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GID Report

Success Story

Since political stability in the late 1980's, Uganda has become a valuable site for disease research because of its academic systems, communication infrastructure and strong support from the Ugandan government. Though this research-friendly setting has produced a number of highly successful collaborations in HIV and tuberculosis research, Uganda lacked trained personnel familiar with malaria research. Since 1988, Dr. Rosenthal, his colleagues from University of California San Francisco (UCSF), and Dr. Moses Kamya, a scientist at Uganda's Makerere University, have worked to address this imbalance. "We literally had to start from scratch," said Dr. Rosenthal. "There was very little research regarding malaria in Uganda."

With research traditionally focused on the biochemistry of malaria parasites and antimalarial drug discovery, Dr. Rosenthal helped to establish a collaborative project between UCSF and Makerere in 1998. Soon after, Fogarty contributed a research training grant that would play an important role in increasing Makerere's research capacity.

Another factor contributing to malaria's prevalence in Uganda was the disease's resistance to older, more affordable antimalarial drugs commonly used throughout Africa for decades. In response, Dr. Rosenthal's team completed six clinical trials of antimalarial drugs in Kampala, supporting a number of related molecular epidemiology studies. The studies have led to over 20 publications, primarily addressing clinical, epidemiology, and molecular aspects of antimalarial drug resistance in Uganda. In collaboration with the Uganda Ministry of Health, and with support from the CDC, the research team has conducted comparative trials at seven other sites in Uganda selected for their diversity in geography and malarial ecology. Most recently, Dr. Rosenthal and his colleagues have expanded its research focus into other areas such as asymptomatic parasitemia, severe malaria, interactions between HIV and malaria, and geographic studies of malaria.

The results of the antimalarial drug resistance studies have been groundbreaking and have influenced the Ugandan Ministry of Health regarding malaria drug policy. "Before the study, the offical policy of the government was to use a chloroquine-based regimen. Our research clearly showed them that some regimens work better than others, and now they fully support the use of the more effective artemisinin-based regimens," said Dr. Rosenthal.

Dr. Rosenthal strongly believes the best opportunities for training in medical research in Uganda come from collaborative efforts that involve both Ugandan mentors and those from developed countries with better-established systems for training. "Even relatively small dollars from Fogarty allowed Ugandan malaria researchers to get an education that would otherwise be unavailable to them at home. Many have earned master's degrees in public health, and a few have even received medical degrees."