Multi-morbidity in Uganda Research Capacity Initiative (MURCI) at Mbarara University of Science and Technology

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1.0 Abstract Chronic, non-communicable diseases (NCDs) now account for over half of morbidity and reductions in quality of life, in resource-limited settings. Of particular importance is the growing epidemic of multi-morbidity, or the accumulation of chronic conditions, including combinations of both non-communicable (e.g. hypertension, diabetes, COPD, traumatic accidents, and cancer) and communicable diseases (e.g. HIV, prior lung disease from pneumonia) on functioning, well-being and quality of life. Despite the growing appreciation of overlapping conditions and their cumulative effect on health outcomes, the majority of disease treatment programs, donor funding mechanisms, and research infrastructures focus on infectious diseases, and such programs remain largely siloed. This separation of efforts results in three critical short-comings to the research infrastructure in many low-income settings: 1) a poor understanding and limited attention paid to the interactive effects between, and management of, comorbid conditions; 2) lack of attention to region-specific risk factors for multi- morbidity that are likely to differ from high-resource settings (e.g. social determinants of health, occupational exposures, air pollution); and 3) a near total absence of the requisite laboratory infrastructure for cross-cutting multidisciplinary clinical research to support holistic care for those with multi-morbid conditions. To respond to these gaps in research infrastructure in Uganda, we will conduct the following specific aims: Aim 1: Develop junior faculty expertise in Uganda on multi-morbidity. We will focus training on a holistic understanding of human health, and an understanding of how accumulation of chronic conditions impacts functioning and quality of life in this setting. Aim 2: Train junior faculty to measure determinants and consequences of the regional social and environmental risk factors for multi-morbidity. Key focus areas will include social-behavioral and environmental determinants of health. Aim 3: Develop laboratory capacity to support clinical research on multi-morbidity. We will leverage an established Memorandum of Understanding between the Massachusetts General Hospital (MGH) and the Mbarara University of Science and Technology (MUST) Clinical Research Laboratory to support capacity building, quality assurance, and a trans-disciplinary clinical laboratory program to focus on multi-morbidity diagnostics and regionally appropriate risk factor testing. In this D43 research training program, we will leverage a 15-year partnership between MUST and MGH, to provide sustained mentorship and protected research time to 12 promising post-doctoral and junior faculty members at MUST and establish a Ugandan regional center of excellence in multi-morbidity research.