Muhimbili Medical Research Centre

NIMR - Muhimbili Research Centre

Background

The history of NIMR – Muhimbili Research Centre starts from 1968 when East African Research Council (EARC) with assistance from British Medical Research Council (BMRC) established the TB Reference Laboratory. When the National Institute for Medical Research was established in 1979, the Institute inherited the TB reference Laboratory, as one of its centres in accordance with the ACT of parliament No. 23 of 1979. Under the EARC and BMRC, the centre was involved in Involved in clinical trials for of short course regimen (2SHRZ/6TH) for tuberculosis. From its inception, it operated as a NIMR- Muhimbili Station until August 2005 when it became a centre. The Headquarters of the Centre is within the Centre for Health and Professional Education (CHPE) Building at Muhimbili University of Health and Allied Sciences (MUHAS). The Centre has five departments and two research stations one at Haydom (in Mbulu District) and another at Kilosa in Kilosa District. The five departments are; Finance, Monitoring and control, Research program, Laboratory Services, and Health Research Information Technology and Documentation. The Centre Director oversees the centre activities. In order to improve implementation of the core centre activities, five research programmes have been formed, these include:i) Clinical and epidemiological research on tuberculosis and HIV; ii) Maternal and child health; iii) Epidemiology of zoonoses; iv) Laboratory research on TB and HIV infection; and v) Health systems research and policy.

 

A significant human resource capacity growth has been witnessed at the Centre in the last decade. In 1980 the centre started with only one research scientist, in 2004 the number of research scientists increased to six and 21 in 2010. Currently there is a total of 42 staff whose academic and professional capacity is as follows: 6 research scientists with PhD degrees; 3 PhD candidates; 6 scientists with MSc/MPhil degrees; 3 scientists with MD degrees; 6 laboratory technologists; 2 clinical officers; 1 nurse and 16 none scientific staff.

The Centre has a well-trained workforce with extensive experience in conducting multi-site projects, some of which are Multicountry using both quantitative and qualitative research methods. Also, the Centre has a vast experience in conducting large scale population-based studies and implementation research and ability to manage large teams in different geographic areas.

Although the Centre has research offices in the Centre for Health and Professional Education (CHPE) Building at the Muhimbili University of Health and Allied Sciences (MUHAS), it jointly runs a BSL-1-3 laboratory for TB, the Central TB reference Laboratory (CTRL) with National Tuberculosis and Leprosy Control Program (NTLP). The laboratory is located within the Central Pathology Laboratory building (3rd floor) of the Muhimbili National Hospital (MNH). Also, the
Centre has research offices for Kilosa and Haydom Stations, and jointly utilises the Kilosa District Hospital and Haydom hospital facilities for research.

Since 2005, the Centre has diversified research focus from a disease specific approach research i.e. carrying out research on TB, HIV/AIDS and the related illnesses to a wider mandate that includes all health research at local, regional, zonal and national levels according to the National Health Research Priorities and Institutional mandate. The current research focus is on major research areas which include; TB and TB/HIV co-infection; NCDs and Co and multi morbidity with infectious diseases including HIV, Zoonotic diseases; Clinical trials; Diagnosis and laboratory sciences; Disease Surveillance and outbreak; Genetics and Molecular Biology; Bio-informatics; Health System and Policy Research; and Child and Maternal health. Over the years, the researches carried out by the Centre, range from social, basic sciences, epidemiology to clinical and implementation trials.

Some of the findings from researches carried out at the centre have contributed to the formulation of national and global policies in the management, prevention and control of diseases (publications: https://doi.org/10.1016/s0140-6736(15)60164-7 and https://www.nejm.org/doi/10.1056/NEJMoa1710922). Such global policy includes:
i) the WHO Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy (http://www.who.int/hiv/pub/guidelines/advanced-HIV-disease/en/), a
ii) Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children (https://www.who.int/hiv/pub/guidelines/cryptococcal-disease/en/),
iii) National Guidelines for the Management Of HIV and AIDS, Sixth Edition, October 2017 (www.nacp.go.tz/site/download/NATIONAL_DECEMBER_2017.pdf ).
iv) Global Advanced HIV Disease Toolkit(TRIP experiences and materials contributed in the development process): (http://www.differentiatedcare.org/Resources/Resource-Library/Global-Advanced-HIV-DiseaseToolkit)

The Centre has over 200 published papers in peer reviewed journals including The Lancet, and New England Journal of Medicine (NEJM), is also leading the development and running of the on-going multi-centre HIV and TB trial web database, the management system, (the REDAMS database) in East Africa. The Centre has also won and successfully implemented several consultancies from national and international agencies including NIH, USAID and PEPFAR programs.

Currently, NIMR-Muhimbili, has active funding from the EDCTP, EU, NIHR, World Bank, UNICEF, USAID (through Engender Health organization), Global Fund, and the National Institute of Health among others.
Being located at MUHAS and MNH, the centre has a pool of qualified research assistants with different disciplines including medical doctors, social scientists, psychologists to mention a few. On average, the Centre has been conducting about 40-45 research projects annually of different magnitude and disciplines.

 

 

Figure 1. NIMR – Muhimbili Research Centre organogram

Tuberculosis Central Reference Laboratory under NIMR and NTLP located at 3rd Floor, Central Pathology Laboratory, at Muhimbili Hospital

NIMR Muhimbili Centre: The Administration and Research Office located at the 4th Floor in the CHPE building at MUHAS

Haydom Research Station

The Station is located within Haydom Lutheran Hospital in Mbulu District, Manyara Region, northern Tanzania. Haydom Lutheran hospital (HLH) is located 80 km from Mbulu town in Mbulu district. The Station is a result of collaborative initiatives between the hospital and National Institute for Medical Research. The National Institute for Medical Research has been carrying out collaborative research with HLH since 1999. Since, then the number of research activities at the Hospital has increased, hence the need for a solid base for research activities was sought. In 2005 a Memorandum of Understanding was developed and signed stipulating clearly modalities for undertaking collaborative research between the National Institute for Medical Research.

Haydom Lutheran Hospital and University of Bergen, Norway. The current research focus is on major research areas which include; TB and TB/HIV co-infection; Health System and Policy Research; and Child and Maternal health.

NIMR Muhimbili Centre : Offices at Haydom Hospital facility

Kilosa Research Station

Kilosa research Station originates from the Rectal Artesunate Clinical (RECTOCAP) Trial which was carried out in Kilosa District from 1999. The Station is within the Kilosa District Hospital, located about 100 kms from Morogoro town in Tanzania. The Station utilizes hospital buildings renovated using funds obtained from the Swedish Embassy in Tanzania. In 2000, permission was granted by the district health authorities to re-construct three permanent offices to constitute a research base for the clinical trials. In 2006, the Kilosa clinical trial offices were formally adapted into the structure of NIMR as the Kilosa Research Station under NIMR Muhimbili Centre.

Currently the Station has 6 permanent employees including 1 medical doctor, 1 assistant medical officer, 2 clinical officers, 1 registered nurse and 1 office attendant. The Station has provided the basis for other research and research capacity building.

NIMR Kilosa Offices at Kilosa District Hospital

Clinical Trial Units

NIMR – Muhimbili Research Centre has three clinical trial units located in Mwananyamala, Temeke, and Amana Regional Referral Hospitals in Dar es Salaam. The clinical units have all the key facilities to support clinical trials. Also, the Centre run a model of one stop clinics for delivering integrated chronic conditions services at the following health facilities:
1. Temeke Regional Referral Hospital,
2. Mbagala rangi tatu Health Centre
3. Mnazi mmoja Hospital
4. Sinza Hospital
5. Kinondoni Hospital
6. Cardinal Rugambwa Hospital
7. St.Vicent health centre,
8. Tegeta Mission Hospital
9. Consolata sisters Dispensaries
10. Tandale, Hospital
11. Yombo vituka, Health Centre
12. Buguruni Health Centre
13. Magomeni Health Centres
14. Tambukareli Dispensary
15. Bagamoyo District Hospital
16. Kisarawe District hospitals

The sites are involved in several clinical trials which are ongoing at the centre. Such trials include INTE AFRICA trial https://inteafrica.org/; TRIP trial http://www.tripproject.org; EXIT TB trial https://eaccr.org/exit-tb-project; Being located at these facilities including the Regional Referral Hospitals, both the hospital facilities and the Centre are mutually benefiting from each other; for example the hospitals benefited capacity building in conducting research and improvement of patients services through the ongoing trials in these clinical trial units. The centre has access to qualified staff with different specialities, research participants and different services provided in these hospitals. For example each Regional Referral Hospital has generally about 500 hospital staff. Some of the Services offered: Includes OPD department which has number of services; to mention few of them are general OPO, Specialized clinic (Internal Medicine, Surgery, Obstetrics & Gynaecology and Paediatric) HTC, CTC, and RCH Clinic with PMTCT inclusive, oral health, ENT/Eye services, DM, TB/Leprosy, and Mental unit. Others are social welfare services and NHIF/NSSF services and Inpatient services, major and minor surgical services.

Research Programs

To improve implementation of the core activities of the centre, Five research programmes were formed;
i) Clinical and Epidemiology on TB/HIV
ii) Clinical and Epidemiology of Zoonotic and Outbreak Diseases
iii) Reproductive and Child Health (RCH)
iv) Non-Communicable Diseases
v) Health System Research and Policy

COLLABORATING PARTNERS

The Centre is collaborating with several partners, nationally and internationally and is open for more partners who will be interested to work with the scientists at the centre. To name a few, the collaborators include;
Nationally: Nelson Mandela African Institution of Science and Technology, Sokoine University of Agriculture, Ministry of Health, Community Development, Gender, Elderly and Children, National Tuberculosis and Leprosy Control Program, Kibong’oto Infectious Diseases Hospital, Kilimanjaro Clinical Research Institute

Internationally: Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, University of Bergen, Edwardo Mondlane University, University of Zambia, Technical University of Munich Germany, World Health Organization, Global Fund, Kenya Medical Research Institute Kisumu, Infectious Diseases Institute, Addis Ababa University, Institute of Endemic Diseases, University of Khartoum Sudan, Liverpool School of Tropical Medicine, MRC/UVRI-Uganda, Makerere University, Fondation Congolaise Pour la Recherche Médicale, University College London, ST. Georges University of London, London School of Hygiene and Tropical Medicine, Foundation Privada Instituto De Salud Global Barcelona, Liverpool John Moores University, University College of Dublin, National Institute for Infectious Diseases Lazzaro Spallanzani, Royal Institute of International Affairs, Njala University, and Royal Veterinary College University of London. Sokoine University of Agriculture, Nelson Mandela African Institute of Technology, Arusha, Tanzania.