RESEARCH ACCOMPLISHMENTS: In 1999, a UIC faculty member came to Malawi with Fulbright funding to form a KCN-UIC research group to adapt an evidence-based peer group intervention originally developed for urban women in Botswana (Authors, 2004). The intervention integrated complementary models including WHO’s primary health care model of health worker-community collaboration for intervention delivery (Bhutta, Atun, Ladher, & Abbasi, 2018), Bandura’s (1989) social-cognitive learning theory for content that builds self-efficacy, and cultural tailoring to ensure cultural appropriateness (Authors, 2006). We successfully piloted the program for teachers-in-training and the short-term results were promising (Authors, 2007)
We then obtained NIH funding to test intervention efficacy in rural Malawi. We trained health workers to offer the intervention to adults and youth. For both the adults and the youth, the intervention improved safer sex outcomes, including condom use and HIV testing (Authors, 2011; 2014, 2016). With Global AIDS Foundation funding, we extended the project to urban health workers, and the intervention was associated with an increased use of universal precautions and patient education and reduced their own risky sexual behaviors (Authors, 2008, 2009; 2010; 2011). Our next grant expanded the intervention to include young women in rural Malawi, who were contracting HIV at younger ages than males. Consistent condom use, condom use at last sex, birth control use, and unintended pregnancies improved at 6 months post-intervention but not 12 months. One possible reason for lack of long-term outcomes was the failure to include the whole community. Our current NIH-funded study addresses this gap and the need to scale-up evidence-based interventions by turning over implementation to the community, a strategy that meets local health needs with minimal burden to the health system (Authors, 2018). We are testing a simple implementation model using a hybrid design emphasizing both the implementation process and effectiveness in rural Malawi (Curran, Bauer, Mittman, Pyne, Stetler, 2012)
CAPACITY-BUILDING THROUGH COLLABORATION: After the Fulbright award, we obtained three 5-year NIH grants and one foundation grant. We published 17 peer-reviewed data-based papers. Career development for each co-investigator includes mentoring, building specific research skills and capacities, and publication as a lead author and co-authors, which leads to promotions and independent research funding. We systematically incorporate and mentor junior faculty and graduate students. One junior UIC faculty was awarded a supplement to add Youth Photovoice to our current implementation study, and two master’s students completed small projects.
Our collaboration and ongoing NIH funding also was important in obtaining other funding for UIC-KCN capacity-building programs. In part because we had an active research program, Malawi was included in UIC’s four-country AIDS International Training and Research Program (AITRP KCN faculty obtained four PhD and two MS degrees from this program. KCN then received an NIH Fogarty capacity-building grant to establish a nursing research center. This collaboration strengthened KCN’s capacities for administering externally-funded research and program grants.
Building strong collaborative relationships is a key element of success and links the educational and research missions of both universities. We include multiple voices of university faculty and leaders of the communities and health systems. Many relationships expand on research advisor-student relationships. At both universities, our presentations and workshops expose additional faculty and students to global health research opportunities. Our publications and international presentations enhance the reputations of both universities as global nursing research centers of excellence.
IMPLICATIONS: Our 20-year collaboration provides strong evidence that sustained multidisciplinary research and capacity-building can make substantial contributions to the urgent global priority of HIV prevention, thus contributing to the UN Sustainable Development Goals and UN global health priorities. Our track record of continuous funding and publication is made possible through a strong and resilient interprofessional network of researchers within nursing and across disciplines, who persist in collaboration despite failures and resubmissions. A consistent conceptual model and health priority allows earlier work to build a track record that supports new funding. Our systematic progression from formative intervention development research through efficacy studies to implementation helps bridge the gap between discovery and scale-up and advances the science of health promotion intervention and evidence-based practice.