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Patients for Pipettes: A model for building research infrastructure in low resource settings

Screen Shot 2016-08-04 at 00.22.18Hey everyone we’re back after a brief stop in the hometown of my colleague Yuvaram Reddy and the amazing Sri Ranganathaswamy Temple. This World Heritage site is the largest functioning Hindu Temple. It covers an area of 631,000 square meters, has 7 enclosures, 21 Gopuram, 50 sub-shrines, 9 sacred pools, a Hall of 1000 pillars (though it is actually 953) and an origin dating back to the 1st century.  As temples go this is some pretty impressive data and “data” is exactly where we’ll take today’s blog post.

In medicine we’ve become increasingly affectionate to data because it allows us to standardize care, improve interventions, and stop old practices that in reality didn’t work. Yet getting good data is tough business. It requires good research that takes time, training, and funding. In many low resource settings these items are in short supply. How often do practitioners have a moment to consider a research trial when their daily case load can be well over 100 patients? Further, with little available funding it is difficult to build the critical mass of research faculty, laboratory space, and advanced equipment. Biomedical research has been a luxury of high resource settings that continues to drive medical advances. However, it can also drive the gap in care between high and low resource settings. This is because the clinical trials, treatment guidelines, and the diseases that make it from the bench of basic science researchers are disproportionally focused on those in high income countries. Further, even if researchers in high income countries wanted to investigate a disease prevalent in a low income settings logistical barriers such as sample procurement, ability to process tissue and the investigator’s first-hand experience with the disease are severely limiting. This makes developing in country talent a critical piece of the global health solution, but how do we do this? One mechanism has been grants that bring interested students to high resource settings for research fellowships. This can be an effective means for exposure, methods training and mentorship. Yet if these trainees are to continue the pursuit of research there has to be a research infrastructure to return to. One outstanding example of infrastructure building was our visit to YR Gaitonade Centre for AIDS Research and Education (YRG CARE). The center was founded by Dr. Suniti Solomon who discovered the first case of AIDS in India. While initially focusing on prevention and early treatment the center quickly accrued a large cohort of HIV patients. This large cohort not only allowed YRG to develop a streamlined approach to treatment but also provided fertile ground for clinical trials. On the whole these trials benefited patients who had developed resistance to previous regimens and also generated the need and subsequent resources for advanced laboratory infrastructure. Through this progression YRG became an internationally recognized research center and now has a robust PhD program where projects ranged from economic analysis of treatment response to the antiretroviral effect on mitochondrial function. In essence YRG took what was seen as a massive burden, India’s epidemic of HIV and turned it into an asset. There are now doubt ethical concerns when leveraging patient populations for institutional gain, but the YRG method may be a model for other low resource sites.

Eddie Briercheck is a PGY-2 at Boston Medical Center and a member of the Global Health Pathway.You can follow him on twitter @eddiebriercheck or search #BMCglobalhealth to learn how the rest of the team is doing. And please tweet us your thoughts, questions and culinary suggestions.

This entry was posted in BMC.
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