Table 3.

Challenges faced in the first year of UINCD and the methods of addressing them

Challenge	Methods of addressing challenge
Agenda-setting: For a research collaboration such as UINCD, the issue of where the decision-makers are physically located and who sets the research agenda needs to be explicitly discussed.	• GHLI facilitated workshops on leadership and communication skills.  • US- and Uganda-based collaborators have held weekly conference calls that help maintain open lines of communication and to bridge the physical distance.  • The 2014 Forum focused on organizational structure, internal reporting, and a clearer description of individual roles and responsibilities.
Sharing academic credit: In a framework in which roles and responsibilities are shared, academic credit too must be shared. How do we explicitly negotiate these roles to maintain parity?	• Explicit discussions about authorship are had between collaborators at the outset of projects.  • All protocols and research documents undergo joint review by US-based and Uganda-based co-investigators.  • The research group strives for balance in authorship of documents, protocols, and grant applications.
Funding: In an equitable collaboration, through what channels does the funding stream? As granting agencies increasingly desire LMIC-based principal investigators (PIs), how do we maintain financial support for US-based collaborators?	• Though it remains unclear where UINCD will be most successful at finding funding, non-traditional sources of funding, such as in the Ugandan private sector, will need to be sought.  • A diversification of funding streams must be pursued because funding options that only allow LMIC-based PIs pose a challenge to HIC-based investigators whose institutions place high value on the acquisition of grant dollars.
Stakeholder engagement: Work related to NCDs involves more stakeholders than disease-specific trials or epidemiologic studies. How do we balance the interests of multiple stakeholder groups and work together to translate scientific results into policy and systemic change?	• UINCD must think broadly about what defines a stakeholder group and specifically aim to include communities often left out of the NCD arena, such as those addressing injury/disability and mental health.  • UINCD must engage with stakeholders early and re-engage with them often.
Balancing research and clinical care priorities: Is UINCD primarily focused on research or patient care?	• Recalling that the original concept of UINCD formed from observing patient care experiences and a desire to improve patient care.  • Agreement that UINCD does not intend to set up a separate healthcare structure, but rather to test models of care that could be rolled out by partner organizations.

GHLI: Yale Global Health Leadership Institute; HIC: high-income country; LMIC: low- and middle-income country; NCD: non-communicable disease; PI: principal investigator; UINCD: Uganda Initiative for Integrated Management of Non-communicable Diseases.