The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/ intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.
INHealthConnect, the Go Local database of local health services for the state of Indiana, was built using the National Library of Medicine (NLM) input system with linking to and from the MedlinePlus health topic pages. It went public in May 2005 with 3,000 records, and construction of the resource leveled off in 2006. Although there are new records being added, some are also being deleted, and the number has held steady at approximately 10,000 for the past two years. Ongoing activities include promoting INHealthConnect, maintaining the database, responding to public contacts, analyzing monthly report data to make decisions on future directions, and continued reporting to NLM. An earlier article by Richwine, Skopelja, and Rider reported on the details about the features and process of building the database.
Sexual harassment and misconduct, particularly against female students and employees, is a significant problem in tertiary academic institutions in most countries. For students and trainees who rely on mentorship to move their careers forward, reporting harassment and misconduct by a mentor can alter the opportunities made available to them and ultimately their career path. For this reason, there may be underreporting of incidents, as victims fear adverse outcomes to coming forward [1].In Nigeria, sexual harassment and misconduct is a significant problem; nearly a quarter of women suffers from some form of sexual violence in their lifetime [2]. In academia, this number may be much higher. One study reported that 70% of Nigerian women reported being victims of sexual harassment and misconduct while in tertiary education institutions [3].In December 2020, the NIH Fogarty International Center (FIC) with support from the Office of Research, awarded supplemental funds to 10 academic institutions in low-middle income countries [4]. This supplement was in response to FIC recognizing that sexual harassment had become an issue that has forced women working in global health to either become stagnant in their career, or change careers entirely [5]. In collaboration with the Robert J. Havey Institute for Global Health, The Women's Center, and The Office for Equity at Northwestern University (NU), the University of Lagos in Nigeria (UNILAG) applied for funds to strengthen institutional resources around prevention of harassment and misconduct already initiated. The timing of this opportunity was ideal, because of the 2019 televised exposé from the British Broadcast Company (BBC) African Eye series titled "Sex for Grades" with UNILAG as one of the focal institutions [6,7]. The BBC exposé reignited efforts to strengthen the policy and improve education and outreach on sexual harassment and misconduct at UNILAG; and create an office to serve as the central resource for victims and survivors. NU and UNILAG have a long history of partnership developing and implementing FIC training grants -since 2009. They have partnered on four in addition to a National Cancer Institute cooperative research project which included a research training component.
BackgroundPre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescribing rates remain low. We examined the effect of an educational intervention on PrEP knowledge and prescribing likelihood among medical residents.MethodsThis was a prospective study using a convenience sample of Internal Medicine and Internal Medicine-Pediatrics residents at a tertiary care center in Portland, Maine. Participants attended a resident-led teaching session on PrEP and completed pre- and post-session surveys. PrEP knowledge was measured with five questions (definition, evidence, patient selection criteria, medication choice, and guidelines), and prescribing likelihood was assessed on a Likert scale. Participants identified motivating factors and barriers to prescribing. Survey data were analyzed with McNemar’s test or a paired Student’s t test as appropriate.ResultsThirty residents completed the study; of these, 24 (83%) had at least 1 patient that they considered at high risk for HIV, and 14 (46%) reported having >5 such patients. None had ever prescribed PrEP. Average PrEP knowledge score increased after the intervention (pre = 2.33 vs. post = 4.1, P < 0.001). After the intervention, more participants reported that they would be likely to prescribe PrEP (pre = 76% vs. post = 90%, P = 0.014), fewer identified unfamiliarity with PrEP guidelines as a barrier (pre = 73% vs. post = 27%, P < 0.001), and Òother residents are prescribing PrEPÓ became a significant motivating factor (pre = 47% vs. post = 70%, P = 0.04). Preceptor comfort with prescribing PrEP was a consistently important influence on prescribing likelihood (90% vs. 82%, P = 0.22).ConclusionFamiliarity with PrEP is relevant to resident practice, and an educational intervention is effective in the short term for addressing inadequate knowledge as a barrier to offering PrEP. Resident practice is influenced by preceptors and peers, suggesting that it may be helpful to include attending physicians in future PrEP education efforts at our institution.
Disclosures
All authors: No reported disclosures.
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