Specific Objectives of MEPI 2

KCMC MEPI2 Project.

Strengthening of Research Capacity for Junior Faculty in Tanzania

Proposed Training: The objectives of the proposed training are as follows;

 

  1. To provide rigorous research training for junior faculty, preparing them to pursue their mentored research training projects.
  2. To provide faculty mentors for junior faculty who will actively participate in the mentored research training projects, and serve as role models for trainees.
  3. To build upon the research culture created in the MEPI-T first cycle, enhancing the competitiveness of junior faculty, increasing their productivity, initiating career development planning, understanding the roles and responsibilities of principal investigators, engaging future generations of junior investigators, and promoting an enabling environment for research.
  4. To sustain the training program beyond the five years of this award, and to extend its impact to others at KCMU College and CUHAS, creating a regional model of excellence in research training.

 

Overview:The proposed training will consist of 2 different programs, one for junior faculty who have already received Master’s level training (Advanced Research Training), and a second for junior faculty who do not yet have Master’s degrees (Comprehensive Research Training). Descriptions of the programs are provided in Figure 2.

 

Figure 1. MEPI-T Research Training Programs
 Advanced Research Training

 

Comprehensive Research Training

 

Eligibility:Junior faculty with Master’s degree (does not include Master’s in Medicine)Junior faculty without Master’s degree (may include Master’s in Medicine)

 

Duration:36 mos (all mentored research time)6 mos didactic,18 mos mentored research
Protected time:50% for 24 mos50% for 24 mos
Launch:Year 1Year 2
Research support:$10,000/year for 3 years$10,000
Deliverables8 trainees (4 at each institution)

At least 1 published manuscript and 1 project proposal/trainee

12 trainees (6 at each institution)

At least 1 submitted manuscript/trainee New Master’s Program in Clinical Research

 

The Advanced Research Training will provide an extended mentored research experience for junior faculty with Master’s and PhD degrees, but will not require didactic course work because of previous exposure. Their prior Master’s degree must include at least 3 courses on research methods, epidemiology or biostatistics, and Master’s in Medicine are not eligible. These trainees will design a mentored research project in collaboration with Program faculty mentors, which will be reviewed by the Leadership Team and the TAC for approval. A detailed mentorship plan must be included with the project proposal, and the expectation is that the trainee will be mentored intensively throughout the project implementation, analysis, publication and follow-up processes. The mentorship plan will be reviewed in detail during the selection process, and will be considered as a critical selection criterion. These trainees will receive up to $10,000/year for 3 years to complete the project, similar to an R03 NIH award. For the initial 24 months, trainees will have 50% protected time to devote to their research. During year 1, these trainees will travel off-site to Morogoro for one-week workshops designed to develop skills for successful academic careers. The topics to be covered in these workshops will include; 1.grantsmanship and peer review, 2. research compliance and post-award grants management with an emphasis on the Office of Grants Management services, 3. mentorship and Personal Development Plans, and 4. leadership skills and time management. These trainees will each present at the annual MEPI-T Research Symposium and will review the proposals of trainees in the Comprehensive Research Training. Every effort will be undertaken to emphasize research rigor with peers, and engender an identity as researchers within and across institutions. For training completion, at least one published manuscript and a project proposal similar to an NIH R21 application will be required. It is anticipated that these junior faculty will become the teachers and mentors for the Comprehensive Research Training Program, and that they will be prepared to become independent investigators.

 

The Comprehensive Research Training will providea 6-month didactic course, followed by 18 months to execute a mentored research project in one of the three scientific priority areas. During the entire 24-month training period, trainees will have a minimum of 50% protected time devoted to research training and research. The content of the 6-month didactic course will be developed during year 1, but will be based on course offerings in the WCMC and Duke Master’s of Science degrees in Global Health, with an emphasis on the fundamentals of clinical epidemiology and research methodology in health services research and implementation science, biostatistics, practical applications in the computer laboratory, sociobehavioral determinants of disease and qualitative research methods, manuscript and proposal writing, responsible conduct of research, and research administration and oversight. It will be taught by faculty at KCMU College and CUHAS, accessible in both locations by videoconference. Visiting faculty from Duke and WCMC will also participate, but their level of participation will decrease over the 5 years of the award as teaching capacity at KCMU College and CUHAS grows. During the first 6 months, trainees will be required to develop their mentored research proposal under the guidance of their faculty mentors. The proposals in development will be actively discussed in didactic class time, refining their rigor and analytical planning. In this 6-month period, trainees will also apply for regulatory clearance to ensure that they can commence immediately upon completion of the didactic course. Trainees will receive $10,000 in research support to perform their mentored research project, exclusive of trainee salaries.During the 18 months of mentored research, they will work closely with their faculty mentors to finish their research project and complete at least one manuscript.

 

Training Timeline: In the first year of this award, the 8 trainees for the Advanced Research Training will be selected and begin their mentored research projects. For the Comprehensive Research Training, in year 1 the course materials will be developed, the videoconferencing faculty at CUHAS will be built, information regarding the training will be disseminated and applications accepted, and the first class of trainees will be selected. Four trainees (two each from KCMU College and CUHAS) will commence the didactic course at the beginning of year 2, and four additional trainees/year will begin in years 3 and 4. The last trainees will graduate at the end of year 5, and the 12 graduates will represent a new generation of well-prepared junior faculty at their respective institutions, with research support services which provide an enabling environment for them. A detailed timeline for year one is presented later in this application. Efforts will be undertaken at both institutions to develop essential research support services in the areas of grants administration.

Candidates for Training: The 2 Programs will primarily target young physician investigators, either at the level of specialty training completion or in the first five years on the faculty. As previously mentioned, candidates for the Advanced Research Training Program (ARTP) must have a prior Master’s degree with at least 3 courses in research methods, epidemiology or biostatistics, and Master’s in Medicine (MMed) degrees will not meet this criterion. Each year approximately 12 physicians graduate with MPH degrees from KCMU College, and WCMC has graduated 6 Tanzanian physicians with MSc degrees in Clinical Epidemiology and Health Services Research from WCMC. These junior faculty will be encouraged to apply for the Advanced Research Training. In addition, research-oriented PhD faculty will also be eligible to apply for the Advanced Research Training, and approximately 5 PhD’s are awarded every year at KCMU College and 2 are awarded at CUHAS.

For the Comprehensive Research Training Program (CRTP), junior faculty at the lecturer level and within 5 years of their last degree will be eligible. It is anticipated that the majority will have been trained clinically with MMed degrees. Both KCMU College and CUHAS have specialty training programs with relevance to the scientific priority areas including Medicine, Pediatrics, Obstetrics and Gynecology, and Surgery. Each year approximately 20 graduates complete MMed training in these 4 specialties at KCMU College and CUHAS. Therefore a substantial pool will be available in both locations, creating a highly competitive application process and ensuring selection of outstanding trainees.

 

Selection of Trainees: Through previous experiences with D43 programs, an application process has been developed which is comprehensive and highly selective, and also emphasizes long-term commitment to research at the host institution. In the previous funding cycles for the Duke D43 AIDS International Training in Research Program (AITRP), 100% of 40 trainees remained engaged in research, 95% in Tanzania, and 78% at KCMC over 7 years. The application process will include submission of written materials including past academic records, a personal essay on career planning, and a preliminary research proposal on a topic in the scientific priority research areas. The trainee must commit in writing to remain at their host institution for 5 years after training. All applications must be accompanied by a letter of support from their Head of Department which explicitly states their commitment to protect 50% effort for research training and research. The Leadership Team will then interview the most competitive candidates, and recommendations will be made to the TAC. Once TAC review and approval has occurred, offers will be made to the selected candidates. The candidate and the senior official at their host institution (KCMU College Provost and CUHAS Vice Chancellor) will be required to sign a commitment to retain the trainee for five years beyond training completion.

 

Linkage of Proposed Training to Objectives: The following description links the proposed training to the Objectives previously outlined.

 

  1. To provide rigorous research training for junior faculty, preparing them to pursue their mentored research training projects.

For the ARTP, eligible candidates must have prior course work in research methods, epidemiology or biostatistics. Additional research skills will be developed during the period of mentored research, under the guidance of Program faculty. The Program faculty who are available as mentors are all highly experienced and productive investigators (please see faculty biosketches). Each proposal for the Advanced Research Training will contain a detailed mentorship plan to ensure that all trainees receive close attention during the performance of their research.

For the CRTP, it is essential to ensure that all trainees have rigorous training in research to build a foundation for later successes. The KCMU College Department of Biostatistics and Epidemiology has expanded to 7 faculty members, including three with PhD’s in Epidemiology. CUHAS has undergone similar expansions of the faculty in their Department. Both Departments have experience in teaching undergraduates, MMed and MPH candidates, and KCMU College offers a Master’s of Science in Biostatistics and Epidemiology. The KCMU College and CUHAS faculty will assume primary responsibility for developing the course content during year one, with guidance from Duke and WCMC.. The didactic portion will be offered to trainees on both campuses by videoconference. Given the relatively small class size, faculty will closely mentor trainees and can give individualized attention to trainees who may have less preparation in research methods to ensure that all trainees have a pathway to mastering the material. During the 6 months of didactic training, the trainees will search the background literature for their mentored research project, identify a testable hypothesis, and outline their methods and analysis plan in a project proposal. Under the guidance of faculty mentors, each trainee will present their project proposal to their fellow trainees in a peer review session.Ultimately each mentored research project proposal will be reviewed and approved by the Leadership Team, and the TAC.

All trainees in both Programs will be required to complete training in the Responsible Conduct of Research and Research with Human Subjects described later in this application.

 

  1. To provide faculty mentors for junior faculty who will actively participate in the mentored research training projects, and serve as role models for trainees.

As mentioned above, the faculty mentors for both Programs have been selected based upon their research expertise, record of mentorship, and ability to serve as role models for trainees. In the ARTP, the detailed mentorship plan, 3-year period of support, requirement for a published manuscript and project proposal, and the workshop topics will foster a close relationship between trainees and their mentors. In addition, the planned activities include participation in teaching and mentoring the Comprehensive Research Training candidates, which will further encourage a culture of research rigor and support within each institution.

During the second phase of their training, each CRTPtrainee will pursue their mentored research project for 18 months. As previously described, each trainee will have a mentorship team led by a primary mentor. The team will closely monitor project implementation, including the training of staff, participant recruitment, quality of data collection, quality of sample collection, and adverse events. Trainees will be encouraged to have an initial pilot phase for their research, and report the results to the mentorship team for trouble-shooting. The development of standard operating procedures will be encouraged, and model procedures will be made available to all trainees. As data collection is completed, the mentorship emphasis will shift to data cleaning and analysis. A standardized approach to data analysis will be encouraged, emphasizing the analysis of primary outcomes first in tables and figures, followed by secondary analyses. Peer interactions among the trainees will be promoted, and the second-year trainees will assist each other and demonstrate their analytical skills to the first-year trainees. The second-year trainees will be required to present their findings in research conferences at KCMU College and CUHAS, and to submit their findings to regional and international symposia. Each trainee will be required to submit a manuscript describing their findings before they can complete their training.

 

  1. To build upon the research culture created in the MEPI-T first cycle, enhancing the competitiveness of junior faculty, increasing their productivity, initiating career development planning, understanding the roles and responsibilities of principal investigators, engaging future generations of junior investigators, and promoting an enabling environment for research.

In the first MEPI-T cycle, an internal opportunity to obtain support for practical experiences in mentored research for medical students was created, MRTP. MRTP encouraged teams of medical students to partner with post-graduate trainees and faculty to developing a one-year projects (non-renewable) which received up to $25,000 in support. MRTP has steadily grown in popularity, and over the first three cycles supported 53 research projects engaging 165 medical students. The fourth MRTP cycle has recently completed review, and applications from 4 medical schools in Tanzania were received, resulting in 40 applications for this single cycle. Such a response underscores the importance of mentored research in the Tanzanian environment, and how such a program addresses an unmet need. The first cycle of MEPI-T has primed the pump for mentored research in the second cycle.

In addition to the rigorous mentorship and didactic preparation described under objective 1, MEPI-T will expose the trainees to a culture of grantmanship. The creation of the KCMU College Office of Research Management and Innovation represents a tremendous resource for the proposed training program, and for the development of a similar office at CUHAS. During the workshop on grantsmanship and peer review and during the first 6 months of didactic course work, the trainees will follow the development of a grant proposal from the identification of a funding opportunity announcement through proposal writing to post-award management. They will receive background on research support opportunities in the United States, Canada, European Union, Medical Research Council, DFID and private foundations. They will develop their own research proposals, and experience peer review of their own proposals and the proposals of fellow trainees. They will meet with grants administration staff to review the creation of deadlines and key milestones in the grant preparation process, and receive guidance on the development of budgets. The Office will create eRA Commons accounts for all trainees and track responsible conduct of research, research with human subjects, and research with animals trainings. They will receive information on post-award management, especially compliance, reporting responsibilities and project closeout. Finally, in years 4 and 5, graduates of the Programs will be eligible to compete for a pool of “bridge funds”, intended to support graduates with the greatest promise of competing for independent external funding.

Another major step to be undertaken is the development of a Professional Development Plan (PDP) for each trainee, in collaboration their primary mentor and the MEPI-T Leadership Team. PDP is a process driven by the researcher, under the mentorship listed above. Each researcher will reflect upon their own status in terms of learning, skills and achievements, and then plan for their personal career development. In this process they will identify the key skills needed for career advancement, and the opportunities to obtain the needed skills.Within the PDP, trainees will be mentored on the development of leadership skills through a series of specific suggestions on opportunities to lead seminars and workshops, and appropriate venues to gain leadership experience. Within the context of PDP, good mentorship will be modeled, and mentoring skills in the trainees will be fostered and encouraged. In addition, key milestones of career advancement will be explicitly discussed, especially as they relate to opportunities for external research funding support and the key thresholds for promotion within their host institutions. Such explicit discussions and the accompanying mentorship have not been emphasized in the recent history of Tanzanian academic culture. The development of a PDP for each trainee, and subsequent monitoring of progress, will represent a key culture shift accomplished within MEPI-T.

MEPI-T has played a key role in the creation of an enabling environment at KCMU College. Resources provided in the first cycle such as reliable and fast internet services, a faculty computer laboratory, rigorous biostatistical and epidemiologic consultation for research, MRTP pilot funds, surveys of faculty satisfaction, and a faculty compensation plan have helped to transform the culture on campus. In addition, the availability of robust laboratory infrastructure through the Kilimanjaro Clinical Research Institute has further enabled state of the art research. Although MEPI-T collaborations with CUHAS are relatively recent, they do include research support. In addition, CUHAS enjoys strong partnerships with WCMC and the Touch Foundation, both of which have undertaken major steps to modernize and empower CUHAS students, trainees and faculty.

The explicit emphasis of the second MEPI-T cycle on junior faculty research development will complement these past achievements. The FIC investment in MEPI-T will build upon past programs, and synergize with them by extending the impact on junior faculty and adding expertise in new scientific priority areas of HIV infection, non-communicable diseases and maternal and child health.

  1. To sustain the training program beyond the five years of this award, and to extend its impact to others at KCMU College and CUHAS, creating a regional model of excellence in research training.

Many of the achievements of the first MEPI-T funding cycle will be sustained beyond the funding period. KCMU College has already absorbed many of the MEPI-T staff, and has extended the impact of the Computer Laboratories and the Wet Laboratory by making substantial investments in them. Furthermore, the Tanzanian Ministry of Education has invested in providing internet bandwidth to universities across Tanzania, (the “Last Mile Project”), assisting to provide continuing access to these services.

Integral to the prospects for sustainability of the proposed MEPI-T Training Program, is the leading role for both KCMU College and CUHAS in health professions education. The success of this Program will be perpetuated into the future by demand from junior faculty and others who seek such a valuable experience, further supported by a visionary and committed leadership at both institutions. Please see the later section on “Institutional Environment and Commitment”.

Role of the KCMU College Office of Research Management and Innovation: This newly established entity under the KCMU College Directorate of Research and Consultancies has received support from iRIM during the first MEPI-T funding cycle. As previously mentioned, it has received mentorship from the Duke University Office of Research Administration and the DGHI Grants Administration team. Planning is underway to support the development of a similar office at CUHAS, supported by the CUHAS Vice Chancellor. The KCMU College Office will play an important role in the proposed MEPI-T Training Programs, providing each trainee with information and training on proposal development, budget preparation, peer review, grantsmanship, responsibilities of principal investigators, post-award management, compliance, reporting, and project closeout. These Offices will also assume responsibility for dissemination of funding opportunity announcements to trainees and other faculty, and serve as a clearinghouse for information related to research-related topics.

Year 1 Timeline: Adherence to the MEPI-T Training Programs timeline will be essential to accomplish all programmatic goals. Adherence will be accomplished by charging the MEPI-T Monitoring and Evaluation Officer with continuously assessing progress on the timeline listed below, and providing monthly reports to the Leadership Team.

August 2015 Notice of Grant Award received

  • First meeting of the Leadership Team
  • Weekly meetings of Operations Team
  • Call for applications to the Advanced Research Training Program
  • Appointment of Didactic Training Curriculum Team
  • Appointment of Office of Research Management and Innovation Curriculum Team
  • Appointment of Mentored Research Project Curriculum Team
  • Appointment of Personal Development Plan Team

September 2015 Procurement of videoconference hardware for CUHAS

  • CUHAS to visit KCMU College Office of Research Management and Innovation

October 2015 Installation of videoconference hardware at CUHAS

  • CUHAS finalizes plan to establish Office of Research Management
  • Selection of Advanced Research Training candidates

August-November 2015 Team meetings to design curricula

  • Team meetings to define principles for PDP
  • TAC Review of recommendations for Advanced Research Training candidates
  • Finalizing mentor panels for Advanced Research Training candidates
  • Advanced Research Training candidates submit protocols for regulatory reviews

December 2015 Teams report to MEPI-T Leadership

  • Implementation of Team plans begins

January 2016 Teaching assignments made based upon curricula

  • Introduction of training opportunities to Department Heads
  • First advertisements for Comprehensive Research Training through websites, conferences and other media
  • Announcement of training opportunities at conferences
  • Advanced Research Training candidates begin their mentored research projects

April 2016 Applications due for Comprehensive Research Training

 

May 2016 Review of written applications by Leadership Team

 

June 2016 Interview of top applicants

  • Recommendations for selected applicants to TAC

July 2016 Selected applicants and their Heads of Department notified

August 2016 First class of Comprehensive Research Training commences

Program Evaluation: Program evaluation will be a major point of emphasis in the next funding cycle of MEPI-T. In the previous funding cycle, rigorous monitoring and evaluation allowed MEPI-T to achieve almost all of its program objectives in a timely fashion. The key metrics for program monitoringwill include;

  • Adherence to the annual work plan schedule of training and program activities
  • Adherence to the mentoring plans
  • Adherence to protection of time for trainees
  • Review of mentor-mentee matching
  • Progress toward achievement of Program objectives
  • Review of training programs

Key metrics for Program evaluation will include;

  • Career development of trainees
  • Development of an enabling sustainable research environment

Key indicators for the Program will include;

  • Numbers of applicants/year
  • Proportion of trainees successfully completing didactic course work
  • Proportion of trainees completing surveys on year one course work
  • Proportion of trainees providing scheduled progress reports on mentored research projects
  • Proportion of trainees completing mentored research projects
  • Proportion of trainees presenting research findings in local, national, regional and international conferences
  • Number of manuscripts produced by trainees during mentored research training projects
  • Research mentor evaluations by trainees
  • Proportion of trainees with completed PDP’s
  • Diversity of research projects of trainee graduates
  • Number of research proposals submitted by trainee graduates
  • Proportion of funded research proposals of trainee graduates
  • Number of published manuscripts of trainee graduates
  • Mentees of trainee graduates
  • Number of trainees utilizing KCMU College Office of Research Management and Innovation
  • Establishment of the CUHAS Office of Research Management

Tools for monitoring will include;

  • Annual work plans
  • Surveys of trainee graduates regarding research skill sets
  • Teaching evaluations of year one faculty
  • Research mentor evaluations by trainees
  • Trainee evaluations of PDP process.

 

Trainee Candidates: Details of the potential applicant pool, their prior qualifications and experiences, the selection process including the role of Program faculty and the TAC, and a plan to ensure that graduates are retained have been presented. At KCMU College and CUHAS, approximately 1/3 of MMed candidates are women. In the selection process, an explicit effort will be undertaken to encourage applications from female candidates. Please note that 12/27 (44%) of proposed faculty are women. The Leadership Team and the TAC, with the goal of reaching gender balance, will carefully review gender in examining the history of selected candidates. The letters of commitment provided by the Heads of Department in the application process, and the commitments of the KCMU College Provost and CUHAS Vice Chancellor will ensure the protection of at least 50% time for the Training Program.. Feedback from trainees regarding their protected time will be solicited in progress reports to the Leadership Team, and if problems are identified, the Leadership Team will intervene to assure protected time.

Institutional Environment and Commitment: Both KCMU College and CUHAS share a commitment to research in their Mission Statements, and they each have robust academic activity portfolios. However, in each institution there is a shortage of faculty, especially faculty with research skills and experience to successfully compete for external funding. The creation of the proposed MEPI-T Training Program will directly address this shortage and add 20 well-trained investigators to their faculty rosters. The value of these faculty to the partnering institutions is reflected in the letters of support from their academic leaders, and in their commitment to provide space, protected time and oversight for the Program. In addition, they have committed to continue the Training Program beyond the five years of the award. They have each commented that the proposed Training Program, with its focus on junior faculty, has identified a population in need of opportunities and that this Program will enhance existing programs focused on undergraduate and post-graduate research training.

Both the KCMU College Provost and the CUHAS Vice Chancellor have also committed to create an institutional environment which enables their research faculty to prosper and become independent investigators. KCMU College recently established its Office of Research Management and Innovation, and the Provost has committed the assistance of this Office to mentor CUHAS as they establish their Office of Research Management. The CUHAS Vice Chancellor has committed space, and 3.5 FTE research staff to operationalize these plans. In addition, KCMU College recently implemented software to transition its Research Ethics Committee to electronic submissions and reviews, and KCMU College will assist CUHAS with the development of this capacity.

The research environment at each institution is developing successfully with infrastructure to support this ongoing progress. Both institutions have received past FIC support, and other USG support for other research and capacity building programs. The proposed MEPI-T Training Program will expand the scientific priority topics beyond existing programs to include the intersection of HIV infection, non-communicable diseases, and maternal and child health. The partnering institutions have complementary expertise in these areas, and will assist each other with strengthening capacity. Together with their US partners, they will create a robust team with a long history of cooperative efforts in capacity development and research.

 

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  31. Hertz J, Munishi O, Ooi EE, Shiqin H, Yan LW, Chow A, Morrissey A, Bartlett J, Onyango J, Maro V, Kinabo G, Saganda W, Gubler D, Crump J. Chikungunya and dengue fever among febrile hospitalized patients in northern Tanzania. Am J Trop Med Hyg 2012, 86:171-177.
  32. Bartlett J, Ribaudo H, Wallis C, Aga E, Katzenstein D, Stevens W, Norton M, Klingman K, Housseinipour M, Crump J, Supparatpinyo K, Badal-Faesen S, Kallungal B, Kumarasamy N. Lopinavir/ritonavir monotherapy after virologic failure of first-line antiretroviral therapy in resource-limited settings. AIDS 2012, 26:1345-1354.
  33. Crump J, Ramadhani H, Morrissey A, Saganda W, Mwako M, Yang L-Y, Chow S-C, Njau B, Mushi G, Maro V, Reller LB, Bartlett J. Bacteremic disseminated tuberculosis in sub-Saharan Africa: a prospective cohort study. Clin Inf Dis 2012; 55:242-250.
  34. Bouley A, Biggs H, Stoddard R, Morrissey A, Bartlett J, Afwamba I, Maro V, Kinabo G, Saganda W, Cleaveland S, Crump J. Brucellosis among hospitalized febrile patients in northern Tanzania. Am J Trop Med & Hyg 2012; 87:1105-1011.
  35. Phillips E, Bartlett J, Sanne I, Lederman M, Hinkle J, Rousseau F, Dunn D, Pavlos R, James I, Mallal S, Haas D. Associations between HLA-DRB1*0102, HLA-B*5801 and hepatotoxicity during initiation of nevirapine-containing regimens in South Africa.J Acquired Immune Def Syndr 2013; 62:e55-57.
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  37. Fiorillo S, Diefenthal H, Goodman P, Ramadhani H, Njau B, Morrissey A, Mwako M, Bartlett J, Shao J, Saganda W, Kinabo G, Maro V, Crump J. Chest radiograph abnormalities and their role for predicting etiology of febrile illness among inpatients in Moshi, Tanzania. Clinical Radiology, 2013; 68:1039-46.
  38. Mavura D, Masenga EJ, Minja E, Grossmann H, Crump J, Bartlett J. Initiation of antiretroviral therapy in HIV-infected adults with cutaneous manifestations in northern Tanzania. Internat Journ Dermatology; 2014: doi: 10.1111/ijd.12563.
  39. Buchanan A, Dow D, Massambu C, Nyombi B, Shayo A, Musoke R, Feng S, Bartlett J, Cunningham C, Schimana W. Progress in the prevention of mother to child transmission of HIV in three regions of Tanzania.PLoS One, 2014; 9:e88679.
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  41. Wallis C, Aga E, Ribaudo H, Saravanan S, Norton M, Klingman K, Stevens W, Kumarasamy N, Bartlett J, Katzenstein D. Drug susceptibility and resistance mutations after first-line failure in resource-limited settings. Clin Inf Dis, 2014; 59: 706-715.
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  43. Ramadhani H, Bartlett J, Thielman N, Pence B, Kimani S, Maro V, Mwako M, Masaki L, Mmbando C, Minja M, Lirhunde A, Miller W. Association of first-line antiretroviral therapy adherence with adherence to second-line antiretroviral therapy among HIV-infected patients in Tanzania. Open Forum Infectious Diseases, 2014; doi:10.1093/ofid/ofu079.
  44. Rubach M, Maro V, Bartlett J, Crump J. Evaluation of integrated management of adolescent and adult illness district clinician manual empiric antibiotic therapy recommendations for severe infections in northern Tanzania. Am J Trop Med Hyg; in press.
  45. Magambo KA, Kalluvya SE, Kapoor SW, Seni J, Chofle AA, Fitzgerald DW, Downs JA. Utility of urine and serum lateral flow assays to determine the prevalence and predictors of cryptococcal antigenemia in HIV-positive outpatients beginning antiretroviral therapy in Mwanza, Tanzania. J Int AIDS Soc. 2014 Aug 8;17:19040. doi: 10.7448/IAS.17.1.19040. eCollection 2014. PubMed PMID: 25109284; PubMed Central PMCID: PMC4127809.
  46. Meda J, Kalluvya S, Downs JA, Chofle AA, Seni J, Kidenya B, Fitzgerald DW, Peck RN. Cryptococcal meningitis management in Tanzania with strict schedule of serial lumber punctures using intravenous tubing sets: an operational research study. J Acquir Immune Defic Syndr. 2014 Jun 1;66(2):e31-6. doi: 10.1097/QAI.0000000000000147. PubMed PMID: 24675586.

47.Wajanga BM, Peck RN, Kalluvya S, Fitzgerald DW, Smart LR, Downs JA. Healthcare worker perceived barriers to early initiation of antiretroviral and tuberculosis therapy among Tanzanian inpatients. PLoS One. 2014 Feb 14;9(2):e87584. doi: 10.1371/journal.pone.0087584. eCollection 2014. PubMed PMID: 24551061; PubMed Central PMCID: PMC3925080.

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  5. Joseph Obure, Pendo Mlay, Gileard Masenga; Olola Oneko and David Walmer; A higher proportion of squamous intraepithelial lesion of cervix in symptomatic HIV – infected women at a tertiary health centre in Tanzania. Infectious Agents and Cancer 2010.5 (suppl.1) A1.
  6. Hussein TH, Kisanga B, Mgongo M, Uriyo JG, Stray-Pedersen B, Msuya SE (2014). Contraceptive use, pregnancy negotiations and associated challenges among HIV-positive discordant couples in Moshi urban, Tanzania: a mixed method study. J of Population Association of America; 8(1):12. Available at www.paa.org
  7. Msuya SE, Uriyo JG, Hussein T, Mgongo M, Damian DJ, Makuwani A, Stray-Pedersen B (2014). Prevention of mother-to-child HIV transmission at primary health care level in Moshi urban, Tanzania: uptake challenges and transmission rate. Global Journal of Medicine and Public Health; 3(1).
  8. Ueno E, Adegoke AA, Masenga G, Fimbo J, Msuya SE (2014). Skilled birth attendants in Tanzania: descriptive study of cadres and emergency obstetric care signal functions performed. Maternal and Child Health J; 18(4): doi: DOI 10.1007/s10995-014-1506-z.
  9. Adewemimo AW, Msuya SE, Olaniyan CT, Adegoke AA (2014). Utilization of skilled birth attendance in Northern Nigeria: a cross sectional survey. Midwifery; Sep 25, doi: pii: S0266-6138(13)00286-6.

119.Kiula E, Jeremiah D & Msuya SE (2013). Predictors of HIV status disclosure to partners among pregnant women in Morogoro, Tanzania: implications for programs. BMC Public Health, 13: 433.

  1. Mgongo M, Mosha MV, Uriyo JG, Msuya SE, Stray-Pedersen B (2013). Prevalence and predictors of exclusive breastfeeding among women in Kilimanjaro region, Northern Tanzania: a population based cross-sectional study. International Breastfeed Journal; 8(1):12.
  2. Uriyo JG, Abubakar A, Swai M, Msuya SE, Stray-Pedersen B (2013) Prevalence and Correlates of Common Mental Disorders among Mothers of Young Children in Kilimanjaro Region of Tanzania. PLoS ONE 8(7): e69088. doi:10.1371/journal.pone.0069088
  3. Makuwani AM, Msuya SE, Haule D, Mogella D, Nkya E (2013) Innovative Accountability of Tracking Test Kit as Locked Resources: A Lesson in a Restricted Resource Setting. Journal of Clinical Laboratory Analysis 27: 391–397.
  4. Ameh C, Msuya SE, Hofman J, Raven J, Mathai M, Van den Broek N (2012). Status of Emergency Obstetric Care in six developing countries 5 years before the MDG targets for maternal and newborn health. PLoS ONE 7(12): e49938. doi:10.1371/journal.pone.0049938.
  5. Adegoke A, Utz B, Msuya SE, Van den Broek N (2012). Skilled birth attendants: who is who? A descriptive study of definitions and roles from nine sub Saharan African countries. PLoS ONE; 7(7): e40220. Doi: 10.1371/journal.pone.0040220.
  6. Amina Abubakar, Jacqueline Uriyo, Sia E. Msuya, Mark Swai, Babill Stray-Pedersen (2012). Prevalence and Risk Factors for Poor Nutritional Status
    among Children in the Kilimanjaro Region of Tanzania. Int. J. Environ. Res. Public Health 9, 3506-3518; doi:10.3390/ijerph9103506
  7. Nkala T & Msuya SE (2011). Prevalence and predictors of exclusive breastfeeding among women in Kigoma Region, Western Tanzania: a community based cross sectional survey. International Breastfeeding Journal; 6:17.
  8. Kapologwe NA, Mahande M, Msuya SE (2011). Provider-initiated HIV testing and counseling in Mbeya city, south-western Tanzania: knowledge and practice of health care providers. Tanzania Journal of Health Research; 13(4): 1-7. http://dx.doi.org/10.4314/thrb.v13i4.5
  9. Kapologwe NA, Kabengula JS, Msuya SE (2011). Perceived barriers and attitudes of health care providers towards Provider-Initiated HIV Testing and Counseling in Mbeya region, southern highland zone of Tanzania. Pan African Medical Journal; 8: 17.
  10. Falnes EF, Moland KM, Tylleskär T, de Paoli MM, Msuya SE, Engebretsen IM (2011). ”It is her responsibility” partner involvement in prevention of mother to child transmission prevention programmes, northern Tanzania. J Int AIDS Soc; April 26;14(1): 21.
  11. Msuya SE, Hashim TH, Uriyo J, Sam NE, Stray-Pedersen B (2011). Anaemia among pregnant women in northern Tanzania: prevalence, risk factors and effect on perinatal outcomes. Tanzania Journal of Health Research; 13(1): 1-10.
  12. Mapingure MP, Msuya S, Kurewa NE, Munjoma MW, Sam N, Chirenje MZ, Rusakaniko S, Saugstad LF, de Vlas SJ, Stray-Pedersen B (2010). Sexual behaviour does not reflect HIV-1 prevalence differences: a comparison study of Zimbabwe and Tanzania. J Int AIDS Soc. Nov 16; 13(1):45.
  13. Sia E Msuya, Jacqueline Uriyo, Akhtar Hussain, Elizabeth Mbizvo, Noel E Sam, Babill Stray-Pedersen (2009). The effectiveness of syndromic approach in managing vaginal infections among pregnant women in northern Tanzania. East African Journal of Public Health; Dec 6(3): 263-267.
  14. Sia E Msuya, Jacqueline Uriyo, Akhtar Hussain, Elizabeth Mbizvo, Noel E Sam, Babill Stray-Pedersen (2009). The prevalence of sexually transmitted infections among pregnant women with known HIV status in northern Tanzania. Reproductive Health; Feb 25;6:4.
  15. Sia E Msuya. Women and infants at risk: The epidemiology of HIV and sexually transmitted infections among pregnant women and challenges facing preventive programs in Northern Tanzania. PhD Dissertation, Faculty of Medicine, University of Oslo, Norway; 2008.
  16. SE Msuya, EM Mbizvo, A Hussain, J Uriyo, NE Sam, B Stray-Pedersen (2008). Low male participation in antenatal HIV counselling and testing in northern Tanzania: implications for control programs. AIDS Care; 20: 700-709.
  17. SE Msuya, EM Mbizvo, B Stray-Pedersen, J Uriyo, NE Sam, S Rusakaniko, A Hussain (2007). Decline in the HIV prevalence among women of childbearing age in Moshi urban, Tanzania. International Journal of STD & AIDS; 18: 680-687.
  18. Sia E Msuya, Elizabeth Mbizvo, Akhtar Hussain, Jacqueline Uriyo, Noel E Sam, Babill Stray-Pedersen (2006). HIV among pregnant women in Tanzania: the role of sexual behaviour, male partner characteristics and sexually transmitted infections. AIDS Research and Therapy; 3: 27.
  19. Sia E Msuya, Elizabeth Mbizvo, Jacqueline Uriyo, Babill Stray-Pedersen, Noel E Sam, Akhtar Hussain (2006). Predictors of failure to return for HIV test results among pregnant women in Moshi, Tanzania. Journal of acquired immune Deficiency Syndromes; 43: 85-90.
  20. SE Msuya, EM Mbizvo, A Hussain, NE Sam, B Stray-Pedersen (2006). Seroprevalence of Hepatitis B and C viruses among women of childbearing age in Moshi urban, Tanzania.East African Medical Journal; 83(2): 38-41.
  21. EM Mbizvo, SE Msuya, B Stray-Pedersen, MZ Chirenje, A Hussain (2005). Cervical dyskaryosis among women with and without HIV: prevalence and risk factors. International Journal of STD & AIDS; 16: 00-00.
  22. EM Mbizvo, SE Msuya, B Stray-Pedersen, ZM Chirenje, A Hussain (2004). Bacterial vaginosis and intravaginal practices: association with HIV. Central Africa Journal of Medicine; 47(3):57-64.
  23. Sia E Msuya, Elizabeth Mbizvo, Akhtar Hussain, Noel E Sam, Stig Jeansson, Babill Stray-Pedersen (2003). Seroprevalence and corraletes of herpes simplex virus type 2 among urban Tanzanian women. Sexual Transmitted Disease; 30(7): 588-592.
  24. EM Mbizvo, SE Msuya, A Hussain, MZ Chirenje, B Stray-Pedersen (2003).HIV prevalence in Zimbabwean women: 54-67% knowledge and perceived risk. International Journal of STD & AIDS; 14: 202-207.
  25. SE Msuya, E Mbizvo, B Stray-Pedersen, J Sundby, NE Sam, A Hussain (2002). Reproductive tract infections among women attending primary health care facilities in Moshi, Tanzania. East African Medical Journal; 79(1): 16-21.
  26. Sia E Msuya, Elizabeth Mbizvo, Akhtar Hussain, Johanne Sundby, Noel E. Sam, Babill Stray-Pedersen (2002). Female genital cutting in Kilimanjaro, Tanzania: changing attitudes? Tropical Medicine and International Health; 7(2): 159 – 165.
  27. Sia E Msuya, Elizabeth Mbizvo, Babill Stray-Pedersen, Johanne Sundby, Noel E Sam, Akhtar Hussain (2002). Reproductive tract infections and the risk of HIV-1 among women in Moshi, Tanzania. Acta Obstetrica et Gynaecologica Scandinavica; 81:886-893.
  28. EM Mbizvo, SE Msuya, B Stray-Pedersen, J Sundby, MZ Chirenje, A Hussain (2001). HIV seroprevalence and its associations with reproductive tract infections in women in Zimbabwe. International Journal of STD & AIDS; 12:524-531.
  29. Mmbaga BT, Lie RT, Kibiki GS, Olomi R, Kvale G, Daltveit AK: Transfer of newborns to neonatal care unit: a registry based study in Northern Tanzania. BMC Pregnancy and Childbirth 2011, 11:68
  30. Mmbaga BT, Lie RT, Mahande MJ, Olomi R, Kvale G, Daltveit: Cause-specific neonatal mortality in a neonatal care unit in Northern Tanzania.A registry based cohort study.BMC Paediatrics 2012, 12:116
  31. Mmbaga BT, Lie RT, Mahande MJ, Olomi R, Olola O, Daltveit A: Causes of perinatal deaths in a tertiary care hospital in NorthernTanzania 2000-2010. A registry based cohort study. BMC Pregnancy and Childbirth 2012, 12:139
  32. Michael J Mahande, Anne K Dalveit, Blandina T Mmbaga, Joseph Obure, Gileard Masenga, Rachel Manongiand Rolv Terje Lie. Recurrence of perinatal deaths in Northern Tanzania: A registry-based study. BMC Pregnancy and Childbirth. 2013; 13:166
  33. Michael Johnson Mahande, Anne Kjersti Dalveit, Joseph Obure, Blandina T Mmbaga, Gileard Masenga, Rachel Manongiand Rolv Terje Lie. Recurrence of preterm birth and perinatal mortality in northern Tanzania: registry-based cohort study. Tropical Medicine and International Health.2013; 18(8): 962–967
  34. Michael J Mahande, Anne K Dalveit, Blandina T Mmbaga, Gileard Masenga, Joseph Obure, Rachel Manongiand Rolv Terje Lie. Recurrence of preeclampsia in Northern Tanzania: a registry-based cohort study. Plos one 2013, 8(11)e79116
  35. Opemipo O. Johnson, Daniel K. Benjamin, Daniel K. Benjamin Jr, Werner Schimana, L. Gayani Tillekeratne,, John A. Crump, Keren Z. Landman, Grace D. Kinabo, MD, Blandina T. Mmbaga, Levina J. Msuya, John F. Shao, Mark E. Swai, and Coleen K. Cunningham: Total Lymphocyte Count and World Health Organization Pediatric Clinical Stage as Markers to Assess Need to Initiate Antiretroviraherapy among Human Immunodeficiency Virus-Infected Children in Moshi, Northern Tanzania: Pediatr Infect Dis J. 2009 June ; 28(6): 493–497
  36. L. Gayani Tillekeratne, Sheng Feng, Werner Schiman, Opemipo O. Johnson, Grace D. Kinabo, Blandina T. Mmbaga, Levina J. Msuya, John F. Shao, Mark E. Swai, John A. Crump and Coleen K. Cunningham: Identifying HIV-infected children who may benefit from early initiation of antiretrovirals. Journal of Pediatric Infectious Diseases 4 (2009) 387–392
  37. Cecilie Nilsen Truls Østbye Anne K Daltveit Blandina T Mmbaga Ingvild F Sandøy. Trends in and socio-demographic factors associated with caesarean section at a Tanzanian referral hospital 2000 to 2013. International Journal for Equity in Health. Accepted 22 September 2014
  38. Downs JA, Kabangila R, Verweij JJ, Jaka H, Peck RN, Kalluvya SE, Changalucha JM, Johnson WD, van Lieshout L, Fitzgerald DW. Detectable urogenital schistosome DNA and cervical abnormalities 6 months after single-dose praziquantel in women with Schistosoma haematobium infection. Trop Med Int Health. 2013 Sep;18(9):1090-6. doi: 10.1111/tmi.12154. PubMed PMID: 23937701; PubMed Central PMCID: PMC4014060.
  39. Downs JA, van Dam GJ, Changalucha JM, Corstjens PL, Peck RN, de Dood CJ, Bang H, Andreasen A, Kalluvya SE, van Lieshout L, Johnson WD Jr, Fitzgerald DW. Association of Schistosomiasis and HIV infection in Tanzania. Am J Trop Med Hyg. 2012 Nov;87(5):868-73. doi: 10.4269/ajtmh.2012.12-0395. Epub 2012 Oct 1. PubMed PMID: 23033399; PubMed Central PMCID: PMC3516262.
  40. Mbabazi PS, Andan O, Fitzgerald DW, Chitsulo L, Engels D, Downs JA. Examining the relationship between urogenital schistosomiasis and HIV infection. PLoS Negl Trop Dis. 2011 Dec;5(12):e1396. doi: 10.1371/journal.pntd.0001396. Epub 2011 Dec 6. Review. PubMed PMID: 22163056; PubMed Central PMCID: PMC3232194.
  41. Downs JA, Mguta C, Kaatano GM, Mitchell KB, Bang H, Simplice H, Kalluvya SE, Changalucha JM, Johnson WD Jr, Fitzgerald DW. Urogenital schistosomiasis in women of reproductive age in Tanzania’s Lake Victoria region. Am J Trop Med Hyg. 2011 Mar;84(3):364-9. doi: 10.4269/ajtmh.2011.10-0585. PubMed PMID: 21363971; PubMed Central PMCID: PMC3042809.