and lay literature. Recently, a comprehensive textbook with 158 global authors (including 52 from Africa) was produced (Mandalakas Statens Serum Institute, Denmark; Karolinska Institute, Sweden; Institute Pasteur, France; FIND Diagnostics, Geneva; Italy; Institute of Child Health, London; Liverpool School of Tropical Medicine, UK; Durban MRC Unit, South Africa; WHO-Tropical Diseases Unit, Geneva; US-NAMRU-3, Cairo, Egypt; Dartmouth-Hitchcock Medical Centre, USA; and the All India Institute of Medical Sciences, among others. With visiting staff from collaborating countries and research institutions, the ailing local medical school has benefited by involving all external groups in examining, teaching and research, projects supervision of medical students and postgraduates. As a regionally focussed project, it has fulfilled all the project aims, which the EDCTP has also delineated for its programme for sub-Saharan African countries (Bosch 2002; Olliaro Walgate 2002; Medaglini Anonymous 2004; Mgone 2008; Kitua et al. 2009). The success of the project is attributable to the commitment of project staff; self-generation of competitive grant funding from various sources; asking health policy relevant scientific questions; local governmental support; regional networking of activities; focusing on training and maintaining staff; building infrastructures to accommodate for increased scientific workload; proper administrative procedures and goodwill of all northern and southern partners and their leadership. The next step is to get the more developed R Walgate 2002; Anonymous 2004; Mgone Walgate 2002; Medaglini Bosch 2002; Anonymous 2004; Mgone 2008; Matee et al. 2009). The initial slow start of the EDCTP (Anonymous 2005, 2007) was followed by development into a formidable funding force for R 2009). The the EU and the EDCTP in resources for funding for existing African scientist led Development of R&D in all African countries will allow for R&D to the growing of and 255 million Euros have been the EDCTP and south–north partnerships must not A of work remains to be performed in terms of the investment into visible and outputs to EDCTP African countries must rise to the challenge and up this opportunity to develop African R&D regionally with the aim to R&D outputs. The authors the by Chifumbe Chintu and Herbert Dupont to the initiation and success of this project. The Zambian Ministry of Health and School of Medicine their support and infrastructure We are Pletschette and for their for African R&D development, and of and of Cape and of Onyebujoh and TB and of Child and for their and and Grange and for our African R&D advocacy academic for of our basic science collaborative