At the REACH Network Annual Meeting in Dakar, Senegal.
NIMR is representing Nigeria to present the update on the SARMAN Project.
The DG/CEO of Nigeria Institute of Medical Research Prof Babatunde Lawal-Salako and members of his Senior Management Committee hosted the Syndicate Bio team led by the Founder/CEO Dr Abasi Ene-Obong at the institute.
The visit was to sign a Memorandum of Understanding of collaboration between both parties to strengthen precision medicine and extend the frontiers of genomic studies and drug discovery in Nigeria.
Can you tell us about your background and how you became interested in health research and innovation?
My name is Dr. Joseph Ojonugwa Shaibu. I am a Molecular Virologist and an Innovator. I work at the Centre for Human Virology and Genomics, Microbiology Department, NIMR, Lagos. I hold a Bachelor’s degree in Microbiology from Obafemi Awolowo University in Ile-Ife, Osun State, Master of Science degree in Medical Microbiology with specialization in Virology from the College of Medicine, University of Lagos. I continued my academic pursuits with a Ph.D. in Microbiology, specializing in Virology, at Lagos State University (LASU).
I have profound interest in research, particularly on viruses. This interest stems from the realization that numerous diseases, both globally and in our nation, are caused by viruses. Unfortunately, the lack and or cost of adequate diagnostic tools has denied the world the knowledge of many causes of diseases in our communities which have been implicated in significant number of fatalities and other health challenges. My interest in virology is driven by the desire to identify and characterize these key viruses of public health significance within our nation and to develop locally-made diagnostic kits capable of detecting them.
What are some of the key research projects you have worked? What inspired you to pursue these specific projects and how do they transpire to innovative products?
Growing up in a village, I witnessed a lot of deaths whose sources were unknown, hence were often attributed to mystical sources and “gods”. In cases where the illnesses manifest febrile symptoms, they are treated as malaria or typhoid fever with traditional concoctions. Even clinics in majority of the communities diagnose such manifestations as either malaria or typhoid fever due to a lack of other diagnostics kits that could detect other pathogens which manifest fever. The need to bridge this gap in diagnosis influenced me into development of diagnostics. It became evident to me that numerous viral agents can cause severe and sudden illnesses. In Nigeria, research in this field faced limitations, particularly due to the absence of affordable diagnostic kits. This lack of knowledge about the causative agents of infections hindered problem-solving efforts.
In 2019, I had the privilege of traveling to China to acquire expertise in designing and development of serological and molecular diagnostic kits at China CDC, Beijing, China. The knowledge gathered from there has since helped us to develop four RT-qPCR kits: SCODA, Yellow fever, Lassa fever and MpoX RT-qPCR kits. SCODA kit was used immensely during the pandemic for COVID-19 testing at NIMR and various Nigerian laboratories, most of which still use it now. It has also been published in a public journal.
Monkeypox kit is our latest innovation, developed for an international grant in collaboration with Canadian partners. Other kits are in the pipeline.
What specific area of health research or project are you currently working on?
As mentioned earlier, I am a Molecular virologist and my work is majorly centered on viruses. Currently, I am focused on Viral Hemorrhagic Fever Viruses, Lassa Fever and Arboviruses (including Rift Valley, Crimean Congo Hemorrhagic fever, Chicago Westnile, Yellow fever, and Zika virus). These pathogens are prevalent in our society and are primarily transmitted through mosquito bites. Unfortunately, the true burden of these infections are unknown due to lack of research. I am part of the Viral Surveillance Team at NIMR, headed by Prof. Rosemary Audu, we are conducting a nationwide surveillance of these Arboviruses and Hemorrhagic viruses. We have made promising progress, with some results published and others at the review stage in public journals.
Can you discuss collaborations and mentorship that has greatly impact your research work and the outcome?
You cannot effectively conduct research without collaborations. In the Viral Surveillance Team at NIMR, we collaborate with institutions such as UNILORIN and UNILAG. We also provide grants to students pursuing their Masters and PhDs from these institutions to collaborate with us. In addition, we have collaborations with NCDC and Institut Pasteur in Senegal and through those collaborations, we have an ongoing WHO/TDR grant. We are also part of the Canadian Monkeypox Partnership (CAMP) grant, collaborating with a Canadian team that is Principal led by Prof. Rosemary Audu of which I am also a co-investigator. When developing kits, we collaborate with NCDC and other laboratories for validation. Prof. Sunday Omilabu’s laboratory in Lagos University Teaching Hospital (LUTH) is one such collaborator that validates our kits.
What challenges would consider or setbacks in your research endeavors? How did you handle or overcome them?
One of the major challenges in research is funding. However, in NIMR, Prof. Babatunde Lawal Salako, our Director General, has been instrumental in supporting research endeavors. I have personally faced financial setbacks, as research results do not always yield positive outcomes. But we have a DG that does not hesitate on spending money on what does not turn out positive. He encourages us by saying “even a negative result is a result”. He consistently funds our research efforts. While we have made significant strides, we need additional funding from external sources to support our innovations.
Another significant challenge is the commercialization of our research findings. Despite having developed kits with extensive detection capabilities, we struggle to find investors, and collaborators to bring these innovations to the market. This is a pressing issue that hinders the widespread availability of our products for research purposes.
Where do you see yourself and your research work in the next five years?
In the next five years, I envision my research becoming a global phenomenon. Many sub-Saharan African countries lag behind Nigeria in terms of research outcomes and access to developed kits. With over 130 molecular laboratories in Nigeria, driven in part by the COVID-19 pandemic, and policies supporting the use of locally-developed kits, I anticipate that these kits will become readily available across Nigeria. This will enable vigorous pathogen detection and contribute to a better understanding of infection burdens within the country, ultimately improving infection management.
What are your long-term goals as researcher with keen interest in developing innovative products from research?
My long-term goals include development of vaccine candidates and therapeutics for each of the diseases of public health concern in Nigeria. Also, I intend to constantly upgrade my knowledge in line with the evolving technologies to solve health challenges.
What infrastructure or efforts would you suggest that NIMR management should add to what are in place to enhance capacity for innovative research in the institute?
Currently, NIMR has a lot of resources in terms of materials and machines. For sequencing, for example, we have all the generations of sequencers so we do not lack sequencing capacity, for other things like Oligosynthesis, we have an Oligo Synthesizer that we use to synthesize our primers. To enhance our work, we are seeking to acquire the capability to synthesize probes. As we move on, we hope to establish a standardized Animal House facility, crucial for vaccine and drug development.
Furthermore, we require the standardization of our Biosafety Level 3 (BL3) Laboratory for broader accessibility. NIMR is doing well as far as the acquisition of machines and resources needed for research are concerned, placing us on par with institutions worldwide.
What advice would you give to other young inventors and researchers who are just starting their journey along your path?
The first thing in life is to know what you want to do because your passion will drive what you become. One thing I will advise young researchers is to define their objectives early and channel their energy, time, and resources into them. There is nothing you put energy and time into that will not bring back a positive result. So, they should get to know what they want to do on time, look for mentors, and put their energy, time, and money there, and with time, they will become what they are meant to be.
Task Strengthening Strategy for the Integration of Hypertension Management into HIV Care in Nigeria
Can you please Introduce yourself?
My name is Dr. David Oladele, a Chief Research Fellow, Consultant, Public Health Physician, and the Head of Department (HOD) Clinical Sciences Department of the Nigerian Institute of Medical Research (NIMR)
We are aware of the ongoing research on TASSH; please tell us more about it.
The research is titled “Integration of Hypertension Management into HIV Clinic using Task Strengthening Strategy (TASSH) in Lagos, Nigeria.”
It is a research project sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institute of Health (NIH) in the United States.
It is a collaboration between three institutions:
The project has three Principal Investigators (PIs):
The research addresses the challenge of providing care for hypertension among patients diagnosed with and living with HIV. With improved access to antiretroviral (ARV) medication, individuals living with HIV are living longer, and many of them are at increased risk of developing non-communicable diseases, including hypertension, a significant risk factor for cardiovascular diseases and stroke. The project seeks to integrate the treatment for hypertension into HIV clinics in Lagos, Nigeria. This is because, currently, patients living with HIV receive care for hypertension in different locations than where they receive HIV treatments. The goal is to bring together the treatment for hypertension and HIV at the same clinic by actively screening HIV-positive patients for hypertension and ensuring timely diagnosis and care.
What is the prevalence of Hypertension in HIV care in Nigeria?
The prevalence of hypertension among persons living with HIV varies, with different studies reporting prevalence ranging from 14% to 16%. However, a recent study in the South-South region of Nigeria reported a prevalence of 25%. Conservatively, we can estimate that hypertension prevalence among people living with HIV in Nigeria is between 15% and 25% depending on the settings and age of the patient.
How does Hypertension impact the health outcome among HIV patients in Nigeria?
Hypertension plays a significant role in shaping the health outcomes of HIV patients in Nigeria. HIV is an infectious disease that affects the immune system, and without proper treatment, it can lead to opportunistic infections and potential mortality. However, thanks to access to HIV treatment facilitated by initiatives like the PEPFAR (U.S. President’s Emergency Plan for AIDS Relief) Funding since 2004, many HIV-positive patients now could receive proper care. In Nigeria, we have successfully decentralized HIV care, transitioning from only three centers in Lagos as of 2002 (Nigerian Institute of Medical Research, 68 Military Hospital, Yaba, and Lagos University Teaching Hospital, Idi Araba) to over 60 comprehensive primary healthcare centers in Lagos State alone. This decentralization and improved access to medications and healthcare commodities have resulted in longer and more productive lives for HIV patients.
The common cause of death among HIV patients before now were opportunistic infections such as tuberculosis, diarrhea diseases among others; however, due to improved access to HIV care and subsequent immune system improvement, there is an increase in non-communicable diseases (NCDs) among HIV-positive patients resembling what is observed in the general population. Therefore, if we do not address the issue of NCDs, particularly hypertension, among HIV-positive patients, the progress achieved in HIV treatment could be undermined. Hypertension stands out as a significant NCD, and it is crucial to screen and diagnose hypertension in HIV-positive individuals to provide timely treatment and control their blood pressure. By effectively managing hypertension, we can prevent the development of hypertension-related diseases such as cardiovascular diseases and stroke, thereby improving the overall quality of life and health outcomes for HIV patients. Addressing the burden of hypertension in HIV-positive individuals is vital to prolonging and enhancing their quality of life, ultimately leading to better treatment outcomes.
What are some of the most significant outcomes from the research so far, and what do they suggest about the effectiveness and feasibility of TAASH?
Integrating hypertension care into HIV clinics using the TASSH strengthening strategy has yielded noteworthy results thus far. The task-strengthening strategy is an off-shoot of Task shifting, defined by the World Health Organization (WHO) as “decentralizing treatment from highly skilled healthcare workers to those with less specialized training, thereby addressing the challenges of limited human resources for health.” Nigeria currently faces a brain drain, with many doctors and nurses leaving the country, resulting in a scarcity of healthcare workers to cater to the substantial population. In response, the TASSH strategy allows nurses and community health officers to play a vital role in screening patients for hypertension, providing lifestyle counseling, administering treatment, and referring severe cases to doctors.
The program is a clustered randomized trial meaning that we are working across 30 primary healthcare centers in Lagos State, Nigeria. Fifteen centers are assigned to receive the intervention, while the remaining 15 receive standard care. After 12 months, the treatment outcomes for hypertension will be compared between the two groups. The intervention involves a practice facilitation strategy, where nurses and community health officers in the selected primary healthcare centers receive additional support from senior healthcare workers. This support includes reminders for patient screening, counseling on lifestyle changes, and dietary habits using evidence-based frameworks like the 5 A’s and C’s. The trial aims to assess the impact of practice facilitation, akin to a coaching strategy, on blood pressure changes in the intervention group compared to the standard care group.
So, what we have learned so far is that for this program to work, there is a need for intense collaboration between researchers and the health system in the State. Currently, the institute is collaborating actively with the Primary Health Care Board in Lagos State as well as Lagos State AIDS Control Agency (LSACA) to intensify the centres and to train health care workers working at these Primary Health Cares (PHCs) at different times both baseline and other training and to be able to improve their skills to make the diagnosis of hypertension and monitor patients on treatment and refer severe cases to doctors. Additionally, the project has donated the necessary screening equipment to these centers through the Lagos State Primary Healthcare Board. This research has highlighted the need for active collaboration between researchers, the health system, doctors, and nurses in primary healthcare centers to ensure the effective implementation and sustainability of the task-shifting strategy in Lagos State, Nigeria.
Furthermore, the challenge of healthcare worker migration, resulting in a reduced number of doctors and nurses to address the growing patient demand, has been recognized. To address this, healthcare workers have been advised and trained to triage and prioritize patients effectively, thereby managing their workload without compromising the quality of care provided. This approach has shown us and the Lagos State Health Management that there is a need to bring hypertension care into the HIV clinic. This integration provides the opportunity to address the double burden of infectious and non-communicable diseases, leading to improved quality of life and long-term health outcomes for patients.
Can you speak to the importance of international collaboration and cooperation in your experience and the opportunities available for other potential researchers in NIMR?
The TASSH project is a collaborative effort between NIMR, New York University, and St. Louis University. The grant was awarded to the three institutions, and we have teams working on this project from the three institutions. So, what that has brought to bear is a robust north-south collaboration on this project, meaning that experiences of researchers working at New York University and St. Louis University have been cross-fertilized with researchers in Nigeria to be able to implement this project in the context of the Nigerian health system because the Nigeria situation is very peculiar.
A similar project to TASSH-Nigeria was implemented in Ghana before the Nigerian study, but the Ghana terrain is entirely different from Nigeria’s. The health system there is different, so there is a need to domesticate the research approach in the Nigerian context, and that is a lesson we have learned that collaboration is needed. This will allow researchers here to liaise with researchers outside the country with a resultant cross-fertilization of ideas on the best way to address challenges that arise during the course of the project implementation and also to build the capacity of local researchers through exposure to education outside the country (e.g., through the Ph.D. program, etc.).
What NIMR researchers can draw from this is that collaboration with institutions outside the country could build local researchers’ capacity. This could be through visiting scholars, whether in the USA or the United Kingdom, to gain new experiences, to collaborate or learn new skills, or through advanced learning in a Master’s, Ph.D., or certificate program through this north-south collaboration. So, I think that is one thing NIMR needs to take advantage of, and this means that we need to broaden our horizon in building collaborations with institutions outside Nigeria and explore how to improve our existing relationships with these institutions. Hence, NIMR, in the long run, will be able to build the capacity of researchers, especially junior and early career researchers, on how to improve their career, skill and be internationally relevant.
What advice would you give to other young researchers considering traveling abroad for research purposes?
As a Chief Research Fellow, my role could include providing guidance and advice to young researchers considering traveling abroad for research purposes. While I may have little direct assistance to offer, I can certainly provide valuable counsel to point them in the right direction and advise them on enhancing their research skills through north-south collaborations. But I would like to encourage young NIMR and aspiring researchers to believe there are possibilities everywhere. Hence, this is an excellent time to go online and browse for these possibilities.
Allow me to share my personal experience to illustrate the potential opportunities available. In 2014-2016, I pursued a Master’s degree at the London School of Hygiene Tropical Medicine, and I was fortunate to secure funding through the African-London-Nagasaki Scholarship program. Interestingly, I became aware of this scholarship opportunity through a friend who forwarded me an email. A wise colleague once advised me that there is nothing to lose by applying for such opportunities, especially when they don’t require any upfront payment. Initially, my application was unsuccessful, but I persisted and advanced to the second phase in the subsequent year. Although I didn’t receive a full scholarship for a Master’s degree, I was offered the opportunity to pursue a certificate course in clinical trials. I completed the certificate course and, during its conclusion, I applied for full funding to obtain a Master’s degree in Clinical Trial, which I completed through distance learning.
I advise young researchers to remain open-minded, keep their eyes wide open, and continue applying for funding opportunities. While it may take time and persistence, fortune may eventually smile upon them, and they can secure the necessary funding to advance their research aspirations.
Prof. Babatunde Lawal Salako, Director General of NIMR, welcomed the Board of Trustees of the NIMR Research Foundation, chaired by Mr. Babatunde Raji Fashola (SAN), Former Minister of Works and Housing on the 25th of July, 2023,
During their visit, the Board members deliberated on how to evangelize financial support for research in Nigeria and also toured the institute’s state-of-the-art research facilities.