Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania

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Abstract Over the last 10 years, Tanzania has made significant progress expanding antiretroviral treatment (ART) to the 1.4 million people living with HIV (PLWH). With improved access to these life-saving therapies, PLWH in Tanzania are living longer, challenging the health system to provide long-term effective HIV care and treatment, ensure adherence to ART and retention, and adequately manage chronic co-morbidities in the growing number of PLWH with chronic disease. Meeting this demand will require a redesign of how HIV and primary care are delivered. Patient centered care (PCC) is an essential component of high quality care. Defined as `providing care that is respectful of, and responsive to, individual patient preferences, needs and values', PCC is critical to low and middle-income countries (LMICs) such as Tanzania where the health demographic is changing from more acute to chronic disease. A growing literature in HIV has shown the crucial role of PCC in improving patient ART and visit adherence, satisfaction and quality of life. Patient centered outcomes research (PCOR) is designed to study how health systems and care delivery should be organized to ensure PCC and improve clinical and patient-reported outcomes that are most relevant to patients and their caregivers. In this grant, we propose to strengthen the PCOR capacity of the Tanzanian Muhimbili University of Health and Allied Sciences (MUHAS) HIV research community with a long-term goal of incorporating this discipline into studies to optimize PCC in HIV facilities in Dar es Salaam, and improve patient and health system outcomes. MUHAS has a successful track record of NIH-funded research training programs in HIV with a growing faculty of accomplished HIV investigators with expertise in several HIV disciplines and socio- behavioral sciences. Our novel research training program in HIV and PCOR will support short, medium and long-term trainings combined with capacity building in mentorship and curriculum design to achieve the following aims and plan for sustainability: Aim 1. Build the capacity and expertise in MUHAS HIV researchers to design and conduct PCOR in HIV in Tanzania; Aim 2. Develop a team of faculty leaders and mentors at MUHAS able to provide mentorship and training for new HIV PCOR investigators and sustain the PCOR scientific agenda; and Aim 3. Advance the in-country HIV PCOR agenda by formally integrating PCOR courses into existing graduate degree programs. This grant will support 6 post-doctoral fellows, 2 Masters and 2 Ph.D. students through long and medium-term PCOR trainings. Short-term PCOR skills building, mentorship and teaching and curriculum design workshops will train over 100 participants in PCOR, mentorship and teaching. Annual symposia will provide opportunities for the broader community of HIV investigators to disseminate their research and form new collaborations. Through this program we will achieve the overall goal of training a new generation of independent Tanzanian HIV PCOR investigators, mentoring them on the path to independence and leading the way for MUHAS to become a center of excellence in PCOR in Tanzania.