Dr. Kathleen Neuzil, FIC Director, presiding, the FIC Advisory Board met via videoconference on June 3, 2:00 p.m. – 4:30 p.m. EDT, for the closed session, and on June 4, 9:00 a.m. – 12:15 p.m. EDT, for the open session.
Advisory Board Members Present:
- Kathleen Neuzil, M.D., M.P.H., Director, FIC
- Otis Brawley, Ph.D., Johns Hopkins University
- Wondwossen Gebreyes, M.D., Ohio State University
- Chandy John, M.D., Indiana University School of Medicine
- Robert Murphy, M.D., Northwestern University
Ex Officio Members Present:
- Gregory Germino, M.D., National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH
- Satish Gopal, M.D., M.P.H., Center for Global Health (CGH) at the National Cancer Institute (NCI), NIH
- Jeanne Marrazzo, M.D., M.P.H., National Institute of Allergy and Infectious Diseases (NIAID), NIH
- Mike Reid, M.D., PEPFAR, Bureau of Global Health Security and Diplomacy, U.S. Department of State
FIC Staff Present:
- Kristen Weymouth, Executive Secretary; Office of the Director
- Nalini Anand, J.D., M.P.H, Director, Division of International Science Policy; Director, Center for Global Health Studies, FIC
- Farid Jarrous, IT Systems Specialist
- Flora Katz, Ph.D., Director, Division of Training and Research
- Peter Kilmarx, M.D., Deputy Director, FIC
- Andrey Kuzmichev, Communications Director
- Amit Mistry, Ph.D., Senior Scientist, FIC
- Annette Rid, M.D., Ph.D., Bioethicist, FIC
- Christine Sizemore, Ph.D., Director, Division of International Relations, FIC
- Rachel Sturke, Ph.D., M.P.H., M.I.A., Acting Deputy Director, FIC
- Susan Vorkoper, Public Health Advisor, FIC
Also Present
- Clement Adebamowo, Ph.D., Professor, University of Maryland School of Medicine
- Ben Chi, M.D., M.Sc., Professor, Institute for Global Health and Infectious Diseases, University of North Carolina
- Jepchirchir Kiplagat, Ph.D., M.P.H., Lecturer, Moi University, and Research Director, AMPATH Kenya and Indiana University Center for Global Health Equity
- Brad Newsome, Ph.D., Program Officer, Division of International Training and Research (DITR)
- Julie Parsonnet, M.D., Professor, Stanford Medicine, Stanford University
- Dianne Rausch, Ph.D., Director, Division of AIDS Research, National Institute of Mental Health (NIMH)
- Michael Scanlon, M.P.H., Assistant Director of Research, Indiana University Center for Global Health
- David Spiro, Ph.D., Director, Division of International Epidemiology and Population Studies (DIEPS)
- Kaiyuan Sun, Ph.D., Research Scientist, Division of International Epidemiology and Population Studies (DIEPS)
- Janet Turan, Ph.D., M.P.H., Professor, Department of Health Policy and Organization, University of Alabama at Birmingham
- Cecile Viboud, Ph.D., Senior Research Scientist, Division of International Epidemiology and Population Studies (DIEPS)
Director's Update and Discussion of Current and Planned FIC Activities
Dr. Kathleen Neuzil, FIC Director, called the open meeting to order and reviewed the agenda. She thanked Dr. Peter Kilmarx for the work he has done as the Acting Director of FIC, and Dr. Chandy John, for whom this is his last meeting, for his work as a Board Member since 2021 as well as serving on the Center for Global Health Studies subcommittee and being the Board Liaison on Promoting Greater Research Equity and Global Health Reciprocal Innovation. She also thanked the ex officio members who are leaving their positions: Diana Bianchi, Janine Clayton, and Walter Koroshetz, and welcomed the new ones: Satish Gopal, Jeanne Marrazzo, Michael Reid, Jane Simoni, and Bruce Tromberg. She recapped a recent FIC All Hands Meeting and Team Building event.
Dr. Neuzil described some of her educational and professional background, which includes working in more than 20 low- and middle-income countries (LMICs) on research projects. She has a strong commitment to training and capacity building. She discussed several of the major issues facing LMICs, including climate health, non-communicable diseases, antimicrobial resistance, the effects of COVID-19, humanitarian crises, and economic stressors on families and governments. She insisted that LMICs not be left behind as scientific progress occurs faster and faster, and that NIH needs to ensure that its studies and discoveries have positive impacts. She informed the Board that FIC would soon be drafting a new strategic plan focused on how FIC can ensure the next generation of scientists is prepared to take on the health threats of the future. The drafting process will be outlined in the coming weeks and will prioritize stakeholder and Board Members input, as well as performance indicators and data analytics.
Dr. Peter Kilmarx remembered Dr. Joel Breman who passed away in April and discussed all of the work he did throughout his life for the global health research community. Dr. Kilmarx provided additional updates on FIC activities including FIC at the Consortium of Universities for Global Health (CUGH) where Dr. Alex Mremi received the James G. Hakim Award for an early-career African with the highest-scoring abstract. The Launching Future Leaders in Global Health (LAUNCH) Research Training Program held a panel training the next generation of global health leaders. Dr. Kilmarx represented FIC at the Novo Nordisk Foundation Global Science Summit in Denmark in May, where the foundation announced that they are partnering with the Gates Foundation and Wellcome, each pledging $100 million in climate and health, infectious diseases, and nutrition, focused on LMIC researchers. Also in May, Dr. Kilmarx attended the INTEREST HIV Research Conference in Benin. FIC supports travel for early-career Africans with accepted abstracts to the conference; while in Benin, Dr. Kilmarx met with several collaborators.
Dr. Amit Mistry updated the Board on the Division of International Science Policy, Planning and Evaluation (DISPPE) and one of its projects on climate adaptation case studies. The project is funded by NIH's Climate and Health Initiative and led by FIC's Center for Global Health Studies (CGHS) and was started to address the limited evidence base for health outcomes of climate adaptation strategies. The project received 133 proposals from 45 countries, mostly LMICs, and 15 were selected to develop into case study articles to be published in Global Health Science & Practice with a target date of April 2025. There will also be further dissemination through conferences, webinars, podcasts, and local events. The case studies are divided equally between Latin America, Africa, and Asia, covering a broad range of climate stressors, health topics, and adaptation strategies.
Ms. Susan Vorkoper updated the Board on the Adolescent HIV Implementation Science Alliance (AHISA), whose goal is to enhance the effective use of evidence and overcome implementation challenges related to prevention and treatment of HIV among adolescents in sub-Saharan Africa. The Alliance brings together teams of NIH-funded researchers and their in-country partners, such as government representatives, research collaborators, program implementers, and youth, who are selected through a competitive process; there are 26 teams across 11 countries. The Alliance's work is mainly guided by members of its steering committee, which is made up of NIH Institutes and Centers, other U.S. government agencies, UNICEF, WHO, members of the FIC Advisory Board, and individual experts; it is funded by PEPFAR and NIH's Office of AIDS Research (OAR). The Alliance held its seventh annual meeting in Kenya at the end of April to the beginning of May, partnering with NICHD's Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H-IN). The meeting had sessions on planning for sustainability, dissemination to non-research audiences, and implementation challenges for using AI in adolescent HIV. The Alliance is continuing to work with its action groups in the local AHISA branches, which have brought together members of ministries, universities, advocacy groups, youth, and others. Positive results are starting to be seen from the alliances, including one that received research funding on antiretroviral therapy (ART) uptake among adolescents that was developed in conjunction with youth, IS researchers, and the Ministry of Health; another led to evidence-based changes in the national policy. The Alliance is awaiting the results from an AHISA evaluation that will capture more outcomes, which will be shared with the Board.
Ms. Vorkoper apprised the Board of another CGHS project called the Childhood Obesity Prevention Across Borders Workshop that has the objective of understanding research conducted in Latin America and among Latino populations in the U.S. by sharing research results and transferable lessons learned, catalyzing new collaborations. The Workshop focuses on cross-cutting questions on social environment, built environment, migration, and implementation science that cut across many regions and disciplines. Building on the Workshop, they supported 13 small awards to catalyze the development of new research partnerships between U.S. and Latin American investigators as well as investigators across different Latin American countries that are all working to address childhood obesity prevention. The Workshop recently held a virtual meeting of the awardees to allow them to discuss their results and the challenges and benefits of working across countries, capacity building, and reflecting on how their work can impact childhood obesity research. There was a session that highlighted opportunities and activities of interest to the researchers, and NIH developed a list of its relevant funding opportunities that it shared with the meeting participants. The awards resulted in successful research applications, formal institutional collaborations, and scientific publications.
Dr. David Spiro, Director of FIC’s Division of International Epidemiology and Population Studies (DIEPS), informed the Board that his division had two new members and updated the members on recent research on computational modeling of infectious disease and viral evolution. The first recent study was on the impacts of human mobility on the city-wide transmission dynamics of 18 respiratory viruses in Seattle between 2018 and 2022. The study found that mobility patterns were more predictive of virus transmission during periods of significant behavioral changes, such as stay-at-home orders, with endemic viruses showing stronger and more lasting associations with mobility than SARS-CoV-2. Another study focused on disentangling the relationship between cancer mortality and COVID-19, displaying that the former only modestly increased during the pandemic with specific variations across cancer subtypes and U.S. states. Excess mortality for other chronic conditions, e.g. Alzheimer's and diabetes, was significantly higher, emphasizing the importance of considering demographic factors and competing mortality risks in regard to mortality from epidemics or pandemics. Another study looked at the comparative evolution of Influenza A viruses H1 and H3 and their stock domains across host species. The study compared the rates of nucleotide substitution, protein evolution, and glycosylation patterns of HA protein in avian, canine, equine, human, and swine hosts, finding that non-human mammalian hosts exhibit higher DNDS ratios and more dynamic glycosylation changes, indicating greater selection pressures for antigenic evolution in non-human mammalian hosts compared to their avian counterparts. Another study researched the potential impact of annual vaccinations with a reformulated COVID-19 vaccine that the COVID-19 Scenario Modeling Hub conducted. The study demonstrated that annual vaccinations can significantly reduce COVID-19 hospitalizations and deaths in the U.S., particularly under conditions of high immune escape and broad vaccine coverage.
Dr. Spiro discussed a recently published study entitled Antigenic Drift and Subtype Interference Shape A(H3N2) Epidemic Dynamics in the United States which examined the associations between Flu virus evolution and epidemic dynamics over 22 seasons in the U.S., focusing on the fast-evolving H3N2 viruses, which are the cause of death in most cases. The manuscript is an important demonstration of the power of a nascent scientific field that is combining evolutionary analysis of large pathogen genomic datasets with machine learning-based analysis of epidemic dynamics. The study found that genetic changes in the hemagglutinin (HA) of H3N2 were more strongly linked to larger epidemic sizes, higher viral transmissibility, and increased deaths than changes in the neuraminidase (NA). The study also found that close circulation of H1N1 viruses is more predictive of H3N2 epidemic sizes than H3N2 viral evolution alone and underscored the need to include NA in Flu vaccines and to monitor both HA and NA evolution for better epidemic forecasting. Dr. Spiro highlighted some of DIEPS's capacity-building workshops taking place in Pakistan. In the past month, several courses were held: a continuation of the genomic epidemiology series, three courses in bio-risk management, a developing and strengthening institutional bio-safety committees course, a responsible conduct in genomic sciences course, and a preparing at-risk veterinary laboratories in Pakistan for ISO 35001 accreditation course.
Dr. Andrey Kuzmichev provided a Communications Office update starting with the Consortium of Universities for Global Health (CUGH) annual meeting in April, where the team promoted and organized Fogarty's listening session, manned the information table, streamed live videos of panels, and passed out the FIC factsheet, which has been translated into seven languages. Communications has also launched the Talking Global Health with Fogarty series on YouTube which consists of interviews conducted with individuals featured in the Global Health Matters newsletter and has both full videos and shorts. The Communications Office plans to start an Instagram account to further share the shorts. The team is currently working on updating its content and plans to transition to multimedia storytelling with interconnected content for all its platforms.
Dr. Neuzil reminded the Board of upcoming events, including the Barmes Lecture 2024 with Ambassador Dr. John Nkengasong, the 7th AFREhealth Annual Symposium, FIC program network meetings, and the future Advisory Board meetings scheduled for September 5-6, 2024, February 10-11, 2025, and June 2-3, 2025.
Scenario Modeling Hub Projections of the Impact of Respiratory Virus Interventions in the U.S., 2023-2025
Dr. Cecile Viboud, Senior Research Scientist, DIEPS, presented to the Board on long-term scenario projections for respiratory viruses and the US Scenario Modeling Hub, which was established in December 2020 to coordinate long-term scenario projections from multiple models at the national and state levels. So far, there have been 25 rounds of projections: 18 on COVID-19, four on influenza, and one on RSV. The projections focus mostly on interventions including vaccinations and non-pharmaceutical interventions, as well as immunity and transmissibility. Traditionally, there has been less attention on RSV than influenza and COVID-19, even though it has a particularly large impact on infants, but there is renewed interest due to new RSV preventive interventions rolled out in 2023 and 2024. The Hub created several RSV scenarios based on differing levels of vaccine coverage and effectiveness against hospitalization in infants and seniors, informed by data from randomized controlled trials available at the time. The projections modeled weekly hospitalizations due to RSV broken down by age group, and determined the number of hospitalizations that were averted by vaccine intervention and the number of doses needed to avert hospitalization. The projections found that RSV burden reduction depends on timing and coverage of interventions and the modeling will allow them to better time interventions for the next year.
Dr. Viboud discussed the COVID-19 projections for guiding ACIP's booster vaccine recommendations for the 2024-25 COVID season. The projection had six scenarios based on different age groups and immune escape. The ensemble projections are based on nine models. They project that COVID-19 hospitalizations will remain at low levels through spring, rise in summer and fall, and peak in late December or early January, but remain below the high CDC threshold. The projections also looked at potential vaccine impacts based on different age groups being vaccinated. The US Scenario Modeling Hub provides multi-year support for respiratory virus preparedness for federal, state, and local health authorities working in close collaboration with CDC and its Center for Forecasting and Analytics. It also provides technical support to the EU Scenario Modeling Hub and studies methodological developments to advance the science of scenario projections.
SARS-CoV-2 Correlates of Protection from Infection-Induced Immunity in the Age of Immune Escape Variants
Dr. Kaiyuan Sun, Research Scientist, DIEPS, defined an immune correlate of protection (CoP) as an immune response that is responsible for and statistically interrelated with protection. Gaps in understanding SARS-CoV-2 immune CoP include CoP for infection-induced immunity, particularly the contribution of neutralizing antibodies (nAbs); CoP against asymptomatic and subclinical infections; CoP for antibody level measured prior to exposure; CoPs against variants; waning of immunity; and protective immunity to reduce transmission. The study aimed to fill these gaps by evaluating neutralizing titers induced by prior SARS-CoV-2 infections against the study's infection outcomes, including asymptomatic and subclinical cases. Over the course of the study 10 serum samples were collected at two-month intervals around each variant wave to look at antibody levels, and nasal swab samples were collected twice a week and tested using rRT-PCR to track infections at the individual level. Regarding the Delta wave, the study found that immunity conferred by prior infection reduced the risk of infection by 61% and anti-D614G serum nAb titer mediated 37% of the total protection. The study also found that prior immunity significantly reduced reinfection's onward transmission risk by 78%. During the Omicron wave the study found immunity conferred by prior infection reduced the risk of infection by 37%, anti-BA.1 serum nAb titer mediated 11% of the total protection, and there was no evidence that prior immunity reduced reinfection's onward transmission risk. The study's research established that nAbs induced by prior infection mediate protection against reinfection, protective titers are variant-specific, and most protection cannot be fully explained by serum nAbs.
Global Alliance for Chronic Diseases (GACD) Concept
Dr. Brad Newsome, Program Officer, Division of International Training and Research (DITR), presented to the Board on the GACD Program supporting implementation research in LMICs and US American Indian/Alaska Native (AI/AN) populations. The program aims to address the growing global burden of chronic non-communicable diseases (NCDs), scaling up proven effective NCD interventions practically, effectively, contextually, and sustainably, while leveraging implementation research to examine what works, for whom, and under what circumstances. The program prioritizes accessible and equitable health research and intervention development, and GACD is the first and only international consortium developed to address the major needs of NCDs in these populations. A trans-NIH program, GACD seeks renewal to support three additional research funding announcements (RFAs) to advance cross-cutting implementation research in LMICs and AI/AN populations. GACD's mission is to reduce the burden of chronic NCDs in LMICs and First Nation populations facing conditions of vulnerability in high-income countries, by building evidence to inform national and international NCD policies and contribute to the achievement of the Sustainable Development Goals under section 3.4. Together, the 15 members of the alliance represent 80% of global public funding for health research. NCDs account for 63% of all annual deaths, or 36 million people, with 80% of all NCD deaths occurring in LMICs. To combat this, GACD funds nine global research programs comprised of 1,300 researchers in 80 countries. GACD and its associate partners have funded 182 projects with $375 million in investment. Starting in 2012, GACD has funded research programs on hypertension, diabetes, lung disease, mental health, scaling up, cancer, life course, and healthy cities. NIH alone, through 12 Institutes, Centers, and Offices (ICOs), has funded 37 research projects with about $130 million in investment.
For FY'26, NIH proposed having notices of funding opportunities (NOFOs) that focused on implementation science (IS) research addressing strategies for equitable transformation of health systems to reduce the prevalence and impact of NCDs in LMICs and among US AI/AN populations. For FY'27, it proposed NOFOs focused on IS research around strategies leveraging settings and sectors beyond the health system. The proposed topic for FY'28 is NOFOs focused on IS research on interventions targeting children and young people. The topics were chosen through a rigorous process that started with the convening of an external advisory board to review accomplishments to date and chart a path forward. They were then reviewed and cleared by the GACD Strategy Board, and finally reviewed and cleared by the GACD Board of Directors. The GACD funding opportunity structure uses both the R01 and the bi-phasic R61/R33 grant mechanisms. There are yearly PARs with two receipt dates per funding opportunity to allow for applicant resubmission, and the PAR can be utilized with no set-aside of funds required from partner ICs, encouraging more IC participation. Both LMIC and US institutions can apply for the five-year awards, which give them about $500,000 per year in direct costs. FIC does not directly support any awards but leads the NIH efforts broadly; partner ICs select, fund, and manage individual awards.
Benefits of the program structure are that it advances critical cross-cutting research to address NCDs in LMICs and Tribal Nations, encouraging research on their health needs. The structure pushes forward innovation, health equity, human-centered design, community-engaged research, data science, and AI/ML along with core implementation research strategies. It also intentionally and strategically advances research training and capacity-building needs alongside international research collaboration. Outside of the value that the awards bring, the partnership also strengthens research capacity and capability through GACD's training and career progression, the GACD e-Hub, implementation science schools, and capacity development workshops. GACD also provides networking and collaboration opportunities with 800 active GACD Research Network members, workshops, webinars, events, 12 active working groups on disease-specific and cross- cutting themes, and yearly knowledge sharing events. It also communicates NIH's work across the entire network through monthly newsletters, blogs, and social media.
Global Health Reciprocal Innovations: Opportunities, Challenges, and a Way Forward
Nalini Anand, Director, DISPPE, CGHS, discussed the development of CGHS's project on Global Health Reciprocal Innovation (GHRI). The project used the working definition of reciprocal innovation as harnessing a bidirectional, co-constituted, and iterative exchange of ideas, resources, and innovations to address shared health challenges across diverse global settings. The project aimed to investigate the untapped potential for high-income country (HIC) settings to learn from health innovations and implementation in LMICs. When interventions developed in LMICs are implemented in HICs it has to be done equitably and with proper attribution, mutual benefit, and opportunities for iterative and mutual learning. The project's goal was to better understand how to operationalize GHRI in an equitable, systematic, and evidence-based manner. The project began in 2019 with an environmental scan and request for information (RFI) to find examples of when GHRI successfully occurred in the past, which then informed a 2020 webinar on implementing LMIC HIV and stigma reduction interventions in the US. The project then conducted a scoping review of the literature in 2021 which informed a 2022 GHRI virtual workshop to further highlight case examples and explore useful models, frameworks, opportunities, and barriers. The workshop resulted in a Supplement in BMJ Global Health. There will be a satellite session entitled Optimizing the Global Impact of Health Interventions through Novel Research Partnerships and Knowledge Exchange, where experts on GHRI and authors in the article series will participate in a session at the AIDS2024 Conference in July.
Dr. Dianne Rausch, Director, Division of AIDS Research, NIMH, reviewed the division's mission and function to provide context as to how GHRI became one of its areas of focus. The division supports research to reduce the incidence of HIV worldwide and to decrease the burden of living with HIV/AIDS, which is done through basic and clinical neuroscience to understand and alleviate the consequences of HIV on the central nervous system (CNS), and basic and applied behavioral science to prevent HIV transmission and limit morbidity and mortality among those living with HIV. From the beginning of the AIDS epidemic, it was clear that HIV is transmitted primarily through behaviors, and NIMH's research on the topic is driven by a psychological and behavioral science framework with the goal of understanding behaviors that contribute to the risk of acquisition, and then to develop tests and implement interventions to modify those behaviors to prevent acquisition. This is complex, because many of the behaviors involved with HIV revolve around sex and intimacy, meaning there is much to learn about the cultural contexts surrounding intimate and sexual behaviors in different populations and cultural practices. Interventions such as condoms, circumcision, and antiretroviral (ART) drug regimens were difficult to implement either due to cultural differences or the complexity of the regimens. The barriers to uptake and adherence to the interventions in LMICs include access to care, mental health, stigma, stock-outs, and food insecurity. These barriers require creative strategies to meet the needs, resulting in very innovative approaches.
Retrospective studies on successful interventions show that input from the communities in the process from development to implementation is necessary to be successful and sustainable. This allows the intervention to be adaptable, consider cultural contexts and beliefs, and create fidelity as well as creative strategies for implementation. It is also important to integrate training opportunities and capacity building to have sustainability. NIMH found that in addition to lessons learned, they need to proactively identify opportunities for GHRI, developing a model for identifying the necessary components. It requires an environment that supports platforms to provide reciprocal learning, innovation exchanges, collaborative connections, and identification of health research priorities, while allowing for the development of proactive, intentional, and innovative research and research training programs. A strong foundation for a GHRI approach to research and learning requires funders to support pilots and formative research, and researchers who engage relevant communities and stakeholders, identify legal, regulatory, and ethical issues, and who can cultivate flexibility, openness, respect, and cultural sensitivity. Research using a GHRI approach must ensure it will provide mutual benefit and opportunity for effective, acceptable, and feasible dissemination.
Moving forward, NIMH recommends a proactive approach that includes developing programs and models that integrate stakeholders into the formative research from the beginning of the process, and that addresses legal, regulatory, and ethical issues that may arise. Frameworks should be developed that can integrate innovation exchange, and globally accessible repositories of GHRI research should be created that include lessons learned and innovation exchange.
Dr. Janet Turan, University of Alabama at Birmingham, discussed her paper in the BMJ supplement that highlights case examples of how GHRI has and is being used to address mental health and wellbeing. The paper highlights 12 case examples: seven focused on common mental disorders, three on HIV-related stigma reduction, three on substance abuse disorders, and two on family/child mental health – all developed in the LMIC settings and implemented in the US. The analysis identified different types of GHRI designs used, most of which utilized psychological techniques developed in HICs for delivery by mental health specialists. The designs often used intervention delivery modalities that used non-specialist or task sharing approaches developed in LMICs that were then adapted for use in HICs. The less common design was parallel intervention adaptation, implementation, and testing in LMICs and HICs. Many of the projects were stimulated by COVID-19 and the increased need for remote mental health care; all of the designs included LMIC-HIC collaboration. One project was the RECOUP-NY project, a task-sharing mental health intervention delivered over five sessions by a non-specialist to address common mental health disorders. Based on lessons learned in Nepal, PM+ was adapted and is currently being implemented in community organizations in New York City. Another intervention the study looks at is the FRESH stigma reduction intervention; an intergroup contact and empowerment intervention to reduce HIV-related and intersectional stigmas in healthcare settings. It was originally developed and tested in Africa and then adapted and tested in Alabama and the Dominican Republic. It used formative research in each setting to help tailor it to populations and their most salient stigmas, with shared leadership from the different country teams.
The study found several benefits from the use of GHRI, including that iterative feedback and learning enhances the way the intervention is delivered at each site, especially in simultaneous design; complementary expertise from each setting expanded the different expertise available to all sites; there's the potential for real-time dissemination of strategies, tools, and materials in simultaneous designs; and providing remote delivery resources across settings can lead to capacity building in under-resourced locations. Challenges included important contextual differences between the LMIC and HIC settings, lack of sufficient resources, travel restrictions, and changes in leadership and political will. The study also identified key resources necessary to do GHRI well: language and translation skills; cultural knowledge, sensitivity, mutual respect and humility across teams; availability of appropriate cadres of interventionists in each setting; technology to facilitate communication and collaboration; funds to support bidirectional travel of teams; medico-legal expertise in each setting; sufficient funds and grant mechanisms for large projects; sufficient clinical expertise to review the adapted versions; and sufficient time, human resources, and community participation.
The paper concluded that there is an emerging body of work with the potential to benefit diverse populations in LMICs and HICs, with clear benefits of bidirectional iterative processes where communication and collaboration are important. GHRI also provides an opportunity to reflect on colonial legacies in global health research and strive for balance and partnership. The paper also highlighted the need for comprehensive targeted funding mechanisms to support long-term multinational interactive, iterative work in the field of mental health and wellbeing. GHRI research should prioritize documenting best practices and processes for co-led LMIC-HIC teams and test the effects of different cultural and contextual adaptation frameworks on implementation and effectiveness outcomes.
Dr. Jepchirchir Kiplagat, Moi University (MU) and Mr. Michael Scanlon, Indiana University (IU), discussed the Indiana Reciprocal Innovation Program that is based on the Academic Model Providing Access to Healthcare (AMPATH), which started back in 1989 when IU and MU began an academic partnership in Kenya, later forming AMPATH in 2001 with MU's Teaching and Referral Hospital along with a consortium of universities. AMPATH has leveraged its strengths to advance care, education, and research by partnering in the delivery of health services and strengthening public sector health systems. It has also developed human capacity through training and education and advanced research to address health needs and priorities. AMPATH serves more than 24 million Kenyans, provides ART care to 110,000, and lowered mother-to-child HIV transmission to four percent. It has educated 2,200 Kenyans and North Americans and trained over 1,000 community health workers, with more than 100 faculty members working in collaboration. AMPATH provides $250 million in research grants, with 20 universities and institutes collaborating, and more than 1,400 peer-reviewed journal articles. After 34 years of successful partnerships AMPATH is now being replicated in Ghana, Mexico, and Nepal. The key principles of AMPATH partnerships include: shared belief in health as a fundamental right, counterpart relationships, collective impact, accountability to community needs, leveraging institutions, self-correction, long-term engagement and equitable partnership, enabling training and research, and reciprocal innovation.
The Indiana Reciprocal Innovation Program was established in 2018 as a module of the Indiana CTSI by a group of long-time AMPATH collaborators with the goal of building research and institutional infrastructure and partnerships necessary to facilitate and grow reciprocal innovation (RI). The program has three primary components: stakeholder meetings and workshops; a grants program; and a learning and dissemination platform. The stakeholder meetings and workshops serve three main purposes: to educate stakeholders and disseminate the concept of RI; to identify shared health priorities in Indiana and in partner LMIC settings and potential areas for RI; and to connect local and global investigators and partners to begin partnership and co-creation. The grant program has two types of RI grants, the first are one-year planning grants for $10,000 to support partnership building, identifying shared priorities and co-developing research projects. The second are two-year demonstration grants for $50,000 to support initial testing or adaptation/implementation of RI. Since 2018, six planning grants and eight demonstration grants have been awarded, with 92% reporting new and deepened partnerships and 69% reporting the RI projects were used to fund subsequent grant applications. The learning and dissemination platform is called the Global Health Innovation Exchange and includes information on funded RI projects like who the collaborators and partnerships involved are, what the shared challenge and priority they're addressing is, what the intervention/adaptation is and its process, and what the next steps for its adaptation and scaling are. The Exchange serves as a repository of case studies of RI in action.
Dr. Annette Rid, NIH Clinical Center, commented that GHRI has great potential to help the global health research enterprise move towards equity, but it needs to be implemented carefully, ensuring that a commitment to ethical conduct occurs across the board. There are also limited resources for research in terms of budgets and investigator time. Currently many GHRI projects focus on harnessing research from LMICs to benefit HICs, making it necessary to ensure GHRI projects don't displace funding or investigative time from research that has more significant benefits for populations in LMICs.
Dr. Chandy John, Board Member, moderated a Board discussion. Dr. Sizemore asked at what point in the GHRI process legal barriers in HICs are being addressed. Dr. Turan answered that they should be addressed from the very beginning, as there were times in the past when they weren't, which led to additional issues.
Dr. Gebreyes commented that GHRI should truly be co-creative at all steps in project development, and that US institutions should not use the term "site" to describe a partner location. Dr. Kiplagat responded that AMPATH does emphasize equal partnership and does not use the term "site" within its program. Dr. Neuzil asked if there is a cost effectiveness piece to the GHRI research agenda. Dr. Turan replied that she's not aware of it as an issue in her work but acknowledged its importance when looking at the differences in health systems, insurance, and information. Dr. Chi asked what happens when a parallel study takes place, and it works in one location but not another. Dr. Kiplagat stated that when things don't work out the way you expect, there are still things to learn, such as why it didn't work, and then using those lessons to inform future projects. Dr. Turan added that this is why flexibility is so important with GHRI projects. Dr. Rausch elaborated that over the years they've gotten better at adapting critical elements in creative ways to fit different settings.
Closing Remarks and Adjournment
Dr. Neuzil thanked the Board members for their time, the meeting organizers and panelists for their hard work, and Dr. Kilmarx for his work as Acting Director. There being no further business, the meeting adjourned at 12:14 p.m.