NIH Clinical and Translational Science Award (CTSA) Programs may benefit from global health research collaborations

July / August 2017 | Volume 16, Issue 4

Dr. Debra Litzelman pictured with two women, one holding a baby, at a research site in Kenya
Photo courtesy of Dr. Debra Litzelman

U.S. researchers involved in Indiana University's Clinical and
Translational Science Awards (CTSA) Program have gained
insights into health challenges from colleagues working
overseas, such as Dr. Debra Litzelman (right), who manages
a Fogarty grant in Kenya.

As scientists at Indiana University (IU) are discovering, the rewards of engaging in global health research are bidirectional. Not only do Kenyan scientists benefit from completing a rigorous 20-course curriculum modeled on the one offered by IU's Clinical and Translational Science Awards (CTSA) Program, but Indiana researchers also gain insights into local health problems by studying lessons learned when working alongside their African counterparts. Whether seeking to reduce high infant mortality rates in rural Indiana or confronting an HIV outbreak in the southern part of the state, IU scientists have found many of the issues they face are the same as in Kenya - a lack of health care workers, populations with similar risk factors, and stigma faced by those seeking diagnosis or treatment.

The Clinical and Translational Science Award (CTSA) Program network - funded at about $500 million annually through the National Center for Advancing Translational Sciences (NCATS) - supports U.S. medical research institutions that work together to improve the translational process to get treatments to patients more quickly.

"The activities supported by the CTSA Program have been transformative to the science and culture of those academic centers across the country," said NCATS Director Dr. Christopher P. Austin.

Expanding CTSA Programs to include global health, as Indiana has, may provide valuable perspectives and help spur innovation, Austin said. Although CTSA Program funds currently cannot be spent overseas - the sharing of curricula, training tools and best practices could benefit all. Another possibility under consideration is to encourage CTSA Program trainees to seek externships in low-resource settings overseas, where they may find novel, cost-effective solutions they can bring back to the U.S.

In 2008, Indiana received funding to establish its CTSA Program hub, a collaboration of IU, Purdue University and the University of Notre Dame, which has become the flagship catalyst for the state's biomedical initiatives, according to Principal Investigator Dr. Anantha Shekhar. Having grown up in India, he sees value in leveraging IU's 20-year relationship with Kenya's Moi University and expanding the curriculum to include more aspects of global health research. A future goal is to establish a platform for reciprocal global health innovation that could provide a model for other CTSA Programs.

Global health research training was added as a pillar of Indiana's career development program a few years ago, combined with standard courses in translational, clinical, implementation and community-based research. The curriculum also includes modules to promote interdisciplinary team science and commercialization of discoveries.

With a separate Fogarty research capacity building award, IU brought Kenyan research fellows to the U.S. and embedded them in the standard training program, said grantee Dr. Debra Litzelman. The curriculum was later adapted to suit Kenyans' specific health research needs and transferred to Moi University in Eldoret, where it has not only slowed brain drain but also propelled local scientists into leadership roles.

In Kenya - and across Africa generally - chronic, noncommunicable diseases (NCDs) will soon be the leading cause of death and disability. The new program at Moi reflects that, by including training on how to design, implement and improve integrated systems of care for Kenyans with hypertension, diabetes, cancer and other NCDs.

The explosion of genomics research provides the opportunity to shed light on the complex interplay between genetic and environmental factors, which determine disease susceptibility and drug response. NIH's Human Heredity and Health in Africa (H3Africa) program is developing African expertise and resources in genomics. This will provide fertile ground for research collaborations on inherited genetic factors, including those related to rare diseases, which are difficult to study in the U.S.

African-ancestry patients in the U.S. can be misdiagnosed because of genetic differences," observed Austin. "Rare diseases have traditionally been largely ignored in low- and middle-income countries because there are higher priorities, though that is beginning to change via the work of the International Rare Diseases Research Consortium and H3Africa," he said. "By working with populations and researchers globally, we are seeing benefits for patients in both the U.S. and foreign countries, and breakthroughs on some of these tough challenges."

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