Fellowship Site: Zambia

The Centre for Infectious Disease Research in Zambia (CIDRZ) is a registered Zambian non-profit company established in 2000 and affiliated with the University of Alabama at Birmingham (UAB). From its offices in Lusaka, CIDRZ manages a large portfolio of public health service and clinical research projects that reach hundreds of thousands of Zambians each year. There are 470 CIDRZ staff members throughout Zambia, including 28 expatriate staff. More detailed description of CIDRZ can be found at www.cidrz.org.

Service:
The CIDRZ HIV prevention and treatment service units support 175 public health facilities in four of the nine provinces of Zambia. Prevention of mother-to-child HIV transmission (PMTCT) services are offered in 154 clinics and hospitals. The PMTCT program has tested over 330,000 women and provided 60,000 women with maternal ARV prophylaxis. The program has a particular focus on expanding access to more efficacious PMTCT regimens and to HAART, and on early infant diagnosis for HIV-exposed babies. HIV care and treatment services are offered in 46 sites. Since the program began in 2004, over 103,000 people have received HIV care, with 65,000 starting antiretroviral therapy. Our related service activities include a comprehensive cervical cancer screening program that has screened over 5,000 women in its first year, and an integrated TB/HIV program that offers HIV testing to TB patients and TB screening for all HIV patients.

Resources:
The CIDRZ IT department supports a sophisticated computer network, with over 140 office computers and over 230 clinic computers connected via a wireless wide area network. The CIDRZ Central Laboratory is one of the busiest laboratories in the region, performing 500-600 CD4 counts each day in support of research and service activities. Lab assays include hematology, chemistry, microbiology, coagulation, HIV diagnostics, molecular biology diagnostics, serology, specimen archiving, and HIV monitoring.

Training:
Alongside NIH/FICRS, CIDRZ has an internship program focused on HIV service implementation called HIVCorps. Established in 2003, this program recruits 6-10 medical students, nursing students, and recent MPH graduates for year-long attachments.

Research:
The CIDRZ research group includes seven UAB faculty members living in Zambia: Drs. Jeff Stringer, Elizabeth Stringer, Benjamin Chi, Groesbeck Parham, Stewart Reid, Perry Killam, and Dara Potter. To date, CIDRZ has completed 16 research projects and has another 27 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 epidemiologists residing in Zambia. The research group meets weekly with study coordinators and the CIDRZ clinical team to discuss ongoing and prospective studies.

NIH Research:
CIDRZ has a large portfolio of research projects, funded by the U.S. government (NIH, CDC) and private foundations (Elizabeth Glaser Pediatric AIDS Foundation, the Gates Foundation, and the Doris Duke Charitable Foundation). Projects currently funded through the National Institutes of Health include:

1. Optimal use of viral load monitoring in resource constrained settings: 12-site cluster-randomized trial comparing use of routine viral load monitoring to discretionary use in reducing overall mortality among HIV-infected patients initiating HAART (U.S. PI: M. Saag; site PI: J. Stringer)
2. HPTN 035: Four-arm randomized controlled trial investigating the efficacy of two candidate microbicides in preventing HIV infection (site PI: M. Kapina)
3. HPTN 039: Randomized controlled trial investigating the efficacy of empiric acyclovir therapy in preventing HIV infection among HIV-negative / HSV-2-antibody-positive men and women (site PI: S. Reid)
4. ACTG 5208: Randomized trial to investigate the impact of previous nevirapine exposure in later treatment among women on HAART (site PI: E. Stringer)
5. PACTG 1060: Randomized trial to investigate the impact of previous nevirapine exposure in later treatment among infants on HAART (site PI: B. Chi)
6. Measles immune reconstitution: Cohort study investigating the magnitude and quality of measles-specific immune reconstitution among HIV-infected children initiating HAART (U.S. PI: W. Moss; site PI: C. Bolton)
7. HAART and regression of cervical dysplasia: Cohort study examining the trends in persistence of cervical dysplasia following initiating of HAART among HIV-infected women (site PI: G. Parham)

Research attachments change from year to year, based on student interests and project needs in the field.

More Project Details from the NIH/CRISP database

Possible additional research: Oncology

Additional research conducted at the site may include the following projects:

• Electronic database of HIV-infected women accessing cervical cancer screening
• Evaluation of HAART on cervical dysplasia regression among HIV-infected women
• Evaluation of markers of post-cryotherapy wound healing in HIV-positive women.

Housing Availability:
Apartments and houses for rent can be identified through local real estate agents and classified ads. The approximate cost for room and board varies, but is usually in the $500-$1000/month range. CIDRZ has access to temporary housing for new visitors; however, this three-bedroom flat is often booked, particularly during the summer months.

Immunizations Needed for this Site:
See the U.S. Centers for Disease Control Web site and The Yellow Book: Health Information for International Travel.

The NIH/FICRS 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).

Safety and Danger Issues:
See the US State Department Web site for information.

Language Requirements Other than English:
None.

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 two malls, a movie theater, a bowling alley, 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.