Centers for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI): Developing Career Pathways for Early-Stage Scholars from Racial and Ethnic Groups Underrepresented in HIV Science and Medicine

Abstract

Background:

There is an urgent need to increase diversity among scientific investigators in the HIV research field to be more reflective of communities highly impacted by the HIV epidemic. Thus, it is critical to promote the inclusion and advancement of early-stage scholars from racial and ethnic groups underrepresented in HIV science and medicine.

Methods:

To widen the HIV research career pathway for early-stage scholars from underrepresented minority groups, the National Institutes of Health (NIH) supported the development of the Centers for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI). This program was created through partnerships between CFARs and Historically Black Colleges and Universities (HBCUs) and other Minority Serving Institutions (MSIs) throughout the United States.

Results:

Seventeen CFARs and more than 20 HBCUs and MSIs have participated in this initiative to date. Programs were designed for the high school (8), undergraduate (13), post baccalaureate (2), graduate (12) and post-doctoral (4) levels. Various pedagogical approaches were employed including didactic seminar series, intensive multi-day workshops, summer residential programs and mentored research internship opportunities. During the first 18 months of the initiative, 257 student scholars participated in CDEIPI programs including 150 high school, 73 undergraduate, 3 post baccalaureate, 27 graduate and 4 postdoctoral students.

Conclusion:

Numerous student scholars from a wide range of educational levels, geographic backgrounds and racial and ethnic minority groups have engaged in CDEIPI programs. Timely and comprehensive program evaluation data will be critical to support a long-term commitment to this unique training initiative.

Introduction

Numerous barriers hinder the inclusion and career progression of early-stage scholars from racial and ethnic groups underrepresented in HIV research; these barriers include insufficient numbers of role models, mentors and mentoring programs, social and professional isolation, financial burdens and the historical legacy of structural racism.^1–5 The HIV research field urgently needs proactive methods to engage, support and train a more diverse and inclusive pool of scholars that is reflective of communities highly impacted by the HIV epidemic. This will in turn engender and empower a more diverse scientific workforce whose expertise, lived experiences and insights into impacted communities could contribute to ending the HIV epidemic.^6–14

The disparities between the racial and ethnic composition of communities highly impacted by HIV in the U.S. and the current medical and scientific work force are striking. Among the estimated 34,800 persons with new HIV infections in the U.S. in 2019, 41% were Black/African American, 29% were Hispanics/Latinos, and 0.7% were American Indian/Alaskan Native.¹⁵ In contrast, among 175,449 active physicians in the U.S. in 2021, 5.2% were Black/African American, 9.7% were Hispanic/Latino and 0.2% were American Indian/Alaskan Native.¹⁶ The disparities are even more pronounced among scientific investigators; of the 41,631 NIH-funded Principal Investigators of research grants in 2022, 3.2% were Black/African American, 5.9% were Hispanic/Latino and 0.2% were American Indian/Alaskan Native.¹⁷

In response to this critical need and aligned with the NIH UNITE Initiative that was announced in February 2021,¹⁸ the NIH supported the development of the Centers for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) to widen the HIV research career pathway for early-stage scholars from racial and ethnic groups who are underrepresented in biomedical research.¹⁹ To facilitate the launch of CDEIPI, NIH leveraged the CFAR network which was established in the late 1980’s to promote HIV research and develop the next generation of HIV scientists at academic institutions throughout the United States.²⁰

CDEIPI began in the summer of 2021 with an initial NIH investment of $3 million to support the first year of this pilot program.²¹ This initiative was designed to build upon existing academic HIV training programs such as the University of California, San Francisco/San Francisco Department of Public Health Summer HIV/AIDS Research Program (SHARP);²² the Johns Hopkins University CFAR Baltimore HIV/AIDS Scholars Program;²³ and the Indigenous Wellness Research Institute Indigenous HIV/AIDS Research Training Program (IHART).²⁴ CDEIPI was also designed to be synergistic with other NIH programs that support the development of HIV scientists from underrepresented minority groups²⁵ including the CFAR ADELANTE²⁶ and Mid-Atlantic CFAR Collaboration (MACC) Scholars programs,^27–30 the HIV Prevention Trials Network (HPTN) Scholars Program^31–32 and the HIV Vaccine Trials Network (HVTN) RAMP Program;^4,33 and with the Centers for Disease Control and Prevention (CDC) Minority AIDS Research Initiative (MARI).^34–36 The development of CDIEPI was also informed by existing training programs at collaborating Historically Black Colleges and Universities (HBCUs) and other Minority Serving Institutions (MSIs) such as the Karsh STEM Scholars Program and the Center of Excellence Program at Howard University.^37–38

The objectives of this manuscript are to describe the development of CDEIPI and to present a snapshot of the types of CDEIPI programs being implemented by collaborating CFARs, HBCUs and MSIs across the United States. This paper will serve as the methodologic foundation for the manuscripts that follow in this supplemental issue of JAIDS in which comprehensive CDEIPI-wide evaluation data and site-specific descriptions of 16 individual CDEIPI programs are presented.

Methods

Goals:

The goals of CDEIPI are to increase the engagement of early-stage scholars from underrepresented racial and ethnic minority groups in HIV-related scientific careers and professions; to rigorously monitor and evaluate short- and long-term program outcomes to inform best training practices; and to create a national network of HIV scientists and educators who would work collaboratively to develop and enhance pathway programs through the generation and sharing of innovative ideas. Central to this initiative was the emphasis on leveraging existing partnerships or creating new partnerships between participating CFARs and HBCUs/MSIs throughout the United States.

Proposal and Review Process:

In summer 2021, an NIH supplement was awarded to the District of Columbia Center for AIDS Research (DC CFAR) to help develop and coordinate this initiative. In consultation with NIH, the DC CFAR developed a Request for Proposals (RFP) for the CDEIPI program which was sent to all 18 active CFARs in September 2021. Fifteen CFARs submitted an initial proposal to the DC CFAR in early October 2021 with budgets of up to $150,000 in total costs per CFAR. To encourage the sharing of approaches, reciprocal critique, constructive idea exchange and cross-CFAR collaboration rather than inter-CFAR competition, these proposals were presented by the CFAR leads at a virtual two-day CFAR-wide meeting. CFARs were then given the opportunity to revise their initial proposals based on the feedback they received from NIH and other CFARs and to submit final proposals in late October 2021.

These proposals were reviewed by the NIH for technical merit and funding decisions. All 15 CFARs were funded and the notices of award, funding amounts and a summary of recommendations were distributed to the CFARs in November 2021. Following receipt of the CDEIPI supplemental funds from the NIH by the DC CFAR, the process of establishing subawards to the 15 CFARs and their collaborating institutions was initiated in December 2021. CDEIPI activities then began in late 2021 and early 2022. Based on the initial progress of the CDEIPI program, the NIH announced in March 2022 that it would support a second year of the CDEIPI initiative through supplemental funding directly to participating CFARs. Fourteen of the 15 CFARs which participated in the first year of CDEIPI, and two additional CFARs which were new to the program, received supplemental funding for CDEIPI in Year 2. More recently in March 2023, NIH indicated that it would support a third year of CDEIPI through supplemental funding of the parent CFARs.

Unique features:

The CDEIPI was designed with a series of unique features that collectively distinguish it from other important DEI training initiatives in the HIV research field.

First, the CDEIPI was designed to create a training pathway along the educational spectrum at the high school, undergraduate, graduate, and post-doctoral levels. This strategic focus on the academic continuum beginning at a relatively early stage in academic development was intentional and designed to build upon and articulate with other focused developmental training programs for HIV scientists from underrepresented minority groups at the undergraduate, graduate and faculty levels.

Second, CFARs were encouraged to institute programs for students at a minimum of two different educational levels. This was intended to ensure the development of a training pathway within each CFAR, encourage peer-to-peer mentoring relationships across educational cadres, and to encourage CFARs with existing HIV-focused DEI programs to extend them so that students at multiple educational levels could benefit.

Third, CFARs were asked to leverage existing partnerships or create new partnerships with Historically Black Colleges and Universities (HBCUs) and other Minority Serving Institutions (MSIs) to develop and implement their CDEIPI programs. This was intended to capitalize on the academic expertise and perspectives of HBCUs and MSIs, as well as to facilitate the engagement of students from underrepresented minority groups enrolled in HBCUs and MSIs in CDEIPI programs.

Fourth, the CFAR principle of local control was respected, which means that individual CFARs are well positioned to know which programs are most likely to be successful in their own environments. CFARs were asked to design a training program that was either new or would enhance an existing program, that would leverage the expertise of their faculty and other existing training opportunities within their CFARs and create or build upon new partnerships with local or regional academic institutions at the high school and/or university levels.

Fifth, CDEIPI was designed to be a collaborative program. CFARs were asked to openly share their proposals with one another and offer constructive feedback during the proposal development phase. Applications were then reviewed by the NIH and feedback from NIH reviewers were provided to further improve the programs. During the implementation phase, CDEIPI site leaders were asked to participate in monthly meetings to share information about program successes and challenges, work together to develop and implement a common program evaluation plan and encouraged to collaborate when feasible across CFARs.

Sixth, each CFAR was asked to designate a Program Lead to be responsible for the implementation of their individual CFAR CDEIPI program, and a separate Evaluation Lead to oversee the monitoring and evaluation component of the program. This structure was created to ensure rigorous monitoring of the progress and impact of the CDEIPI program. CFARs were encouraged to select Program and Evaluation Leads with prior experience in training programs for scholars from underrepresented minority groups.

Seventh, at least 80% of CDEIPI funds were required to be designated to support the CDEIPI programs themselves with no more than 20% used for CFAR investigator salary support. Complementary support for local CDEIPI initiatives from CFAR home institutions and from the CFARs themselves was encouraged.

Eighth and finally, all students who participate in CDEIPI programs across the academic spectrum were designated as “CFAR Scholars” with the intent of creating a large cadre of trainees from underrepresented minority groups across the U.S. who can develop peer-to-peer mentoring relationships across educational levels and CFARs.

Coordinating Center:

The CDEIPI Coordinating Center (CC) is housed in the DC CFAR and comprised of the Program, Evaluation and Administrative Cores. The Program Core serves as the primary point of contact and has coordinated monthly virtual meetings with the Program Leads from participating CFARs. The Evaluation Core rigorously chronicles the development of the CDEIPI programs and supports the development, harmonization and ongoing assessment of short- and long-term process and outcome measures across all projects. The Evaluation Core serves as the primary point of contact and has coordinated monthly virtual meetings with the Evaluation Leads from participating CFARs. The Administrative Core provides administrative oversight and support for this initiative and serves as the principal point of contact with the NIH CFAR Program. The Administrative Core ensures that CDEIPI is addressing NIH goals, meeting or surpassing NIH expectations and communicates with other CFAR Directors and Administrative Directors for technical and fiscal inquiries as needed.

Results

CDEIPI Projects

The 17 CDEIPI projects that were funded in Years 1 and 2 are summarized in Table 1. CDEIPI programs were designed for a wide spectrum of educational levels from high school (8) to undergraduate (13), post baccalaureate (2), graduate (12) and post-doctoral (4). CDEIPI programs focused on developing or enhancing training programs for Black/African American, Hispanic/Latino and Indigenous students with one CFAR adopting an intersectionality approach for students from both underrepresented racial/ethnic and sexual/gender minorities. A variety of pedagogical approaches were employed including didactic seminars, intensive multi-day workshops, summer residential programs and mentored research internship opportunities in laboratory, field work and public health department settings. During the first 18 months of the initiative, 257 student scholars participated in CDEIPI programs including 150 high school, 73 undergraduate, 3 post baccalaureate, 27 graduate and 4 postdoctoral students.³⁹

Table 1.

Summary of the Year 1 Centers for AIDS Research (CFAR) Diversity, Equity and Inclusion Pathway Initiative (CDEIPI) projects

CFAR	HBCU/MSIa	Project Title	Program Description	Educational Levels
DC CFAR	Howard University	Developing an Inclusive Generation of HIV Researchers through Diversity and Community	Mentored research opportunities, professional development, community volunteer activities, summer residential program	High School, Undergraduate
Duke CFAR	Benedict College, South University, Claflin University, Voorhees College, Morris College	Evidence2Practice: Leveraging Implementation Science to Recruit HBCU/MSIa Students into Careers in HIV Research	Intensive on-campus 3-day workshops with interactive lectures and experience-based introduction to implementation science, development of campus-specific HIV prevention and PrEPb action plans	Undergraduate, Graduate
Emory CFAR	Morehouse School of Medicine	Emory CFAR Building a Pipeline: Health Equity Research Program for College and High School Students	Enhance established pipeline programs, seminars, resources, financial support	High School, Undergraduate
Harvard CFAR	Community partners	Harvard CFAR DEI Pipeline Initiative	Support recruitment of URM investigators into HIV research; provide a sustained mentorship model for retaining URMs in HIV research; and expand educational/outreach programs about HIV to the communities affected by the epidemic	High School through Postdoctoral
Johns Hopkins University CFAR	Howard University, Morehouse College, Morgan State University, Prairie View A&M, Spelman College	Generation Tomorrow: Summer Health Disparity Scholars	10-week summer program training in HIV/Hepatitis C testing and counseling, mentored research, lecture series, community outreach	Undergraduate, Graduate
Miami CFAR	Florida International University, Florida Atlantic University	Miami CFAR Diversity, Equity, and Inclusion Pipeline Initiative (CDEIPI)	Co-mentored laboratory research internships	Undergraduate, Graduate, Postdoctoral
Penn CFAR	Lincoln University, College of Physicians of Philadelphia	Penn CFAR Scholars for Diversity in AIDS Research	Leverage five existing academic and community-based pipeline programs by expanding trainee slots, building HIV-specific content and mentored research opportunities	High School, Post-baccalaureate, Undergraduate
Providence/Boston CFAR	Howard University, Xavier University of Louisiana, Spelman College	Providence/Boston CFAR Diversity Equity Inclusion and Belonging (DEIB) Program	HIV-focused pilot program to expand the reach of existing STEMc pipeline programs	Post-baccalaureate, Undergraduate, Graduate
Rustbelt CFAR	University of Puerto Rico campuses at Rio Piedras, Humacao, Cayay, and Mayagüez	Rustbelt CFAR CDEIPI Scholars Program/ Rustbelt Investigators for the Next Generation (RING Program	Ten-week mentored experience in HIV research and enrichment activities including weekly seminars in laboratory techniques	Undergraduate, Graduate
San Diego CFAR	San Diego State University	San Diego SUN: Supporting and Uplifting New and Diverse Scientists in HIV	Nine-week seminar/ workshop attendance with informal peer support sessions, mentored career development, training seminars, professional experience in HIV research through ‘seed’ grants	Graduate, Postdoctoral
Tennessee CFAR	Meharry Medical College	The Tennessee CFAR Training Program for BIPOC/URMd High School and Undergraduate Students	Enhance established pipeline programs with education and training in HIV research, 10-week summer research program	High School, Undergraduate
Texas D-CFAR	Michael E. DeBakey High School for Health Professions in Houston, Science Academy of South Texas High School	Texas D-CFAR Initiative to Promote Diversity in HIV Science	HIV research presentations, mentorship, participation in virtual national meetings	High School, Graduate
Third Coast CFAR	Southern AIDS Coalition	Partnering and Programming for a BIPOCd SGMe Runway to HIV Research	Two-week Summer Intensive Program to engage URM/BIPOCd SGMe trainees in intersectional HIV science	Graduate, Postdoctoral
UAB CFAR	Multiple partners	Strengthening Training and Advancement in Research (STAR) – A Pipeline Program Geared to Promote Excellence through Fostering Diversity	Investigate critical elements needed to create a highly impactful program	High School, Undergraduate Graduate
UCSF CFAR	San Francisco State University (SFSU), San Francisco Department of Public Health	Accelerating Research Careers in Science through Early Mentored Research Experiences at the UCSF CFAR and SFSU	Mentored HIV research experience leveraging the CFAR Mentoring Program, Mentoring the Mentors Training, 16-week Summer Program	Undergraduate, Graduate
UNC CFAR	North Carolina Central University (NCCU)	UNC and NCCU Diversity and Inclusion Pipeline Program (UN-DIPP)	Year-long research internship, summer global health attachments, enrichment of local high school curricula	High School, Undergraduate, Graduate
UW/Fred Hutch CFAR	University of Hawaii at Manoa	Building Indigenuity, Generating HIV Science: HIV/AIDS Research Training (BIG HART)	Pilot program for Indigenous students with Indigenous mentors, networking, training opportunities in HIV research, mentoring the mentors training to better support Indigenous scholars	Undergraduate, Graduate

^aHBCU/MSI = Historically Black Colleges and Universities/Minority Serving Institutions

^bPrEP = Pre-exposure prophylaxis

^cSTEM = Science, Technology, Engineering and Mathematics

^dURM/BIPOC = Underrepresented Minorities/Black, Indigenous, and People of Color

^eSGM = Sexual and Gender Minorities

CFARs and collaborating HBCUs/MSIs institutions that participated in CDEIPI are located throughout the United States (Figure 1). CFARs partnered with a large number of HBCUs including Benedict College, Claflin University, Howard University, Lincoln University, Meharry Medical College, Morehouse College, Morehouse School of Medicine, Morgan State University, Morris College, North Carolina Central University, Prairie View A&M, Spelman College, Voorhees College, and Xavier University of Louisiana; and with other MSIs including Florida International University, Florida Atlantic University, San Diego State University, San Francisco State University, South University, the University of Hawaii at Manoa and the University of Puerto Rico. The Texas Developmental CFAR partnered with the Michael E. DeBakey High School for Health Professions in Houston and the Science Academy of South Texas which educate large numbers of high school students from underrepresented racial and ethnic minority groups in Texas.

Figure.

Centers for AIDS Research (CFARs), Historically Black Colleges and Universities (HBCUs), and Minority Serving Institutions (MSIs) Participating in the CFAR Diversity, Equity and Inclusion Pathway Initiative (CDEIPI)

Coordinating Center Activities

The Program Core has led monthly video calls with the CFAR Program leads since the beginning of the initiative. These meetings have served as the principal forum for exchanging programmatic ideas among the CFARs, identifying best practices and common challenges throughout the CDEIPI network, and providing high level feedback to the NIH about how CDEIPI can be improved and sustained over time. Topics have included CDEIPI programs sharing their progress and challenges with project implementation; varying pedagogical approaches for CFAR Scholars including didactic sessions, laboratory and field internships, and summer programs; mentoring approaches; and engagement with HBCUs and MSIs. Small group breakout sessions to focus on common elements between CFAR programs have been held during the meetings as well.

The Evaluation Core has led monthly video calls with the CFAR Evaluation leads. Through these meetings, the Core developed a harmonized evaluation plan which includes a quarterly survey of all CDEIPI sites to document and monitor the overall progress of the initiative across the CFAR network. The Core worked with the sites to develop a bank of standardized survey questions that is being administered to individual CFAR Scholars to capture their experiences with the programs including impact on career progression, challenges encountered, assessment of program components, and recommendations for program improvement. Individual CFAR projects also developed their own evaluation components to complement the aggregate measures, with the Evaluation Core providing technical support and consultations for local evaluation efforts as needed. The Core is now collecting and analyzing CFAR-wide and individual site level data that will serve as the basis for reports to the NIH and manuscripts for the peer-reviewed literature on the progress and lessons learned from the CDEIPI program.

The Administrative Core was responsible for fiscal oversight of CDEIPI resources and for the subawards to CFARs and collaborating HBCUs/MSIs in Year 1, and the NIH assumed responsibility for CDEIPI supplements in Year 2. The Core also developed the CDEIPI logo, a CDEIPI homepage on the DC CFAR website,²¹ and a monthly CDEIPI e-newsletter that highlights CDEIPI projects and provides updates from all three Coordinating Center Cores. The newsletter has a distribution list of >200 persons and includes the CFAR Directors and Administrative Directors, all CDEIPI Program and Evaluation leads, key contributors at the CFARs and collaborating HBCUs/MSIs, and NIH staff.

Discussion

The CDEIPI program was successfully launched in 2021–2022 through the collaborative effort of 17 CFARs and more than 20 HBCUs and other MSIs with the common goal of widening the pathway for student scholars from underrepresented minority groups to engage in HIV science and other scientific careers. This initiative has considerable breadth: geographically from Hawaii to the Pacific Northwest, northern and southern California, the Midwest, Texas, Florida, Puerto Rico and multiple sites in the South and the Northeast; educationally from high school through post-doctoral training; and demographically with the inclusion of students from underrepresented racial/ethnic and sexual/gender minority groups. During the first 18 months of the initiative, 257 high school, undergraduate, post-baccalaureate, graduate and post-doctoral students have participated in CDEIPI training programs and represent the first wave of CFAR Scholars.

The CDEIPI program aims to capitalize on the expertise and engagement of the numerous academic institutions and faculty involved in the program. CFAR institutions are openly sharing pedagogical approaches, mentoring and educational expertise, and programmatic lessons learned with one another during monthly calls with the Program leads. Partnerships with leading HBCUs and MSIs across the nation are ensuring that their important educational perspectives and priorities are included in program development and implementation as well as facilitating access for their students to CDEIPI programs. A wide range of CFAR investigators are contributing to CDEIPI by opening their laboratories and research programs to hosting and mentoring CFAR Scholars. Faculty with extensive monitoring and evaluation expertise are serving as the Evaluation leads and collaborating across CFARs to develop harmonized tools to collect program-wide and site-level data that will inform the evolution of the CDEIPI program. As the program evolves, the size and scope of the CDEIPI network will create educational opportunities for CFAR Scholars as students graduate and leave their home institutions to pursue their next level of education at other academic institutions participating in CDEIPI.

The CDEIPI initiative will also open pathways for the development of peer-to-peer mentoring at several levels. CFAR Scholars within any given educational cadre have had the opportunity to meet and learn from one another during group CDEIPI training programs at their own institutions. Because the CDEIPI program is designed to include two or more educational levels at each site, CFARs are encouraged to facilitate cross-cadre interactions and mentoring as well. Lastly, through online connectivity and possible future national in-person meetings of CFAR Scholars and mentors, we aim to support the creation of an extensive national CDEIPI network with interactions and mentoring relationships being developed across geographic sites and educational cadres.

The sustainability of the CDEIPI program has been a central topic for discussion since its inception. CFAR and HBCU/MSI leaders recognized early on that to create a true career pathway for CFAR Scholars, a long-term commitment of resources over a prolonged period would be required. Progression through the academic ranks from high school or undergraduate student to faculty member can take a decade or more, and approaches to retaining scholars as they progress along the scientific career pathway need to be developed and supported. This reinforces the importance of collecting timely and comprehensive program evaluation data on the positive impact that CDEIPI programs are having on the career progression of CFAR Scholars to support a long-term commitment to this initiative. The sustainability of CDEIPI could also be addressed through the CFAR application and renewal process by extending the focus of the CFAR developmental mission on early-stage investigators to include the educational cadres that are the focus of CDEIPI.

As the CDEIPI consortium matures and programmatic and outcome data become available, lessons learned and best practices that result from the pilot phase of the CDEIPI initiative will inform the development of future initiatives with an even broader geographic and academic reach. Finally, as the overall goal of the CDEIPI program is to contribute to the development of a more diverse and inclusive scientific workforce, this initiative could help combat persistent inequities in HIV- and other health-related outcomes for highly impacted communities throughout the United States.