A team from the National Institutes of Neurological Disorders and Stroke (NINDS) has travelled to Zambia and met with U.S. and Zambian researchers and clinicians who have been building a decades-long partnership to address the neurological burden of diseases like cerebral malaria, HIV, and stroke.
The constellation of research, education, and clinical activities that the NINDS team reviewed during their visit owe their origin to partnerships first formed by University of Rochester Medical Center (URMC) neurologist Gretchen Birbeck, M.D., back in 1994. Birbeck’s research in sub-Saharan Africa, primarily Zambia, aims at identifying risk factors and effective treatments for the neurological problems common in resource-limited tropical settings. She also see patients in Zambia, where she spends five to six months per year, and serves as the director for Chikankata's Epilepsy Care Team in Zambia's rural Southern Province and principal for the Neurology Research Office at the University Teaching Hospital (UTH) in Zambia’s capital, Lusaka.
In partnership with the Zambian Ministry of Health, UTH, the University of Zambia, Johns Hopkins University, Harvard University, Michigan State University, and other institutions, these efforts have grown to include a wide range of complementary neurological research, training, and care programs based in Zambia. The Neurology Research Office established by Birbeck on the main UTH campus serves as hub for many of these efforts, which have received more than $15 million in funding from the National Institutes of Health and other organizations and foundations over the past 29 years.
U.S. and Zambian research teams are studying the neurological problems that arise from cerebral malaria, nutritional deficiencies, and aging with HIV. These diseases – which are prevalent in sub-Saharan Africa – have broad effects on cognitive, behavioral, quality-of-life, and economic outcomes. The studies seek to understand the mechanisms of these diseases and improve care through evidence-based interventions and clinical trials.
An on-going example of this research is the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) study, an ongoing longitudinal study that has followed a cohort of 600 HIV positive and negative Zambian children ages 8 to 18 for 5 years. Data from the HANDZ study was the basis of a recent publication, co-authored by URMC pediatric neurologist David Bearden, M.D., that showed that even HIV+ children with well-controlled HIV disease are more likely to do worse on neurological assessments, and the findings pointed to specific to targeted interventions via improved nutrition and avoidance of neurotoxic antiretroviral therapies.
Several URMC faculty hold adjunct positions with the University of Zambia, UTH, and the Zambia College of Medicine and Surgery, and are involved in training programs and mentoring for African and U.S. at undergraduate, graduate, post-graduate, and fellowship level trainees.
- Michael J. Potchen, M.D., URMC professor of Imaging Sciences, founded the first radiology post-graduate training program in Zambia, which will be graduating its first class of specialists this year.
- Birbeck has been a leader in developing neurological training programs for non-physicians who are often the only clinicians available to provide care for patients in rural Africa and has served as an advisor to the World Health Organization on the development and assessment of such programs.
- URMC neurologist Michelle Kvalsund, D.O., M.S., is developing the first neuromuscular program for fellowship level training in Zambia.
- Bearden mentors Ph.D. students and junior faculty in Zambia and has been recognized for his work with Rochester students conducting research abroad.
The NINDS delegation, which included Clinton Wright, M.D., director of the NINDS Division of Clinical Research, and Richard T. Benson, M.D., Ph.D., director of the NINDS Office of Global Health and Health Disparities, met with the U.S. and Zambian teams, learned about their research, and toured facilities at UTH. The delegation met with academic and government leaders, including Elliot Kafumukache, dean of the University of Zambia School of Medicine, Charles Mutemba, senior medical superintendent of UTH, and also visited Chikankata Mission Hospital in Mazabuka, home to research and clinical programs focusing on rural populations.
The visit is a part of broader NINDS efforts to support global research partnerships aimed at strengthening understanding of the burden of neurological disease and identifying opportunities for improved diagnostics, treatment, and prevention strategies. NINDS is also interested in building sustainable capacity in targeted countries to enable the conduct of research and training in neurological disorders and stroke in low-resource settings.