Building infrastructure for HIV/AIDS and mental health research at institutions serving minorities

Building a Diverse Workforce and Thinkforce to Reduce Health Disparities

The Research Centers in Minority Institutions (RCMI) Program was congressionally mandated in 1985 to build research capacity at institutions that currently and historically recruit, train, and award doctorate degrees in the health professions and health-related sciences, primarily to individuals from underrepresented and minority populations. RCMI grantees share similar infrastructure needs and institutional goals. Of particular importance is the professional development of multidisciplinary teams of academic and community scholars (the "workforce") and the harnessing of the heterogeneity of thought (the "thinkforce") to reduce health disparities. The purpose of this report is to summarize the presentations and discussion at the RCMI Investigator Development Core (IDC) Workshop, held in conjunction with the RCMI Program National Conference in Bethesda, Maryland, in December 2019. The RCMI IDC Directors provided information about their professional development activities and Pilot Projects Programs and discussed barriers identified by new and early-stage investigators that limit effective career development, as well as potential solutions to overcome such obstacles. This report also proposes potential alignments of professional development activities, targeted goals and common metrics to track productivity and success.

European mental health research resources: Picture and recommendations of the ROAMER project

As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis^®, On-Course^® and Meril^® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.

Advancing Health Equity through Organizational Mentoring Policies at Minority-Serving Institutions

Objective

Morehouse School of Medicine, a collaborative partner in the National Research Mentoring Network, established the Mentoring Academy Institutional Planning Forum (MA Forum) to help minority-serving institutions (MSI) optimize research mentoring. In this commentary, we describe the policy workshop and review survey data from six MSIs to assess the current state of organizational policies and activities that advance research mentoring.

Participants

Twenty-eight institutional leaders, representing six MSIs, participated in an MA Forum between May 20, 2016 and May 11, 2017.

Methods

After describing the MA Forum's background, design and recruitment strategy, we present a synthesis of institutional summaries built from responses to a 45-item survey that explored existing mentoring infrastructure, policies, and activities at each institution.

Results

There is a heavy reliance on extramural funds to facilitate research mentoring initiatives. Mentoring policies and activities were most often governed by individual programs rather than the institution. Thus, the research mentoring expertise was concentrated at the local level, which may prevent opportunities for future scalability and optimization.

Conclusions

Given these findings, we offer recommendations to help MSIs establish a mentoring culture backed by institutional policy.

Exploring Professional Development for New Investigators Underrepresented in the Federally Funded Biomedical Research Workforce

Objective

The National Research Mentoring Network (NRMN) is a strategic partnership whose goals include remedying documented disparities by race and ethnicity in the awarding of National Institutes of Health research grants. Our objectives were to offer a profile of early-career investigators who applied to NRMN's Grantsmanship Coaching Programs (GCP) and test for differences in the research productivity, professional obligations, research resources, and motivations of applicants from underrepresented groups (URGs) compared with applicants from well-represented groups (WRGs). We also evaluated how employment at a minority serving institution (MSI) influenced access to research resources and professional obligations.

Participants

880 investigators who submitted online applications to join an NRMN GCP between August 1, 2015 and February 1, 2018.

Methods

We used two-sample tests of proportions and logistic regression to explore differences in applicants' characteristics and local research environment by group (URG vs WRG) and institution type (MSI vs Other).

Results

URG and WRG applicants did not differ in grant application submission history. However, URG applicants had published fewer articles than WRG peers (9.8 vs 15.3, P<.001) and fewer articles as first/last author (4.4 vs 6.9, P<.001). URG applicants reported less access to core facilities to conduct research (74% vs 81%, P<.05). Investigators at MSIs reported less access to collaborators (P<.01) and departmental colleagues with federal funding (P<.001) and spent less time on conducting research (P<.001). URGs were more motivated to seek professional development support to expand their peer networks (P<.05) and advance their careers (P<.001).

Conclusions

Our findings identified several points of intervention to help applicants from URGs to improve their future chances of obtaining competitive funding.

The Final Frontier-Transitions and Sustainability: From Mentored to Independent Research

A recurrent theme in much of the contemporary HIV behavioral and social science research is that ecological approaches that acknowledge the interplay of structural, institutional, and individual-level factors are essential to improve HIV prevention efforts in racial/ethnic minority communities. Similarly, an ecological approach provides an innovative framework for understanding the challenges that many racial/ethnic minority HIV prevention researchers face in their quest to transition from mentored researcher to independent researchers. Informed by an ecological framework, and building on our experiences as two racial/ethnic minority women HIV prevention researchers who transitioned from a formal research mentorship relationship to become independent HIV prevention researchers-principal investigators of NIH-funded R01 grants-, we frame our discussion of the mentored to independence research trajectory with a focus on structural, institutional, and individual determinants. Throughout, we integrate suggestions for how institutions, mentors, and HIV prevention researchers can facilitate the final frontier from mentored research to independence.

Minority Entity Disability, Health, Independent Living, and Rehabilitation Research Productivity Facilitators

The U.S. federal research agency’s (i.e., National Institute on Disability and Rehabilitation Research [NIDRR], National Institutes of Health [NIH]) sponsored research capacity building (RCB) efforts in the field of disability, health, independent living, and rehabilitation have historically focused on individual research skill building activities (e.g., postdoctoral fellowships, advanced research methods and statistics courses, grant-writing workshops) as a main intervention to facilitate increased research productivity among investigators. However, investigators’ personal intrinsic attributes as well as federal research agency policy and systems context are rarely considered as research productivity facilitators. On trend, minority entity (ME) RCB efforts tend to focus on addressing a single challenge, research skill building, while oftentimes neglecting the importance of intrinsic factors and federal agency policy and systems context. The purpose of this review was to synthesize the available peer review and gray literature, and policy on factors that facilitate investigators’ research productivity. Recommendations for advancing the current state of the science on research productivity facilitators are presented.

Evaluating health services research capacity building programs: implications for health services and human resource development

Evaluation of research capacity building programs presents challenges, including defining "research capacity building" and measuring it. The present study evaluates infrastructure capacity-building strategies and barriers and facilitators of two federally funded health-related research capacity building programs within the United States. We developed a conceptual framework and abstracted 223 data elements from existing project files. We administered questionnaires to 17 principal investigators and conducted 2-h interviews of 15 principal investigators. Finally, we conducted one-and-a-half-day site visits with five projects. We aggregated data and analysis results across the two programs. Impacts and strategies were also analyzed as to whether host institutions had little or no existing research infrastructure ("seed projects") or had well-developed research infrastructure ("fertilizer projects"). Projects were associated with increases in publication and presentation rates by Principal Investigators and staff, increases in research funding, changes in organizational research culture, and positive impacts on the community. Project characteristics and activities associated with each of these outcomes were identified. It was also noted that the correlations between these outcomes were small and non-significant.

Improving capacity in ethnicity and health research: report of a tailored programme for NHS Public Health practitioners

Aim

To determine whether an intervention designed to enhance research capacity among commissioners in the area of ethnicity and health was feasible and impactful, and to identify programme elements that might usefully be replicated elsewhere.

Background

How healthcare commissioners should be equipped to understand and address multiethnic needs has received little attention to-date. Being able to mobilise and apply evidence is a central element of the commissioning process that requires development. Researching ethnicity and health is widely recognised as challenging and several prior interventions have aimed to enhance competence in this area. These have, however, predominantly taken place in North America and have not been evaluated in detail.

Methods

An innovative research capacity development programme was delivered to public health staff within a large healthcare commissioning organisation in England. Evaluation methodology drew on ‘pluralistic’ evaluation principles and included formative and summative elements. Participant evaluation forms gave immediate feedback during the programme. Participants also provided feedback at two weeks and 12 months after the programme ended. In addition, one participant and one facilitator provided reflective accounts of the programme's strengths and weaknesses, and programme impact was traced through ongoing partnership work.

Findings

The programme was well received and had a tangible impact on knowledge, confidence and practice for most participants. Factors important to success included: embedding learning within the participants’ work context; ensuring a balance between theory and practical tips to enhance confidence; and having sustained interaction between trainers and participants. Despite positive signs, the challenging nature of the topic was highlighted, as were wider structural and cultural factors that impede progress in this area. Although it is unrealistic to expect such programmes to have a major impact on commissioning practices, they may well make an important contribution to raising the confidence and competence of staff to undertake work in this area.

Translational research in NeuroAIDS: a neuroimmune pharmacology-related course

Neuroimmune pharmacology (NIP) can be considered a multidisciplinary science where areas of neuroscience, immunology, and pharmacology intersect in neurological disorders. The R25 training program titled "Translational Research in NeuroAIDS and Mental Health (TR-NAMH): An innovative mentoring program to promote diversity in NeuroAIDS Research (R25 MH080661)" at the Johns Hopkins University is a web-based interactive course with the goal to improve the capacity of high quality research by developing mentoring programs for (1) doctoral and postdoctoral candidates and junior faculty from racial and ethnic minorities and (2) non-minority individuals at the same levels, whose research focuses on NeuroAIDS disparity issues such as HIV-associated neurocognitive disorders (HAND). This web-based interactive course overcomes the limitations of traditional education such as access to expert faculty and financial burden of scientists from racial and ethnic minority groups in the field of NeuroAIDS research and NIP and identifies rich nurturing environments for investigators to support their careers. The TR-NAMH program identifies a cadre of talented students and investigators eager to commit to innovative educational and training sessions in NeuroAIDS and NIP. The interplay between NIP changes precipitated by HIV infection in the brain makes the study of HAND an outstanding way to integrate important concepts from these two fields. The course includes activities besides those related to didactic learning such as research training and long-term mentoring; hence, the newly learned topics in NIP are continually reinforced and implemented in real-time experiences. We describe how NIP is integrated in the TR-NAMH program in the context of HAND.

Key issues in mentoring in HIV prevention and mental health for new investigators from underrepresented racial/ethnic groups

We examine the challenges and barriers to quality mentoring for new investigators from underrepresented racial/ethnic groups and propose solutions for establishing a robust pipeline of early-career scientists who are well equipped to conduct research on disparities in HIV and mental health. In addition, we review contributions to this special supplement on mentoring and advocate a multilevel strategy that targets funding agencies, academic and research institutions, mentors, and mentees to enhance the diversity of the nation's scientific workforce and ensure that the public health system benefits from innovations derived from the optimal use of existing human capital.

Introduction: the case for diversity in research on mental health and HIV/AIDS

This introductory article provides background and sets the stage for the mentoring programs described in this special supplement. The goal of these programs is to develop scientists from racial/ethnic groups underrepresented in the area of HIV/AIDS research on issues related to mental health. We describe recent epidemiological trends associated with HIV infection in diverse populations, the need for mentoring programs to study disparities, and the ongoing mentoring programs supported by the National Institutes of Health targeting investigators underrepresented in the workforce. We also provide a summary of the content of the articles to follow. We conclude with a comment on future needs and actions.