SANTHE [https://www.santheafrica.org/] is an African-led HIV and TB research and capacity building consortium (currently based at five primary sites in South Africa, Botswana, Kenya, Rwanda and Zambia) which received an investment of approximately $11.2 million USD over 5 years. We aim to carry out cutting-edge HIV/TB research, train the future leaders of African science, develop strong institutional networks to facilitate research on the continent, and facilitate effective CPE to ensure meaningful research translation and maximum community impact. The goals of institutional strengthening and CPE cannot be overemphasised - they are as critical to the long-term sustainability of the DELTAS funded programmes as are our scientific activities and capacity development of our researchers. We believe that these efforts should be led and executed by locally-based individuals who have in-depth understanding of the institutions and communities who stand to benefit from the research. From 2015 to the present, SANTHE has established a strong foundation with, as an example, 119 peer reviewed publications in the past 4 years. We have demonstrated a good level of success in supporting our Fellows to convert their scientific findings into manuscripts with 42 of these publications first-authored by SANTHE Fellows. We recruited 105 trainees from 10 different African countries who included 15 graduate interns, 38 Masters students, 38 PhD students and 14 post-doctoral researchers with 64% of these being females. To date, 42 have completed their Fellowships (which includes 17 Masters graduates, 3 PhD graduates, and 4 individuals who have upgraded from Masters to PhD). Our Fellows have given 82 presentations at international conferences which include CROI, IAS and Keystone. Figure 1 outlines the key tools that were introduced initially to support our scientific capacity building efforts. As an example, to support the production of outstanding science we convened a scientific advisory board of outstanding scientists familiar with the state of science and training institutions in Africa to provide scientific and capacity building advice to the consortium. This group of individuals met yearly at our annual consortium meeting (ACM) and were consulted to provide feedback on an ongoing basis. We have provided continuous and systematic monitoring and evaluation of the effectiveness of our interventions and used our data to help propose new solutions or amend existing ones. As we look towards SANTHE’s future, and a potential expansion to 3 new partner sites (in Cameroon, Zimbabwe and Uganda), we have assessed the tools we use, with help from internal and external monitoring and evaluation efforts, and propose to introduce new tools to supplement our initial offering (highlighted in Fig. 1). The new tools include the development of a leadership development curriculum, intensive and holistic supervisor training, the incorporation of a panel of experts to help guide our CPE efforts, and the provision of an advisory committee for post-doctoral researchers.
Our proposed pathway for successful capacity building in Africa is highlighted in Fig. 2. Step 1 is the identification and development of a critical mass of trainees and supervisors. This results in an increasing number of scientific projects identified and led by African-based researchers, which in turn will lead to publications with African-based scientists as first and last authors and increasing numbers of grant applications with African-based scientists as principal investigators (PIs). Increased local grant funding, infrastructure development, and investment in training of science support staff will lead to the development of local research environments optimally supporting ongoing science and the scientists based therein. The foundation of an empowered cadre of local scientists, trainees and support staff will then lead to locally-driven CPE efforts that are dovetailed with relevant cultural and policy contexts applicable to African settings. This combination of a rich and growing pipeline of scientific expertise, research support and CPE activities will then lead to more efficient production of new knowledge and translation into policy and practice. Our current model acknowledges that sustained external funding support will initially be needed, providing time and stability to establish a functional and sustainable programme. External funding will need to be combined with scientific collaborative support from non-African based researchers and laboratories. However, over time increasing levels of African government and philanthropic financial support for research on the continent hold the key to unlocking Africa’s scientific potential. While we acknowledge that each country and consortium may have their own unique challenges and require their own tools, based on our experiences we highly recommend the following key components (and associated tools) to optimally support the capacity building pathway: 1.Directly empowering African-based researchers, 2. Offering quality training to large numbers of junior and early career African scientists and support staff, and 3. Effective information exchange and collaboration.
Directly empowering African-based researchers
Our first step towards directly empowering African-based researchers involved the identification and support of locally initiated and led efforts. The scientific concept sheets for proposed studies funded by SANTHE were developed by supervisors who are mostly based on the continent and peer-vetted (by a team of three scientists based at the consortium secretariat site in South Africa, or invited experts affiliated with the consortium), for relevance to local problems, feasibility of implementation and potential impact. Trainees are identified to work on selected projects following innovative and competitive recruitment procedures (that include panel interviews, critique of an assigned manuscript, a written scientific proposal assignment, and online abstract and numerical reasoning tests). SANTHE makes stipend and consumable support available for these projects thus benefiting trainees and their supervisors, particularly more junior supervisors with worthy ideas but limited grant funding support. Although SANTHE benefits from non-African collaborating partners for scientific input, collaboration, and assistance with training of Fellows, projects are mainly conceived and executed by African-based supervisors. Research is performed primarily in Africa, with students enrolled in both African institutions of higher learning, and in universities in well-resourced countries that are affiliated with SANTHE (if local facilities are not yet adequate). Our second step towards directly empowering African-based researchers involved the inclusion of all our scientists in a wide network to support scientific efforts. As an example of one of our tools, our ACM has proved to be highly valued by both our junior and senior scientists, and in addition to providing an opportunity to provide scientific critique and obtain feedback on ongoing science, has allowed the growth of training and scientific collaborative efforts, allowing the expansion of our research focus and enhancing our ability to tackle projects that would not be possible if each site operated in isolation.
One advantage of holding such a large and diverse capacity building grant is that it makes it possible to support initiatives that would normally be difficult to fund on their own, due in part to limited funding options on the African continent, such as career advancement opportunities including our Path-To-Independence Awards and our Collaborative Grants. Between 2015 and 2020 SANTHE funded 15 Collaborative Grants (up to $50,000 USD each). Awards were generally given to junior investigators and, involve researchers from a total of 23 different African sites. SANTHE has also awarded five Path-to-Independence (PTI) awards ($100,00 USD each), which provide critical bridge funding to support young scientists who are establishing themselves as independent investigators (often a critical bottleneck in a scientist’s career development pathway). As an example, one PTI award enabled a former SANTHE post-doctoral researcher to return to his home country of Cameroon after spending eight years training in South Africa. In addition to establishing his own research programme, this award facilitated new collaborations and expanded the SANTHE consortium to include a second site in Francophone Africa. It is of great satisfaction to us that many of our early career scientists who received SANTHE seed funding have leveraged these opportunities to benefit from additional funding including the AAS’s FLAIR Fellowships and Wellcome Trust Fellowships. Overall, the investment that SANTHE received has directly benefited African-based researchers by raising their profile and that of their institutions, and enabling them to directly identify and address problems, set a research agenda, supervise students on these projects on site, promote their careers in the process, and directly impact local and international stakeholders. Crucially, one demonstration of the scientific impact of these efforts is that important discovery and policy impacting research has been performed within a short period of time [30,31,32].
Offering high quality training to large numbers of junior African scientists and scientific support staff
SANTHE aspires to provide high-quality training for a large cohort of African trainees so that graduates are internationally competitive. It is anticipated that these efforts will help to reduce ‘brain-drain’, which is more likely to occur when African researchers are trained primarily overseas. The emphasis on large numbers, although variously defined is deliberate because it should be noted that funding through our consortium is not only building the capacity of individual researchers but also directly contributing to the building of a critical mass within institutions. Instead of identifying single talented individuals, consortium-level funding is able to invest in providing student stipends and research support to enable recruitment of a cohort of trainees at a site, providing an opportunity for peer support and interactions that are critical to sustaining research interest, increasing the numbers of scientists at one site, and helping to avoid the frequently encountered challenge of working in relative intellectual isolation.
One critical component of high-quality training we have emphasised is skills development. We have provided training by developing in-house value-adding courses or workshops and partnering with key collaborators, including academic supervisors. For example, we have offered internal manuscript and grant writing workshops and partnered with institutions such as Simon Fraser University and the Ragon Institute of MGH, MIT and Harvard to offer specialised courses that have included international faculty and trainees. This has proved to be a cost-effective approach, facilitated exploration of cutting-edge topics and approaches while allowing scientists beyond our network to benefit from the SANTHE funding. Another example of one such course took place in January 2019 when SANTHE co-hosted a workshop on HIV reservoirs and evolution (in collaboration with the Max Planck Society and with additional financial support from the Victor Daitz Foundation, a South African philanthropy), which brought together leading researchers in the field of HIV cure research and treatment failure and provided SANTHE scientists the opportunity to learn about the latest developments in research in this area and engage with other leading scientists. Examples of other course topics include CPE, biostatistics, phylogenetics, and immunology. In all our efforts we work to support the development of independent and critical thinking.
Travel scholarships are another tool that we used to enhance training, exposure and representation of our scientists and their work, enabling our trainees to attend conferences and key training events, and supporting the production of outstanding science. Travel scholarships have allowed us to support trainees to attend external training events and acquire training from other laboratories and sites. This support for our trainees to visit institutions in well-resourced countries (or to other African research sites) to learn new skills and to exchange ideas with international colleagues is highly beneficial. Increasingly, travel funding is being utilized for knowledge exchange and training within the network and amongst sub-Saharan African sites. For example, one of our PhD Fellows based at the Centre de Recherche sur les Maladies Emergentes et Re-Emergentes (CREMER) is conducting aspects of his research at the Africa Health Research Institute (AHRI) in South Africa, and will return to Cameroon with the necessary molecular biology skills to continue his research. By managing the process through African-based investigators and from African institutions, we believe that we can better match trainees with local needs and offer more conducive environments to integrate new knowledge into the core experience of African-led research teams. Over the last five years we have awarded 205 Travel Scholarships (awards ranged from $162 USD to $18,536 USD (average of $3256 USD)). 15% of awards supported training in other labs, 17% were for conference attendance and 68% were used to attend workshops/courses (both internal and external).
A second component in offering high-quality training to our junior scientists involves the promotion of effective mentorship. SANTHE has benefited from a large pool of scientists based in both well-resourced countries and local institutions. These individuals have acted as supervisors to our Fellows, as members of our SAB, or as members of our Thesis Advisory Committees (TAC). As an example, we have 74 supervisors representing 34 institutions (21 of which are based in Africa). We designed and introduced evaluation forms to enable both trainees and supervisors to provide feedback on the ongoing supervision and project progress. Our supervisors and postgraduate trainees have benefited from the introduction of TACs, as demonstrated by the very positive feedback received in these evaluations. These committees, which are not a requirement in most African institutions of higher learning, consist of at least three individuals, one of which is the primary supervisor to the Fellow. We have also identified the need for similar formal support for postdoctoral researchers and early career researchers, and will introduce this in the next phase of our programme. Indirect scientific and career mentorship has also been available through access to the larger SANTHE community. Furthermore, we plan to introduce comprehensive and holistic supervisor training on topics from conflict resolution and effective supervision techniques to core skills training such as biostatistics and CPE.
Our third component of high-quality training for our scientists involves leadership and career development support. Examples of this include soft skills training and opportunities to take leadership roles in SANTHE events and at an institutional level. We are currently further developing our curriculum to include compulsory training on topics from grants management to comprehensive CPE skills. These trainees also receive support through direct investment in our research environments, yet another advantage of receiving consortium-level funding. Our training has not just focused on our scientists; we have also funded support staff training in the areas of leadership, administration, grant management, financial management, and science communication. One key reason for SANTHE’s success as a consortium has been its strong secretariat (five full time staff members providing comprehensive logistical support in key science support areas). The advantage of this support being African-led is that it has enabled us to learn and build capacity in these key areas and therefore allow the strengthening of the research environments at all our sites. We have also taken the lead and helped to train others beyond our immediate SANTHE community. This is demonstrated in part by our leadership in activities such as the three-day Risk Management Workshop at the DELTAS 2018 Annual Meeting.
Effective information exchange and collaboration
A pervasive challenge to scientific excellence in Africa is the lack of opportunities to meaningfully engage with peers and experts in one’s field of research. It is vital for scientists to have opportunities to exchange ideas and information, to obtain critical feedback on their work, and to partner on projects to facilitate the ability to address cutting-edge issues. SANTHE has worked hard to create a forum for the exchange of ideas and interactions between researchers both on the African continent and beyond. For example, in addition to our ACM, through our site-specific research days (at which all SANTHE trainees at each site get an opportunity to give an oral presentation of their ongoing research and receive detailed feedback and critique), and our monthly meetings (opportunities for trainees to present their scientific or CPE activities). We have also hosted seminars, workshops and roundtable discussions to share and discuss information, results, and key challenges.
Another step towards effective capacity building is the development of strong collaborations in key areas including science, training, science support and community and public engagement. Effective cross-site collaborations are vital in helping to address scientific questions as a consortium, catalysing research synergies. To help assist with this with have used our collaborative grants and travel scholarships as key tools. A key part of our efforts is sharing information beyond SANTHE and regularly take the lead in activities to encourage dialogue between researchers even beyond the continent. Examples of our interaction with the global scientific community include hosting symposia and satellite sessions at international conferences. For example, the Strategies for Diagnosing and Managing Acute HIV Infection in the Context of PrEP and Immediate ART Symposium at IAS-AIDS in 2018 [33]. Our efforts to collaborate extend beyond the merely scientific to include all areas of science support. For example, in 2019 we hosted the 2019 Africa Asia Communications Forum which aims to identify ways to maximise impact from research being performed, in turn supporting the development of stronger communication and public engagement activities. This is an important component of our efforts to support the promotion of African science.