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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:
- 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)
- HPTN 035: Four-arm randomized controlled trial investigating
the efficacy of two candidate microbicides in preventing HIV infection
(site PI: M. Kapina)
- 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)
- ACTG 5208: Randomized trial to investigate the impact
of previous nevirapine exposure in later treatment among women
on HAART (site PI: E. Stringer)
- PACTG 1060: Randomized trial to investigate the impact
of previous nevirapine exposure in later treatment among infants
on HAART (site PI: B. Chi)
- 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)
- 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.
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