Xiangya-UCLA HIV Nursing Research Training Program: A Global Health Collaboration Between the U.S. and China

This paper describes an international collaboration between academic health institutions in the U.S. and China to promote knowledge exchange and research of post-doctoral degree nurses and mental health specialists (psychologists/psychiatrists) to advance research in the area of HIV/AIDS prevention and treatment and related nursing care. The partnership involves the University of California, Los Angeles, School of Nursing and the Xiangya School of Nursing of Central South University (CSU) and affiliating institutions in Hunan Province, China. Hunan is the 11^th largest province of China, located in the southeast. The project is supported by a Fogarty Global Health Training (D43) National Institutes of Health grant that provides funding to foster the next generation of global health scientists in low- and middle-income countries and at established biomedical and health research sites in the U.S. The evidence-based success of Fogarty International educational programs is demonstrated by over 1,200 peer-reviewed publications in infectious and non-communicable disease areas by trainees (U.S. Department of Health and Human Services [DHHS], 2016).

The purpose of this collaborative international global health educational project is to 1) develop research expertise in a cadre of Chinese nurses and psychologists/psychiatrists who will conduct HIV/AIDS behavioral research, and 2) enhance the institutional capacity for behavioral HIV/AIDS research at Xiangya School of Nursing and affiliating health care institutions. The educational project responds to and extends ongoing HIV/AIDS collaborations that have demonstrated the need for additional postdoctoral training in order to conduct rigorous studies of emerging questions related to mental health and behavioral aspects of HIV/AIDS in China.

The rationale for the program is that while Xiangya/CSU has strengthened its doctoral studies program for nurses and psychologists, local expertise is limited regarding the behavioral research methods that are essential to rigorous studies of psychosocial and self-management issues of interest to nurse-researchers and mental health professionals. The specialized training provided in this project enhances the ability of trainees to conduct high quality research needed to prevent and treat HIV/AIDS as well as help people living with HIV (PLHIV) to self-manage their infections. The number of cases of HIV/AIDS continues to grow in China despite the remarkable progress made by that country in tackling their epidemic during the past 2 decades. By the end of 2013, it was estimated that the number of people living with AIDS in China was 810,000 (0.0598%), and new HIV infections remained at approximately 50,000 each year between 2007-2011, but increased to 80,000-100,000 each year in 2012-2014 (Huang et al., 2016). The Hunan Provincial Center for Disease Control had recorded 20,556 HIV/AIDS cases at of the end of 2015, including 2,247 new cases in 2015 and 4,621 new cases in 2014 (C. Xi, personal communication, December 5, 2016). The longer survival of people living with HIV/AIDS as a result of effective antiretroviral therapy partially contributes to the increasing number of HIV infections, particularly in the aging population (Huang et al., 2016; see also OAR Working Group on HIV and Aging, 2012; Watkins & Treisman, 2015). The expanded epidemic among Chinese men who have sex with men (MSM) is another contributing factor (Zhou et al., 2014). Research shows that in some regions, 26%-31% of MSM have had female partners in the last 6 months (Yun et al., 2011; Zhang et al., 2013).

Major components of the program are designed to prepare trainees to address the AIDS epidemic in China and related factors. Components of the training program include:

1. Mentored long-term (9-month) postdoctoral research training in HIV behavioral studies for four nurses and four psychologists/psychiatrists at the University of California, Los Angeles. Each trainee develops an Individual Development Plan (IDP) that identifies coursework relevant to enhancing their knowledge and skills in rigorous research design, ethical issues and protection of human subjects, the HIV/AIDS epidemic, and other areas relevant to their proposed research. In addition, trainees meet with their research mentorship team on a regular basis.

2. Part-time training in behavioral research methods, the HIV/AIDS epidemic, and related areas is provided in China for a cohort of 20 Chinese nurses and psychologists. This training, including biannual conferences and workshops, is designed to increase the ability of trainees to conceptualize and think through research problems with increasing independence.

3. Support is provided for mentored research projects conducted by the long-term trainees following their return to China from the U.S.

As part of this training program, a process for recruitment and selection of trainees was designed and implemented. Research support was allocated for trainees with mentored studies approved by the Institutional Review Boards of the partnering institutions. The program evaluation plan tracks the progress of trainees and outcomes related to their career development as well as the research capacity of participating Chinese institutions. Benchmarks used include the number of research projects conducted by trainees, peer-reviewed publications and professional presentations, successful applications for external funding, and courses taught and individuals mentored by trainees. The achievements of six scholars who have completed the training program are highlighted in this paper to illustrate outcomes of the training.

This project is significant because it is designed to substantially increase the number of young and mid-career nurse-scientists, psychologists, and others conducting research related to mental health and behavioral aspects of HIV/AIDS. The international collaboration design to enhance research training may be replicated by similar countries with maturing HIV epidemics.