The V-BRCH Project: Strengthening HIV Research Capacity in Nigeria through Intensive Workshops in Implementation Science and Grant Writing

ABSTRACT.

As persons with HIV live longer as the result of antiretroviral therapy, morbidity from HIV-associated noncommunicable diseases (NCDs) is increasing. The Vanderbilt–Nigeria Building Research Capacity in HIV and Noncommunicable Diseases program is a training platform created with the goal of training a cohort of successful Nigerian investigators to become leaders in HIV-associated NCD research. We describe survey findings from two week-long workshops in Kano, Nigeria, where trainees received instruction in implementation science and grant writing. Surveys assessed participants’ self-perceived knowledge and confidence in topics taught during these workshops. Thirty-seven participants (all assistant professors) attended the implementation science workshop; 30 attended the grant-writing workshop. Response rates for the implementation science workshop were 89.2% for the preworkshop survey and 91.9% for the postworkshop survey. For the grant-writing workshop, these values were 88.2% and 85.3%, respectively. Improvement in participant knowledge and confidence was observed in every domain measured for both workshops. On average, a 101.4% increase in knowledge and a 118.0% increase in confidence was observed across measured domains among participants in the implementation science workshop. For the grant-writing workshop, there was a 68.8% increase in knowledge and a 70.3% increase in confidence observed. Participants rated the workshops and instructors as effective for both workshops. These workshops improved participants’ knowledge and competence in implementation science and grant writing, and provide a model for training programs that aim to provide physician scientists with the skills needed to compete for independent funding, conduct locally relevant research, and disseminate research findings.

INTRODUCTION

Following the widespread introduction of antiretroviral therapy, HIV has become a chronic condition resulting in people with HIV (PWH) living longer and experiencing increasing morbidity and mortality from HIV-associated noncommunicable diseases (NCDs).^1,2 Africa has the highest HIV burden in the world, and there is an emerging epidemic of NCDs among PWH on the continent.^3,4 This epidemic is especially notable in Nigeria, Africa’s most populous country, which has more than 2 million PWH—the fourth largest number of PWH of any country in the world.⁵ This statistic is critical, because studies^6–9 have shown that PWH and persons receiving certain antiretroviral medications have greater rates of hypertension, dyslipidemia, and metabolic syndrome compared with their age-matched peers. The challenges presented by the increasing burden of NCDs in resource-constrained settings such as Nigeria are further complicated by an undercapacitated health-care system.^10,11 To address these unique challenges, country- and region-specific data are needed to guide policies and interventions focused on preventing the development of NCDs and improving their management in PWH.^10,12–14 Conducting such investigations will require training clinical investigators with the skills to generate evidence, disseminate discoveries, and implement solutions to the growing challenges posed by NCDs.¹⁰ One approach to building a cohort of researchers with these skills is through formal training programs focused on developing specific research skills in early-stage investigators. Unfortunately, few institutions in Africa, including in Nigeria, have such structured training programs, which creates a gap in skills, knowledge, and access to research funding in the continent with the largest HIV burden.^15–18

To address this gap in Nigeria, the Vanderbilt–Nigeria Building Research Capacity in HIV & Noncommunicable Diseases (V-BRCH) program was created.^10,19 This training program is supported by the Fogarty International Center of the NIH with the purpose of training Nigerian investigators to initiate and implement successfully high-quality clinical trials in HIV-associated NCDs. These goals are accomplished through short- and medium-term learning opportunities, including paired mentoring arrangements, mentored research projects, and intensive onsite workshops for physician scientists and research staff focused on essential research topics and skills. We describe the results of two such workshops in Kano, Nigeria—one focused on implementation science and the other focused on essential grant writing.

MATERIALS AND METHODS

Workshop objectives.

The two workshops were held at the Aminu Kano Teaching Hospital (AKTH) in Kano, Nigeria. The first workshop focused on implementation science research. It was a 5-day workshop and was held in October 2021, with the objective of helping participants understand core implementation science concepts, strategies, and design principles. Participants learned how to select the key components of an implementation science study, apply theories and frameworks to the design of implementation science trials, identify adaptations and strategies that might be needed, and select implementation science outcomes for developed proposals.¹⁹ The second 5-day workshop focused on grant-writing skills and was held in April 2022, with the objective of helping participants understand core skills and competencies in grant writing. During this workshop, participants learned about metrics for grant review, key components of the grant review process, principles of effective scientific communication for grant applications, strategies for effective communication with grant funding agencies and foundations; how to design a research question and develop specific aims and hypotheses for a potential grant application; and how to identify the different types of career development, research, and programmatic grants relevant to their personal or professional goals. The V-BRCH program was designed with substantial input from local partners and with their assurance of active participation as equal partners in program implementation and evaluation. Workshop objectives and content were created similarly in collaboration with Nigerian investigators and U.S.-based colleagues.²⁰

Workshop development and preparation.

A core principle of the V-BRCH program is that all programs and proposed activities receive considerable input from local partners. This includes shared responsibility for and collaboration on content creation and delivery for the workshop, shared leadership and responsibilities for planning and coordinating the workshop, and shared mentorship of participants throughout the workshop.

Participants.

For both the implementation science and grant-writing workshops, the program’s website and social media outlets were used to generate publicity for the application process.²⁰ These workshops targeted early-stage physician scientists with faculty appointments at the host university and/or teaching hospital whose research interests focused on the intersection of HIV and NCD-related health outcomes. Potential participants completed an online application via REDCap (Vanderbilt Univeristy, Nashville, TN), a secure, Web-based data collection platform.²¹ The application included submitting their curriculum vitae and detailing their interest in attending the workshop. Applications were reviewed by the training program executive committee, prioritizing applicants who met the criteria just mentioned and were enrolled in or were alumni of other U.S. government–funded training programs at the host institution. The demographic characteristics of the participants for both workshops are shown in Table 1.

Table 1.

Demographic characteristics of participants, implementation science, and grant-writing workshops (Kano, Nigeria)

Characteristic	Implementation science, n (%), (N = 37)	Grant writing, n (%), (N = 34)
Sex
Female	18 (48.6)	16 (47.1)
Male	19 (51.4)	18 (52.9)
Specialty
Clinical research	2 (5.4)	1 (2.9)
Dentistry	2 (5.4)	1 (2.9)
Laboratory sciences	8 (21.6)	5 (14.7)
Medicine	5 (13.5)	5 (14.7)
Pediatrics	7 (18.9)	8 (23.5)
Public health	5 (13.5)	3 (8.8)
Surgical specialties	2 (5.4)	4 (11.8)
Family medicine	4 (10.8)	4 (11.8)
Psychiatry	1 (2.7)	2 (5.9)
Radiology	1 (2.7)	1 (2.9)
Academic rank
Assistant professor	30 (81.1)	26 (76.5)

Workshop format.

Both the implementation science and grant-writing workshops included didactic presentations, small group activities, and interactive discussions.^19,20

Implementation science.

The first day of the implementation science workshop consisted of introductions as well as lectures and group work focused on key components of implementation science. Day 2 focused on theories and frameworks in implementation science, day 3 covered adaptation and strategies, and day 4 included sessions on implementation outcomes. Each day included a recap of the prior day’s training, at least one lecture, and time for group work. Day 5 consisted of a recap as well as presentation of certificates by the program leadership. The full schedule for this workshop can be found at https://www.vumc.org/v-brch/introduction-implementation-science-workshop. Instructors for the workshop included a lead instructor from Vanderbilt University Medical Center (VUMC), five support faculty from AKTH, and two support faculty from VUMC.

Grant writing.

For the grant-writing workshop, the first day consisted of introductions and lectures/group work focused on the fundamentals of a strong grant proposal, fundamentals of research methodology for grant proposals, and how to identify sources of grant funding. Day 2 focused on the grant review process and the basics of scientific communication and writing. Day 3 focused on generating research questions, specific aims, and hypotheses for a grant proposal as well as interacting with funders. Throughout days 1 through 3, participants were divided into groups of five based on research areas of interest, and they had time to write a group-specific aims page that consisted of one or more specific research questions, two to three specific aims, and accompanying hypotheses. On day 4, each group presented their specific aims page and received group feedback. Each day consisted of a recap of the prior day’s information, at least one lecture, and time for group work. On day 5, there was a recap and question-and-answer session followed by a certificate ceremony. The full schedule for this workshop can be found at: https://www.vumc.org/v-brch/v-brch-grant-writing-workshop. Instructors for the workshop included two lead instructors from VUMC, six support faculty from AKTH, and two support faculty from VUMC.

Evaluation and analysis.

Individuals who participated in the implementation science and grant-writing workshops were sent surveys both before and after the respective course to assess their self-perceived knowledge and confidence in specific topics, skills, and competencies related to implementation science or grant writing (see Supplemental Figures S1–S4). Elements of the Kirkpatrick Four-Level Training Evaluation Model were used to design the surveys.²² These surveys were also used to gather participant feedback related to the course and instructors. Surveys were administered using a secure REDCap link that was sent via e-mail to all participants.

In the preworkshop survey, participants were first asked to rank their knowledge of specific topics in implementation science or grant writing on a Likert scale of 1 to 4 points, with 1 point indicating “no knowledge,” 2 points indicating “little knowledge,” 3 points indicating “some knowledge,” and 4 points indicating “advanced knowledge” (see Supplemental Figures S1 and S3). This was repeated in the postworkshop survey (see Supplemental Figures S2 and S4). These Likert scale–based self-perceived knowledge rankings were then transformed to the following ordinal scale: 4 = 100, 3 = 75, 2 = 50, and 1 = 25. Averages of knowledge in these specific topics were then taken with these new values. The gap was determined by taking the difference between the postworkshop and the preworkshop average rankings for knowledge of specific topics in implementation science or grant writing. The percentage increase in knowledge was then found by dividing the gap by the preworkshop average. This process was then repeated for the participants’ answers for their reported level of confidence in specific competencies related to implementation science or grant writing.

RESULTS

Implementation science workshop.

Thirty-seven participants attended the implementation science course, of which 33 participants (89.2%) completed the initial preworkshop survey and 34 completed the postworkshop survey (response rate, 91.9%). Attempts to maximize participant response rates for the preworkshop survey included sending reminder e-mails to complete the survey prior to the workshop start date, providing a verbal reminder to complete the survey on the first day of the workshop, and giving participants who had not completed the preworkshop survey time to complete it prior to the start of the first session. For the postsurvey, we announced that it was going to be sent at the end of the workshop, and we sent a reminder e-mail approximately 1 week after the workshop ended to participants who had not completed it. Of the 33 individuals who completed the initial preworkshop survey, four (12.1%) had received prior training in implementation science. Among all workshop participants, the average overall preworkshop knowledge level was 43 ± 5.88 (SD), consistent with “little knowledge” of implementation science skills. For the postworkshop survey, the average knowledge level among all participants across all implementation science topic areas was 85 ± 6.16, consistent with “some self-reported knowledge” or “advanced self-reported knowledge.” Table 2 demonstrates there was a significant improvement in participant-reported knowledge in all topic areas measured, with postworkshop knowledge averages of > 80 in all topic areas, with the exception of implementation grants. Furthermore, all topic areas had > 70% increases in participant knowledge. This ranged from a 72% increase in participant knowledge for the session “Factors that impact implementation success” to a 127% increase in participant-reported knowledge for the session “Adaptation frameworks.”

Table 2.

Improvements in implementation science knowledge by topic area

Topic	Preworkshop average knowledge*	Postworkshop average knowledge*	Increase in knowledge, %
Factors that impact implementation success	53	91	72
Implementation theory and frameworks	44	86	95
Implementation strategies	41	89	117
Adaptation frameworks	37	84	127
Implementation outcomes	43	87	102
Implementation study designs	45	86	91
Implementation grants	35	72	106

Self-reported average knowledge preworkshop vs. postworkshop for topics in implementation science, and percentage increase in knowledge by topic area.

^*Based on a scale of 0 to 100.

Among all workshop participants, the average preworkshop confidence level across all implementation competency areas assessed was 39 ± 3.35, consistent with “not confident at all” or “a little confident” on a 4-point Likert scale. The average postworkshop confidence level among all participants across all implementation science areas was 85 ± 7.27, indicating that most respondents rated their knowledge of specific topics in implementation science between 3 and 4 (“somewhat confident” and “very confident”). Table 3 shows there was a significant improvement in the postworkshop confidence averages for all competencies, with all postworkshop averages being > 80, except for “writing a hybrid grant,” which was 69. Furthermore, there was a > 90% increase in all competencies assessed. This ranged from a 92% increase in participant knowledge in “writing a hybrid grant” to a 143% increase in participant knowledge in “teaching others about implementation science.”

Table 3.

Improvements in confidence in implementation science competencies by topic area

Topic	Preworkshop average knowledge*	Postworkshop average knowledge*	Increase in knowledge, %
Identifying setting characteristics that impact implementation success	44	92	109
Identifying individual characteristics that impact implementation success	43	92	114
Selecting a good framework for one’s own implementation science research	41	86	110
Selecting the most important implementation science outcomes	36	85	136
Assessing implementation measures	40	86	115
Analyzing implementation measures	36	81	125
Writing a hybrid grant	36	69	92
Teaching others about implementation science	35	85	143

Self-reported average confidence preworkshop vs. postworkshop for implementation science-related competencies, and percentage increase in confidence by topic area.

^*Based on a scale of 0 to 100.

In addition to evaluating changes in self-reported knowledge and confidence in competencies related to the topics taught during these workshops, we also used the pre- and postsurveys to ascertain feedback regarding the workshop and the instructors. Among respondents, the average overall rating for the course was 4.7 of 5 points, with 1 point being “poor” and 5 points being “excellent.” The average overall rating for the effectiveness of the instructors was 4.7 of 5 points, with 1 point being “poor” and 5 points being “excellent.” When asked to rate the difficulty of the course on a scale of 1 to 100, with 100 points being “much too hard” and 1 point being “much too easy,” the average rated difficulty was 53.2 ± 14.7 points. When asked to rate the organization of the course on a scale of 1 to 100, with 100 points being “extremely well organized” and 1 point being “not at all organized,” the average was 86.3 ± 13.1 points. When asked to rate the ease of learning information during the course on a scale of 1 to 100, with 100 points being “easy to learn” and 1 point being “difficult to learn,” the overall average was 75.1 ± 18.9 points.

Grant-writing workshop.

Thirty of 34 individuals completed the preworkshop survey and 29 of 34 participants completed the postworkshop survey for the grant-writing workshop (response rates, 88.2% and 85.3%, respectively). Attempts to maximize participant response rates for the preworkshop survey included sending reminder e-mails to complete the survey prior to the workshop start date, providing a verbal reminder to complete the survey on the first day of the workshop, and giving participants who had not completed the preworkshop survey time to complete it prior to the start of the first session. For the postsurvey we announced that it was going to be sent at the end of the workshop, and then sent a reminder e-mail approximately 1 week after the workshop ended to participants who had not completed it. Of the 30 individuals who completed the initial preworkshop survey, 12 (40%) had received prior training in grant writing. Among all workshop participants, the average preworkshop knowledge level across all grant writing topic areas assessed was 55 ± 11.62—meaning, most respondents rated their knowledge of specific topics in grant writing at approximately 2 points on a scale of 1 to 4 points, indicating the average participant reported “little knowledge” of grant-writing skills. For the postworkshop survey, the average knowledge level among all participants across all grant-writing topic areas was 89 ± 2.71, indicating that most respondents rated their knowledge of specific topics in grant writing between 3 and 4 points (“some knowledge” and “advanced knowledge”). Table 4 shows there was a significant improvement in participant-reported knowledge in all topic areas measured, with postworkshop knowledge averages of > 80 in all topic areas. The percentage increase in participant-reported knowledge was greatest for “types of grant funding sources” (115%) and least for “principles of study design/methods” and “developing specific aims and supporting hypotheses for a grant proposal” (34% each).

Table 4.

Improvements in grant-writing knowledge by topic area

Topic	Preworkshop average knowledge*	Postworkshop average knowledge*	Increase in knowledge, %
Generating research questions for a scientific grant proposal	48	91	90
Principles of study design/methods to evaluate a research question for a grant proposal	68	91	34
Development of specific aims and supporting hypotheses to investigate a research question for a grant proposal	70	94	34
Key components of scientific grant proposals	46	91	98
Scientific writing techniques for grant proposals	65	89	37
Features of strong grant proposals	46	90	96
Types of grant funding sources	40	86	115
Data analysis plans for different types of studies being conducted	59	86	46

Self-reported average knowledge preworkshop vs. postworkshop for topics in grant writing, and percentage increase in knowledge by topic area.

^*Based on a scale of 0 to 100.

Among all workshop participants, the average preworkshop confidence level across all grant writing competencies assessed was 51 ± 1.58, indicating that the average confidence level in grant-writing competencies was approximately 2 points (“a little confident”) on a 4-point scale. The average postworkshop confidence level among all participants across all grant-writing topic areas was 85 ± 4.65, indicating that most respondents rated their confidence level in grant-writing competencies between 3 and 4 points (“somewhat confident” and “very confident”). Table 5 demonstrates a significant improvement in the postworkshop confidence averages for all competencies, with all postworkshop averages > 80. The percentage increase in participant-reported confidence was greatest for “strategies for effectively communicating with funding agencies” (116%) and least for “selecting the appropriate study design for a specific research question” (29%).

Table 5.

Improvements in confidence in grant-writing competencies by topic area

Topic	Preworkshop*	Postworkshop*	Increase in knowledge, %
Developing a research question and hypotheses to evaluate one’s own research question	63	91	44
Selecting the appropriate study design for a specific research question	66	85	29
Selecting the appropriate analysis plan for a chosen scientific study	61	82	34
Writing specific aims pages for a grant proposal	50	93	86
Identifying the important features of the grant review process	39	81	108
Interacting with funding agencies	37	80	116
Providing feedback on grant proposals	48	84	75

Self-reported average confidence preworkshop vs. postworkshop for grant writing–related competencies, and percentage increase in confidence by topic area.

^*Based on a scale of 0 to 100.

As with the implementation science workshop, we also used the postsurveys to ascertain feedback regarding the workshop and the instructors. Of the 29 participants who completed the postsurvey, the average overall rating for the course was 4.8 of 5 points, with 1 point being “poor” and 5 points “excellent.” The average overall rating for the effectiveness of the instructors was 4.9 of 5 points, with 1 point being “poor” and 5 points being “excellent.” When asked to rate the difficulty of the course on a scale of 1 to 100, with 100 points being “much too hard” and 1 point being “much too easy,” the average rated difficulty was 45.8 ± 14.3 points. When asked to rate the organization of the course on a scale of 1 to 100, with 100 points being “extremely well organized” and 1 point being “not at all organized,” the average was 77.3 ± 23.1 points. When asked to rate the ease of learning information during the course on a scale of 1 to 100, with 100 points being “easy to learn” and 1 point being “difficult to learn,” the overall average was 72.6 ± 19.9 points. When asked to rate their comfort in applying grant-writing skills on a scale of 1 to 100, with 100 points being “extremely comfortable” and 1 point being “not comfortable at all,” the average among all participants at the end of the course was 67.9 ± 18.9 points.

DISCUSSION

The V-BRCH program is a training platform built on a long-standing relationship between AKTH in Nigeria and VUMC in the United States, with the purpose of developing a sustainable Nigerian research capacity in HIV-associated NCDs.^10,23 To accomplish this, the V-BRCH program takes a multifaced approach to training Nigerian investigators, using short- and medium-term learning opportunities, paired mentoring arrangements, and seed research funds to eligible mentor–mentee teams.²³ In our evaluation, we found that these short-term workshops targeted toward early-stage physician scientists focused on implementation science and grant writing were viewed favorably by the vast majority of participants. Furthermore, these workshops were effective in improving knowledge, skills, and confidence in select areas and competencies related to implementation science and grant writing. We found significant improvements in trainee-reported knowledge and confidence across all topic areas for both the implementation science and grant-writing workshops. In addition, an overwhelming majority of participants rated both the overall workshop as well as the instructors as “good” or “excellent.” A similar majority of participants for both workshops responded that they would be “somewhat likely” or “very likely” to recommend these courses to other clinical researchers.

Our work adds to the body of literature that shows intensive, hands-on training programs focused on developing research skills in early-career investigators are an effective method of building research capacity in resource-constrained nations.^10,24–28 The workshops presented here, as well as multiple prior V-BRCH workshops,^24,29 have proven to be effective in advancing the skills of early-stage investigators in Nigeria and provide a useful model for future interventions to foster research capacity in Africa. In addition, given the paucity of structured research capacity-building programs in Africa, expanding similar training programs to include other institutions in analogous settings has the potential to lead to a greater impact over time. These workshops, and the V-BRCH program at large, provide a framework for the establishment of similar hybrid training models for building capacity in various research competencies in HIV and NCD research, including implementation science and grant writing.

An essential component of the success of the V-BRCH training program—and similarly successful training platforms—is that the development and implementation of the training programs is done in congress with local institutions and/or countries to ensure the content is locally relevant and tailored to meet the needs of the participants, the institution, and the research needs of the target communities.^10,12,24,25 In doing this, these programs are able to gain the backing of institutional leadership and receive high-level support for future workshops. Furthermore, this strategy addresses the power imbalances that exist in traditional global health programing and confronts practices that permit the development of programs in low- and middle-income countries without the input or leadership from host communities.²⁴ Beyond the immediate benefit of training workshop participants and building research capacity in undercapacitated research environments, programs such as these facilitate larger efforts to “decolonize” global health by providing physician scientists with skills needed to compete for independent funding, develop sustainable implementation strategies tailored to local needs, and disseminate their research findings.^30,31

Our study has limitations. One such limitation is that it focused on a small select group of early-career academic physician scientists from a single center in Nigeria, thus potentially limiting the generalizability of these results to other groups. Despite this limitation, early-career physician scientists from different medical disciplines participated in these workshops, highlighting the potential for these types of workshops to serve as scalable training platforms for early-career investigators from various medical disciplines. In addition, these workshops were developed and conducted in congress with local leadership and researchers to meet local research needs and the needs of the participants. We believe that engagement of institutional leadership and tailoring future workshops to account for local needs will lead to similar success in analogous settings. Another limitation of this study is the workshops were only conducted once and did not include a control comparison group that did not attend the training. One strength of this study is the use of a presurvey and a postsurvey to capture participant feedback regarding the course and instructors, as well as improvements in participant knowledge and confidence in select topic areas, reflecting the short-term sustainability of the impact of these courses. Of note, we do plan to remain in contact with workshop participants going forward to track receipt of investigator-led research grants and attainment of other academic metrics such as academic promotion (to associate and full professor) and more.

In conclusion, we present findings from two workshops in implementation science research and grant writing in Nigeria that were viewed favorably by participants and found to be highly effective in improving participants’ skills and confidence in selected areas related to implementation science and grant writing. These workshops targeting early-stage Nigerian physician scientists, in conjunction with other interventions as part of the larger V-BRCH training platform, have shown promise in helping create a cohort of early-stage investigators with advanced knowledge and skills in conducting research on the intersection of HIV and NCDs. Training platforms like the one described can be used to support a robust framework for future development of research capacity-building programs in resource-constrained settings.

Note: Supplemental materials appear at www.ajtmh.org.