Study Design

We adopted a qualitative approach to report activities and lessons learned under UVP. This was a process review and documentation with the goal of sharing experiences.

Data Extraction

We reviewed annual progress reports and activity reports and consulted with key program personnel. Generally, reports were limited to descriptions of an activity, output, or outcome but not impact, which will be accomplished with long-term follow-up. All descriptions were extracted and reviewed manually. We also interviewed some beneficiaries of the program to get their perspective and experiences on UVP.

The data were organized by UVP’s specific aims and relevant subthemes related to the aims. For consistency and shared learning, three research team members independently reviewed the reports and agreed on major themes and subthemes and content. When discrepancies were noted, these were discussed until consensus was reached.

Data Synthesis and Analysis

The team reviewed all extracted material. We followed pre-determined themes based on project aims and objectives to report our findings. While we explored individual aims, we also focused on linkages across the aims. The findings were checked with other program staff to ensure the study reflected what was achieved and limitations. Their feedback helped to focus the analysis and to validate and interpret the results.

Ethical Considerations

The study obtained exemption from the University of Zambia Biomedical Research Ethics Committee, as it was deemed evaluation of an existing university program.

Aim 1. Train PhD Scientists from UNZA to Investigate Complex Nutritional and Metabolic Factors Related to Long-term HIV Complications and Comorbidities

UVP’s most intensive activity is to support UNZA PhD students whose research interests align with the focus of UVP, through a highly tailored and flexible program. Students first apply and are accepted into the UNZA PhD program, which requires a preliminary research proposal under the guidance of an UNZA mentor. Upon acceptance, students apply for support from UVP through an application developed in Vanderbilt’s Research Electronic Data Capture (REDCap) tool [12]. Applicants are evaluated principally on the alignment of their proposed research topics with the mission of UVP and the availability of suitable co-mentors at Vanderbilt, as a key concept in UVP’s design is interdisciplinary mentorship from investigators at both UNZA and Vanderbilt (Table 1).

UVP’s support is organized in a “sandwich” fashion, in which students come to Vanderbilt early in their first PhD year (except in one case, the University of Cape Town, South Africa) to take courses tailored to their specific interests and requirements for new skills, to solidify relationships with mentors, to identify additional Vanderbilt mentors where needed, and to work with their UNZA and Vanderbilt mentors to refine their research proposals. Courses taken have included biostatistics, research ethics, epidemiology, clinical trials, genetics, immunobiology, bioregulation, microeconomics, and analysis of survey data. Additionally, UVP trainees join the community of international scholars at Vanderbilt Institute of Global Health (VIGH) as well as the diverse international student community at Vanderbilt.

After two to four months at Vanderbilt, the trainees return to Zambia where they apply for approval of their PhD thesis research proposals by the UNZA Board of Graduate Studies and the UNZA Biomedical Research Ethics Committee. In years two and three, they typically collect their research data with modest research cost support from UVP. In year three or four, they may return to Vanderbilt for additional mentorship and training including data analysis, manuscript preparation, and grant writing. To date, all biological assays on collected specimens have been conducted in Zambia, but students may transfer samples to Vanderbilt if the required technology is not feasible in Zambia. In year four, they write and defend their theses orally (viva voce) and submit manuscripts for publication.

Eleven PhD students have received sponsorship from UVP thus far (Table 1). All of them have continued their primary occupations while pursuing PhD studies: six of them teach at UNZA (three of these are also physicians at the University of Zambia Teaching Hospital [UTH]), four teach at Zambian universities other than UNZA, and one is a research fellow at a local research institute. Below are some observations by UVP fellows on how the program helped and some challenges:

[Benefits and gaps filled by UVP]

“I have been sponsored for tuition, trip to the USA (twice) for enhancement courses, had one on one mentorship…have had opportunity to present ideas to a broader community in Zambia and the USA.” [Most important gaps filled by UVP] “Exposure to more ways of handling research, statistics, and clinical investigation research and mentorship.”UVP Fellow_1

“The clinical trial course I took at Vanderbilt was so key to the development of my research focus area and the Vanderbilt trip was an eye open to a number of things pertinent to career development.” UVP Fellow_7

[Mentorship experience]

“I have a well-rounded team with my primary supervisor being my main mentor and I have also received great mentorship from the Vanderbilt team.”UVP Fellow_2

“I feel comfortable and well equipped with a flexible, serious, and helpful mentorship team. I have received all the necessary help. My mentorship team is multidisciplinary and this has been helpful in tackling various issues I had.”UVP Fellow_5

“I have a great mentorship team with different expertise which are all cardinal to my career path. My mentors are always there when I need help.”UVP Fellow_8

[Challenges faced by fellows]

“Given that we are doing PhDs, the financial amount for research is not enough to run the project smoothly. There is a limitation to what one can explore hence having some potential to affect (to some degree) the impact of the research. Otherwise, it has been a successful journey and program.”UVP Fellow_4

“My main challenge has been integrating work and research time…. I did not know what to expect at Vanderbilt. I wish I had used the resources better at Vanderbilt if I had prior arranged time in the lab to learn techniques and have more practice time.”UVP Fellow_7

“The research money is not very enough for someone to do all the lab tests deemed important in answering the aims. However, the project is running smoothly generating results of public health and policy importance.”UVP Fellow_2

“I have not been able to obtain all the required online learning materials on time due [to] internet challenges.”UVP Fellow_8

Aim 2. Strengthen the UNZA PhD Program to Enhance Its Capacity to Train Future Researchers, Attract Research Funding, and Generate High-impact Research Outputs Across a Broad Range of Studies

Aim 3. Ensure and Document the Long-term Success of the Training Program (Evaluation Plan)

We evaluate UVP using a mixed-method approach including process, outcome and impact (see Figure 3). Process evaluations are routinely conducted to ensure that we meet program objectives and to identify opportunities for program process improvement. For example, the first cohort of UVP applicants was solely from the School of Medicine, so we needed to evaluate how to broaden our reach across the schools. Through an iterative process, evaluation, advertisement, recruitment, and selection procedures were streamlined in the second year to provide a broader reach across the four RWC schools. This was effectively actualized in the remaining UVP PhD trainee cohorts. Additionally, we routinely conduct evaluations assessing trainee progress toward PhD degrees to ensure timely completion; trainees’ and mentors’ perceptions of the quality of the mentor support to ensure that mentor-mentee relationships are productive; and exit interviews of UVP trainees and mentors to enhance program strengths and identify areas for improvement. Anonymous online program evaluations are conducted at the completion of all short courses to assess skills enhancement and overall opinions about the courses. Each course evaluation informs the development of subsequent courses.

Importance of High-level Support and Engagement at Program Initiation

UVP was designed to engage with senior management at both institutions to ensure their input on the priorities for the collaboration, especially gaps that could be bridged to catalyze future research collaborations. The focus on capacity building was therefore based on consensus and priorities for the University of Zambia. Past collaborations also informed this initiative, as very little attention had been paid to doctoral training and faculty support, which were major gaps. With this in mind, both senior and junior faculty members have been capacitated to co-mentor and supervise PhD students through this initiative. UNZA senior administration has taken much interest, including a high-level visit of UNZA administrators to Vanderbilt to show support and encourage the collaboration. The high-level involvement has resulted in shared vision and commitment. For example, processes to recruit PhD program graduates into full-time positions at UNZA and other collaborating local universities have been streamlined. UNZA is also implementing a plan to integrate the PhD curriculum plan and the mentorship curriculum supported by UVP into the university system as part of UNZA’s standards and requirements.

Co-mentoring for PhD Fellows and Capacity Exchange

UVP aims to build capacity not just for students but for UNZA faculty as well. Senior UNZA faculty were deliberately paired with those at Vanderbilt, creating a shared vision for mentorship and expanding opportunities for mentors from both institutions. The Vanderbilt faculty were selected based on their special expertise that aligned with the students’ research interests. Students share their progress regularly with all mentors, leading to collegial interchanges with input from both sides. The UNZA mentors understand the field-work logistics and PhD standards at UNZA, a combination that provides scientific strength and general research capacity and innovation. The PhD trainees’ tenures at Vanderbilt at the beginning and end of their PhD studies provide them with both intensive international mentorship and peer learning. Some of these groups have extended their collaborative activities beyond the PhD training, evidencing the communities of researchers we wish to create.

Institutional Capacity Building

While UVP’s Aim 1 focuses on individual PhD students and junior faculty members, institutional research capacity building is the program’s overarching objective. In the annual research workshops, UNZA faculty members present their research findings along with and aligned with student research presentations. This was the first regular platform at the University of Zambia in which research could be shared and themes chosen by faculty members each year. The platform also allows for internationally renowned scientists, including those from other regional institutions, to share their research with UNZA faculty and students as invited guests. Another institution-level activity is the collaborative development of the mentorship training curriculum which is being adopted as standard for training all PhD mentors at UNZA RWC. Moving forward, it is hoped these activities will be locally owned and extended to other schools.

Leveraging Existing Structures and Opportunities at UNZA

UVP utilizes UNZA resources that had been introduced through previous projects and collaborations, including prior extramurally funded research training programs such as NIH AITRP grants. For example, faculty trained through previous grants are the main resource used to support current PhD students and UVP’s activities. Selected existing UNZA courses have been identified and offered to UVP-supported PhD students, and are now being modified to enhance the education of all UNZA PhD students. Additionally, both previous and ongoing studies, cohorts, and specimen and data banks are being utilized by PhD students to conduct their research.

These synergies have been realized at a lower cost than that required to start such a program from scratch and have emphasized the need for long-term investments in research training and collaboration. UVP’s achievements were built on the foundation of previous gains that might have gone unnoticed yet are vital to success in building LMIC institutions’ research capacity.

The Role of Technology

UVP has benefitted from advances in technology that support learning. Students and faculty have utilized platforms like WhatsApp to communicate and share ideas rapidly. Zoom, Skype, and GoToMeeting have been used for fortnightly leadership meetings as well as trainings, webinars, and mentorship sessions. This has helped overcome barriers associated with distance, costly telephone calls, and logistics of local and international travel. Technology is supplemented with physical mentorship meetings and workshops, thus making the program seamless and efficient despite the distance between the US and Zambia.

Research Electronic Data Capture (REDCap) is an additional technological resource that has been instrumental in UVP students’ acquisition and management of data for their research projects [11]. Invented and managed by scientists at Vanderbilt’s Department of Biomedical Informatics, REDCap is a secure web application for building and managing online surveys and databases. REDCap was made available to UVP-supported students upon enrollment. UVP resources and workshops facilitated the installation and implementation of REDCap at UNZA, and it is anticipated that UVP will support training in its use as well, as a resource for investigators throughout the institution.

Challenges and Limitations

As a research training program supported by a grant that has an NIH-imposed cap on research costs, UVP’s major challenge has been the modest level of funding available to support robust PhD student research projects. This, coupled with the modest number of ongoing Zambia-based research projects and UNZA-based research mentors that PhD students can join, has restricted the scope of the students’ biomedical and public health research. Given these circumstances, it is vital to have complementary research funding to enable students and faculty to conduct advanced and rigorous research. This mirrors the challenges of LMIC institutions generally [23, 24]. The goal over time is to expand collaborations that enhance training and mentoring of program graduates in grant writing in order to obtain independent research funding. This promises to advance LMIC research generally and to strengthen the institutional fabric of mentoring and training at UNZA.

Similarly, the program has a stipend budget to support the students only while they are in the US; while UVP supports their tuition at UNZA to keep them enrolled in the PhD Program, it does not provide stipends while they are in Zambia. This affects students’ progress, as they must maintain employment to have adequate incomes, but it enables us to support more students.

Finally, high-speed internet access and access to some software resources at UNZA have been a challenge for students. While they have reasonable access to software through Vanderbilt, it will end when they are no longer students, so we are seeking local support for online resources to keep the PhD graduates competitive on the global scene.

As UVP has completed only four years, we have focused here on its features and short-term outcomes. We will report long-term impacts in a future publication after more trainees have graduated and their outcomes have matured.