Global HealthResearch inSan FranciscoCasting the NetPaul Volberding
Perspectives on GlobalHealth Research and UCSFPast, Present, Future Pre-HIV epidemic: TB, reproductive rights, parasitic infections, others. (Department of Epidemiology and International Health) GHS: Focused program with aspirations. Investigative group. Educational effort. HIV not a central focus as Haile had established ARI in 1996. HIV: ARI established to counter perception of fracturing, competing effort. ARI as a loose, minimally resourced “umbrella” charged with creating/sustaining a community of science encompassing individual PIs and larger groups (CFAR, CAPS, HIV/AIDS Division, GIVI and, later, DEM).
Recent History Haile Debas steps down from GHS, Jaime Sepulveda recruited Strategic planning begun immediately and to some degree still in progress Research a key element of planning along with education and other elements. Structure TBD. Directions open for adding to GHS research portfolio: Grow within existing GHS Add programs to GHS (GHS as center of “federation”) GHS as ARI-like umbrella Combination of above
Charge to CollectInformation GHS Research Team appointed: Craig Cohen, Paul Volberding: Co-Chairs Colin Boyle Phil Rosenthal Jim McKerrow Madhavi Dandu Dominic Montagu Sarah Royce Caryn Bern Georgina Lopez Met to develop approach Produced three focused community discussions
GHS Research Community Discussions Parameters, objectives: Site: All at Mission Bay to reinforce as “home” Three meetings, each with discipline theme Basic sciences (drug and assay discovery, etc.) Clinical/translational sciences Population, prevention, policy and implementation sciences Participants: Wide. Slant to established investigators. All sites, schools, affiliates. Objectives: Open but guided dialog, ideas sought, no input excluded. Summaries prepared for further consideration.
The Community Discussions Basic Science: August 28th. Genentech Hall. 25 attendees representing UCSF, Gladstone, GB3, Cancer Center, others. Clinical Science: August 29th. Genentech Hall. 62 attendees representing SOM, SOP, GHS, CTSI, Cancer Center, others. Population Science: September 25th. CVRI. 45 attendees representing IHPS, orthopedics, OB/GYN, FCM, DGIM, others.
Guide for CommunityDiscussions Global Health Research at UCSF Community Discussion Guide Vertical Priorities and Horizontal Linkages (Cross-Cutting Programs) 1. What field(s) of research does UCSF have particular strength which is/has potential for expansion as a priority area in global health. Discuss why this particular field has promise for expansion. 2. What field(s) of research does UCSF not currently have considerable strength, but has potential for expansion in global health. Include your perspective on why this particular field has promise for expansion. 3. What “horizontal linkages” (e.g. implementation research, drug discovery) does UCSF have strengths which have potential for further expansion in to global health. Discuss why this/these horizontal linkages have promise for expansion. 4. What “horizontal linkages” (e.g. implementation research, drug discovery) does UCSF not have strengths which have potential for further expansion in to global health. Discuss why this/these horizontal linkages have promise for expansion. 5. What does UCSF lack in regards to disciplines important to global health, and what strategies could be used to improve multi/interdisciplinary collaboration?
Take-Homes for Today’sConsideration: Meeting 1 The perception of a separation between that community and the clinical and translational research programs, especially as contained within the CTSI Supporting graduate student and post-doctoral fellow participation in global health research GHS needs to approach more basic scientists to further inquire about areas of need, resources and collaboration Education plays a central role in the potential expansion of global health research in the basic science community at UCSF Potential value in UCSF taking the lead in rebuilding the infrastructure of basic science laboratories at academic medical universities in resource limited settings Opportunity for scientists interested in global health to teach basic science abroad Pilot research grants directed at global health research proposals from early career stage investigators Partnerships with private industry in the Bay Area Oncology was seen as an area where UCSF could become an international leader. It was advocated as an important disease area with a high burden, with limited strength in many of our comparison universities
Take-Homes for Today’sConsideration: Meeting 2 Vigorously endorsed cross-disciplinary collaboration The “verticals” in the clinical research discussion were already quite evolved and well- funded Primary task was thought to fall on finding “horizontals” that will make a greater impact on the community (greater return on investment) Critical to bridge basic science and clinical and translational research more than we have done to date Education and training needs were also identified as crucial areas where investment could yield a great competitive advantage to our efforts Clear that many participants were meeting for the first time Vertical suggestions: Oncology, tobacco control, mental health NCD, maternal/child health Horizontal suggestions: Education and remote learning, health disparities, low cost point of care tests, pathology and lab medicine, ethical and legal issues in global research
Take-Homes for Today’sConsideration: Meeting 3 Most institutions have given up the vertical /horizontal model in the 70’s Since UCSF has a chance to build a new model, we should offer a “way of doing Global Health” that is different A key theme of UCSF is evidenced based medicine and rigorous science. These could be a central means of differentiating our global health research identity from competitor institutions. What made the UCSF response to HIV so effective? It worked because the trans-disciplinary collaborations worked well UCSF expertise in HIV/AIDs grew out of both the fundamental basic science of the university, and the ongoing active interaction of many people in many disciplines working on HIV issues Focus on building the infrastructure that facilitates the kind of interaction that made us HIV leaders.
Take-Homes for Today’sConsideration: Meeting 3 IRAC summarized as example of attempt to break down barriers and engage broader community in dialog aimed at identifying and reducing barriers to research conduct Create programs that think about positive outcomes in new ways, in which interventions do not have to be a set of numbers that often times does not tell us the whole story but set against a larger frame of health and culture. Orthopedics/trauma could be a vertical given vibrant program and limited external competition Education, clinical / research integration, humanitarian research and policy research proposed as possible “horizontal” linker. UCSF has content expertise, methodological expertise, expertise in a continuum of care (prevention thru treatment), expertise in participatory research and community building and engagement. We need to diffuse this expertise across disciplines, while addressing scalability Implementation science is important because it can identify gaps in care. UW has a PhD in implementation sciences aimed at operation efficiencies, where they use expertise from business and engineering schools to identify efficiencies. UCSF is a great discoverer. We just need to add in the pragmatism of Implementation science Policy is addressed at UCSF in pockets- and needs to be brought together. We need to build stronger links among ourselves and other disciplines
Where Next? Community of global health research large, broad, complex Strong desire to work together and decrease isolated efforts Suggestion to continue discussions with country, discipline etc. focus Broad agreement that education and training crucial HIV as model of cross-disciplinary collaboration Structure of GHS as it relates to entire global research effort evolving and needs clarification and communication
Improvement Opportunities Time-limited community discussions with regional or discipline focus Ongoing discussion group for concentrated programs (E. Africa) Support TAG for new funding opportunities and use RDO Convene administrative group to compare models, influence policies Work with departments re: promotion barriers for GH investigators