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Articles

The Africa non-communicable diseases (NCD) Open Lab: Impact of a portfolio of clinical studies to deepen the understanding of NCDs in sub-Saharan Africa

Juliet Addo1, Maria Davy2, Amy Newlands1, Lindsay Orford2, Phyllis Guta1, Rhona Scott1, James van Hasselt3, Gareth Maher-Edwards1

1 GSK, Brentford, Middlesex, UK
2 GSK, Stevenage, Hertfordshire, UK
3 General Medicines Regional Medical Affairs, GSK, Gauteng, South Africa

DOI: 10.7189/jogh.14.04065

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Abstract

Background

Clinical research in sub-Saharan Africa (SSA) has often focussed on communicable diseases. However, with the increasing burden of non-communicable diseases (NCDs), there is a need for Africa-specific NCD research.

Methods

GSK established the Africa NCD Open Lab in 2014. Three calls for proposals were advertised through various media channels. An external independent scientific advisory board, predominantly representing African scientists and NCD experts, reviewed and selected projects to receive funding. An additional programme in the Africa NCD Open Lab was designed to build statistical capability by supporting training initiatives. We assessed the impact of the Africa NCD Open Lab in three ways: scientific quality with impact; research training and professional development; and research environments. We captured metrics through regular reports/interactions with researchers; via a final report; and through exit interviews with principal investigators.

Results

Twenty projects in 11 African countries were funded; reports from 18 completed projects are available (data capture is ongoing). Overall, 139 articles have been published in peer-reviewed journals and other data have been presented at conferences and other forums. Most completed projects led to positive outcomes, such as further research, informing policy, or positively impacting clinical care, including three projects that saw changes to regional or national practice guidelines: the CREOLE study in Nigeria; the African Severe Asthma Program in Uganda; and the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension in South Africa. Participation in the Africa NCD Open Lab led to the award of 34 grants related to or influenced by increased research capacity or experience. Significant professional development related to the projects also occurred with higher-level degrees being awarded, including 30 MScs, 30 PhDs, and nine postdoctoral fellowships. Through these projects, research capacity was strengthened across the region by equipping core research facilities, training research staff, strengthening research support services, and supporting the expansion of investigator networks.

Conclusions

The completed Africa NCD Open Lab projects demonstrate high-quality research outcomes addressing important health challenges with potential benefits to African populations. Based on the success of the Africa NCD Open Lab, additional funding has been secured to extend the Open Lab initiative.

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Non-communicable diseases (NCDs), such as cardiovascular diseases (CVDs), chronic respiratory diseases, and diabetes, are a major cause of morbidity and mortality worldwide [1]. They disproportionately affect people in low- and middle-income countries, where almost 80% of the total annual global NCD-related deaths (31.4 of 41.0 million) occur [1].

In Africa, more than one-third of annual deaths are due to NCDs, and premature deaths from NCDs in people aged <70 years are rising [2]. NCDs threaten public health and social and economic development in Africa. Furthermore, the dual burden of NCDs and infectious/communicable diseases, such as malaria, tuberculosis, and human immunodeficiency virus (HIV), presents an additional economic and health system strain [3].

Clinical research in sub-Saharan Africa (SSA) is predominantly funded by governments, foundations, or industry, and is often focussed on communicable diseases [47]. This leads to research funding and capability gaps in the region, particularly regarding NCDs [8,9]. Furthermore, due to the unique environmental and genetic determinants of NCDs, research findings from high-income countries are not consistently generalisable to Africa, leaving a need for Africa-specific NCD research [10].

In light of these challenges, the GSK Africa NCD Open Lab was established in 2014 with the aim of supporting NCD research in SSA. A key objective was to support African investigators at their local institutions by funding research projects designed to quantify the regional burden of NCDs and to understand unique aspects, such as the drivers and pathophysiology of NCDs, variations in clinical features, and determinants of treatment response. Other key objectives were to directly support the training and research capabilities of African scientists participating in a portfolio of projects, strengthen statistical capability by supporting training initiatives, and to support the development of a new generation of African NCD researchers.

Here we describe the Africa NCD Open Lab, its reach, and its impact and legacy regarding the scientific development and progression of researchers; improvements in infrastructure; and the creation of collaborative networks. We discuss the successes and challenges of the Africa NCD Open Lab, noting gaps and opportunities for future collaborations and partnerships designed to support further research in Africa.

METHODS

Call for proposals

Three calls for proposals were launched and advertised through various media channels. Call 1 was launched in 2014 and was aimed at researchers in Cameroon, the Gambia, Ghana, Kenya, Côte d’Ivoire, Malawi, Nigeria, and Uganda [11]. Call 2 was launched in 2015, in collaboration with the South African Medical Research Council and the UK Medical Research Council via the Newton Fund [12], and was open to South African academics and clinicians to reflect the relative regional strength of the country’s research capabilities. Call 3 was launched in 2016 and targeted early-career researchers in Cameroon, the Gambia, Ghana, Kenya, Côte d’Ivoire, Malawi, Nigeria, Uganda, Ethiopia, Senegal, and Tanzania [4].

Scientific advisory board

An independent scientific advisory board – mainly comprising African scientists – reviewed, short-listed, and selected the project proposals to receive research funding, as detailed further in Gatsi et al. [11] and Addo et al. [4]. In brief, for each project proposal, the scientific advisory board reviewers evaluated the scientific merit; potential significance and impact; the feasibility of the proposed approach; the strategies and methods outlined; the applicant’s research environment and support; and the track record of the investigators [11]. Throughout the scientific advisory board’s review process, any apparent or potential conflicts of interest were disclosed and managed by excluding the conflicted member from the review and discussion on the proposal [11].

Measuring impact

We assessed the impact of the Africa NCD Open Lab in three ways:

  1. Scientific quality with impact: The research objectives and milestones achieved; the number and type of relevant publications and how research findings led to changes (e.g. in local practice; policy and guidelines; and further research and additional grants).
  2. Research training and professional development: The number of MSc/PhD qualifications funded; the number and type of sustainable, high-quality training programmes in place; and the extent of improved access to global scientific expertise.
  3. Research environments: The physical research infrastructure enabled; the research support functions strengthened; and the networks created and/or facilitated.

Metrics were captured through regular reports and interactions with researchers and via a final report submitted for the projects. We obtained further feedback through exit interviews with principal investigators (PIs) (Appendix S1 in the Online Supplementary Document). Information from the exit interviews (collected between 11 June 2020 and 31 May 2023) was collated, analysed, and presented in tables and graphically using bar charts.

RESULTS

The three calls for proposals resulted in the funding of 20 projects in 11 countries in SSA. Five projects were funded from Call 1 – three in Uganda, and one each in Nigeria and Malawi. They investigated aspects of CVD and interactions between CVD and HIV infection, oncology (breast cancer), chronic respiratory disease (asthma), chronic kidney disease (CKD), and diabetes. Six projects in South Africa were funded from Call 2. They addressed CKD, heart disease, awareness of cancer symptoms in women, the genomics of oesophageal cancer, and determinants of CVD and diabetes. Lastly, nine projects were funded from Call 3 – three in Uganda, two in Tanzania, and one each in Nigeria, Kenya, Malawi, and Ethiopia. They investigated different NCDs and associations with infectious diseases. Therapy areas included diabetes and its complications; chronic obstructive pulmonary disease (COPD); CKD in a birth cohort of children; CVD in pregnancy; and CVD, CKD, and COPD in people living with HIV. To date, 18 out of 20 projects have concluded and have completed exit interviews; the key outcomes of the projects are described in Table 1 (note that data capture is ongoing).

Table 1.  Overview of projects funded by the Africa NCD Open Lab compiled based on the exit interviews and in collaboration with the PIs*

WordPress Data Table

CBD – cerebrovascular disease, cfDNA – cell-free DNA, CKD – chronic kidney disease, COPD – chronic obstructive pulmonary disease, CVD – cardiovascular disease, DFU – diabetic foot ulcer, eGFR – estimated glomerular filtration rate, GFR – glomerular filtration rate, GI – gastrointestinal, HCTZ – hydrochlorothiazide, HIC – high-income country, HIV – human immunodeficiency virus, ICS – inhaled corticosteroid, LABA – long-acting β-2 agonist, LADA – latent autoimmune diabetes of adults, LMIC – low- and middle-income country, LTBI – latent tuberculosis infection, miRNA – micro RNA, NCD – non-communicable disease, OSCC – oesophageal squamous cell carcinoma, PCR – polymerase chain reaction, PI – principal investigator, PICRUSt2 – Phylogenetic Investigation of Communities by Reconstruction of Unobserved States, sCD14 – soluble CD14, SSA – sub-Saharan Africa, T1D – type 1 diabetes, T2D – type 2 diabetes, TB – tuberculosis

*Brief information is provided about key project outcomes and the impact of the projects completed.

†Articles published in peer-reviewed journals as of 31 May 2023; see the reference list within Appendix S2 in the Online Supplementary Document for full citations.

‡The Malawi/Uganda CKD project (first call) and the South African CKD project (second call) were conducted using the same protocol, thus permitting a collaborative approach and pooling of results from three countries in SSA.

§Articles under references 104, 105, 107, and 112 are joint publications across the Malawi/Uganda CKD project (first call) and the South African CKD project (second call).

Scientific quality with impact

As of 31 May 2023, 139 articles have been published in peer-reviewed journals, including some notable publications in high-impact factor journals, such as The New England Journal of Medicine [13], The Lancet Global Health [14], The British Medical Journal [15], and The Journal of the American Society of Nephrology [16] (see full reference list in Appendix S2 in the Online Supplementary Document). Further journal publications are expected to follow. Other communications, including conference proceedings, press releases, and reviews have also been outcomes of the Africa NCD Open Lab.

Most of the completed projects (17 out of 18) contributed to change (e.g. change to institutional, regional, or national guidelines), follow-on research, and improved patient awareness (Figure 1). Notably, three projects led to change to regional and national practice guidelines: the CREOLE study in Nigeria [13], the African Severe Asthma Program (ASAP) in Uganda [17], and the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) [1821].

Figure 1.  Number of projects in the Africa NCD Open Lab that contributed to change or follow-on research (based on 18 out of 20 exit interviews collected between 11 June 2020 and 31 May 2023). NCD – non-communicable disease.

The CREOLE study showed that the combination of amlodipine with either hydrochlorothiazide or perindopril was superior to perindopril plus hydrochlorothiazide in reducing blood pressure in Black individuals with hypertension in SSA [13]. Previously, guidelines for the treatment of hypertension in Nigeria focussed on combination schedules containing a thiazide diuretic. However, new data from the CREOLE study [13] showed that calcium channel blocker-based combinations are more efficacious than thiazide-based combinations, which will help inform drug choice for hypertension in Black individuals.

The ASAP study led to an update to national asthma treatment guidelines in Uganda, informed in part by some of the project findings [17]. The importance of spirometry in diagnosing and monitoring chronic respiratory disease was recognised by the Ministry of Health and NCD Directorate, and the updated guidelines (yet to be published) will recommend spirometry in all referral and tertiary hospitals and peak flow measurements for those in zonal and district hospitals. The study investigator commented: ‘All of our patients suspected of having airway disease will have spirometry and definitive diagnosis of asthma or COPD will be made and based on guidelines, appropriate management will be started; this helps us to improve the quality of care of our patients and also helps to monitor patients’ response to therapy.’

The African-PREDICT study in South Africa identified distinct ethnic-specific inflammatory mediator patterns and a clearly suppressed renin-angiotensin-aldosterone system profile in Black adults, despite them having similar blood pressures to their White counterparts [1821]. Metabolomic analyses identified increased collagen biosynthesis in young Black adults, which may suggest a pathway for increased arterial stiffness as a precursor for future hypertension development. Two biofreezers were purchased to support the long-term biobanking initiative of the study. The study’s PI commented: ‘Access to this very unique biobank is likely one of the most valuable assets of the study, with massive potential impact on the long term. Such biobanks are rare in Africa…’ Furthermore, the PI was the senior author of the International Society of Hypertension Practice Guidelines (2020), which included a comprehensive section on ethnicity and lifestyle modifications, some parts of which were based on observations from the African-PREDICT study.

Participation in the Africa NCD Open Lab led to the award of 34 external grants related to/influenced by increased research capacity or experience (Figure 2). Several investigators reported receipt of awards or recognition. For example, one investigator was awarded a certificate of recognition for a high-impact paper published in the journal Hypertension in 2019 [22], while another was awarded runner-up in the best poster competition at a conference, in recognition of outstanding scientific work for an oral and poster presentation [23].

Figure 2.  Additional grants won by projects that participated in the Africa NCD Open Lab (based on 18 out of 20 exit interviews collected between 11 June 2020 and 31 May 2023). *Indicates one PI had two grants (one each from research outcomes and capacity building). †Indicates one PI had four grants (three from capacity building (also included in research outcomes), and the other is a faculty research grant). ‡Indicates one PI had four grants, but there is an overlap between the research outcomes and capacity building for all grants. Another PI received an AREF Research Development Fellowship Grant (included under both research outcomes and capacity building). One PI received a World Health Organization/Tropical Disease Research fellowship and a postdoctoral fellowship, and these have both been included along with the grant. For Call 3, grants related to/influenced by original research outcomes are also represented in the column pertaining to grants related to/influenced by increased research capacity or experience due to participation in the Africa NCD Open Lab. AREF – Africa Research Excellence Fund, NCD – non-communicable disease, PI – principal investigator.

Research training and professional development

The Africa NCD Open Lab resulted in significant professional development opportunities, evidenced by the extent of reported higher-level training, with 30 MScs, 30 PhDs, and nine postdoctoral fellowships being funded (Figure 3). One investigator reported that winning a GSK Africa NCD grant strengthened their fellowship application and led to them successfully securing a World Health Organization/Tropical Disease Research fellowship in 2019 and a postdoctoral fellowship at the University of Cape Town in 2021. Furthermore, there was substantial capability training in the Africa NCD Open Lab projects centred around aspects such as Good Clinical Practice, specific additional clinical training, finance, and project management, which was accessible to a broader group than just PIs and students. Capability training across research support groups was key to broader capacity-building impact.

Figure 3.  Research training and professional development funded by the Africa NCD Open Lab (based on 18 out of 20 exit interviews collected between 11 June 2020 and 31 May 2023). NCD – non-communicable disease.

Project participants identified expertise in biomedical statistics as a key need. In response, GSK provided substantial statistical support based on individual project circumstances, including (but not limited to) design discussions and statistical analysis plan input. The Africa NCD Open Lab hosted a one-week, face-to-face statistics summer school in Stevenage, UK, in 2017, to which 18 SSA statisticians supporting projects from the first and second calls were invited. This event enabled the roll-out of technical and non-technical training (e.g. influencing skills and presentation skills) and also helped to build a statistical network among the SSA statisticians, fostering a sense of community and providing a forum for technical problem sharing in the future. Feedback from the investigators was very positive, as seen from the following statements:

  • ‘The workshop was very useful and it came at a very important time in my career.’
  • ‘The lesson on genetics was very educative and presented in very simple terms to easily understand.’
  • ‘I have captured lots of knowledge for future professional application [and] am applying the acquired knowledge at the earliest opportunity.’

Mentorship opportunities were also made possible during the Africa NCD Open Lab, with some of the early career researchers in Call 3 being mentored by the more experienced PIs from Calls 1 and 2. One investigator provided feedback about the benefits they had experienced from being mentored for three years, as well as the wider impact of the project: ‘She [the mentor] has shared most of our findings and helped improve measurements of glomerular filtration rate (GFR). We are trying to work with laboratories to make sure they report the GFR without the risk formula, helping in early diagnosis of patients. This was not being done before. Now we have a big database. There are multiple applications from students across Uganda and other parts of the world, where we can unravel kidney disease in sub-Saharan Africa.’

Driven by the need for experienced and qualified statisticians, a separate, additional programme in the Africa NCD Open Lab aimed to support statistics training initiatives. The Africa NCD Open Lab provided funding for:

  • Six PhDs and 10 MScs through the Sub-Saharan Africa Consortium for Advanced Biostatistics training programme, a Wellcome Trust-funded consortium under the Developing Excellence in Leadership, Training and Science in Africa Scheme.
  • Three statistics fellowships at The London School of Hygiene and Tropical Medicine (LSHTM). These fellowships ran as two-year blocks and focussed on recruitment from Africa. The first year was an MSc in Medical Statistics at the LSHTM, and the second year was a placement in Africa, with emphasis on NCD-focussed research.
  • Six 12-month internships for students who had completed an MSc in Mathematical Sciences at the African Institute for Mathematical Sciences in Tanzania.

Research environment

Two in-person workshops (in 2018 and 2019, held in Cape Town, South Africa) and one virtual workshop (in 2021, during the coronavirus disease 2019 (COVID-19) pandemic) involving all Africa NCD Open Lab PIs were held to provide networking, mentoring, opportunities to share best practice, and training on topics that would build capabilities, such as scientific (e.g. genomics) and practical skills (e.g. grant writing and publications). An attendee of the workshop commented: ‘I would like to say a huge thank you for a really fantastic, warm, inspiring meeting. It feels we have become a family – and so wonderful to see the growth in all of our projects. It’s hard to sum it all up – but the ripple effects will be far and wide and deep for the African research community… I am deeply appreciative of all the effort made to support us and pull all of us together – it makes us stronger – and together we can achieve so much.’

In addition to the workshops, the PIs could access scientific and statistical expertise from GSK and non-GSK sources throughout the duration of their projects.

Another benefit to the research environment and wider clinical setting beyond the projects is that equipment purchased and used for the research, including ultrasounds and echocardiogram machines, is continuing to support routine clinical services at several sites, where these were previously limited or absent. An example of this is a local rural clinic in Uganda that was equipped with facilities for safe sputum collection in a project recruiting patients with COPD. The equipment and facility are now being used for the collection of sputum samples from patients with tuberculosis (TB), locally providing a safe environment for staff and patients where facilities did not previously exist. Furthermore, in terms of improvements in services, a researcher from one hospital spent some time with another investigator at another site through one of the GSK-funded projects and came back proficient at performing echocardiography. Not only is the researcher now competent at echocardiography and providing thorough reports, which makes a difference in the management of patients, but they have gone on to train further people to enable the service to be established. The echocardiography service is still running despite the researcher having temporarily left to complete training elsewhere. This example highlights how, by training just one person, a valuable service can be made available, not just in one hospital, but also for the rest of the region.

Notably, a ready willingness of the Africa NCD Open Lab researchers to share their expertise maximised the opportunities to extend their research. They demonstrated agility, leadership, and the ability to address various challenges. For example, in a study investigating CKD in South Africa, asymptomatic pyuria was noted in several study participants, indicating a high burden of unrecognised genitourinary pathology. The investigators started screening for schistosomiasis and discovered a significant undiagnosed prevalence in the rural Agincourt community, which was reported to the provincial health authorities [24]. In addition, the Soweto study site offered a dual-energy x-ray absorptiometry (DEXA) scanner to the remote Agincourt research facility, which enabled researchers to study body composition in depth in this rural area. Independent funding was raised to get the DEXA scanner to Agincourt, which was initiated by the study investigators.

Exit interview feedback

During the exit interviews, we included a free-text field to allow the investigators to comment on their experiences in their own words. One investigator researching CKD in Malawi, Uganda, and South Africa in collaboration with researchers in South Africa commented: CKD prevalence was significantly underestimated [in SSA]. As a result of the multicentre collaboration anchored in three African countries, replicating the findings across all the sites strengthened the impact of the research results. In addition, the existing equations for estimation of GFR in our study populations are inappropriate and inaccurate, and worsened by including race-based adjustments based on African American ethnicity. The findings confirm that we are underestimating the burden of CKD.

The investigator also highlighted: … we were unable to model a new GFR estimating equation appropriate for African populations, as creatinine is a poor biomarker for assessing kidney function in our study populations. This has very important implications for the current laboratory standard for CKD diagnosis, highlighting the need to evaluate other biomarkers, such as cystatin C, which performed better than creatinine in our study.

The initial collaboration referred to by this investigator expanded the networking opportunities for both research groups and led to the formation of the African Research on Kidney Disease (ARK) Network [25].

Another investigator commented that the Africa NCD Open Lab was more than just research development: ‘(There is) an incredible range of people whose lives have been changed and it has widened their horizons for the future.’ Generally, the investigators spoke of gaining skills to transfer knowledge to other colleagues for future research. They also emphasised that the Africa NCD Open Lab had provided researchers with the benefits of collaboration and demonstrated that team achievements can surpass individual efforts. Specifically, one investigator spoke about an awareness of certain conditions to improve patient outcomes, such as the increasing cases of stroke in young people with HIV in Malawi. The investigators also became more aware that TB was implicated as the problem. Consequently, young people with HIV who currently present with stroke are investigated for TB. This study has resulted in a large change in terms of survival of young stroke patients. This is a key example of how a small amount of information from a study has a big impact on the outcome of patients.

DISCUSSION

NCDs are a major cause of morbidity and mortality in Africa, threatening public health and social and economic development [1,2,26]. In addition, their epidemiology, presentation, management, and prognosis in Africa can substantially differ from those in high-income countries [8]. Understanding and addressing specific factors associated with NCDs in this context can help with identifying justifiable changes and lead to significant benefits in disease management. For example, broader incorporation of standard screening measures (such as blood pressure and peak expiratory flow measurements) into African clinical practice and updating regional and national disease-management guidelines can help SSA countries better respond to the burden of NCDs.

The Africa NCD Open Lab aimed to support NCD research in SSA, quantify the burden of NCDs, and better understand the unique aspects of NCDs in Africa. It is evident from the outcomes presented here that these aims have been met and exceeded in many cases. Not only have many of the projects led to a greater understanding of the NCDs investigated, but the outcomes have been instrumental in leading to changes in the way some NCDs are managed and treated locally, and in some cases, more widely. Furthermore, the training and research capabilities of those participating in these projects has been enhanced, enabling the development of a new generation of African NCD researchers. It is also important to recognise the legacy of the Africa NCD Open Lab in terms of enabling sustainable improvements for the teams and the skills and services they provide, as well as some improvements in infrastructure and equipment. A network of talented African NCD researchers has been established, including individuals with strengthened capabilities in statistics. Crucially, these researchers can transfer knowledge to other projects and colleagues for future research.

Other successes of the Africa NCD Open Lab, which are a testament to the scientific quality of the research and the talent and commitment of the investigators working on the various projects, are evident from the numerous publications produced; project-influenced changes to regional and national guidelines; and researchers gaining recognition and awards for research conducted together with project-facilitated grants for additional research.

Despite the COVID-19 pandemic causing unforeseen challenges to which investigators and researchers had to adapt, considerable effort and diligence by the investigators throughout the pandemic limited the impact. In one project, a significant loss to follow-up occurred due to COVID-19, and in another project, longitudinal data were unavailable (unpublished due to delays from the pandemic). However, in other cases, the pandemic resulted in faster reviews and a new appreciation of the advantages of telemedicine. Another challenge noted by some investigators included the reliance on international laboratories and collaborations for expert sample analysis – this resulted in shipped samples falling to the back of the queue when the pandemic hit, thus delaying the conclusion of some studies. This highlights that further upskilling and improved capacity for these kinds of facilities to be fully operational within SSA could allow investigators to have greater control over their own work and less reliance on competing with other priorities at collaborator facilities. Ambitious timelines were set for all projects including recruitment and follow-up of participants where indicated; as mentioned above, there were delays in achieving these numbers within the timelines for some studies, especially during the pandemic (e.g. lockdown restrictions meant participants were unable to attend the clinics). Regular reports and support with the project management helped minimise these challenges. Other limitations faced during the implementation of the projects included political unrest, strikes by healthcare workers, and challenges with the procurement processes.

CONCLUSIONS

The Africa NCD Open Lab allowed African scientists to address challenging questions in areas of unmet research need. The findings demonstrate that appropriate infrastructure and support enables African scientists to conduct high-quality research. Relatively small investment has resulted in significant impact on patient care locally through enhanced scientific knowledge, improved skills and services, and the personal development of PIs and their teams, which will enhance local care, as well as future research. In some cases, the impact has been recognised nationally or across borders, including being highlighted as an example of industry best practice in the 2021 Access to Medicines Index [27]. As the Africa NCD Open Lab concludes, focus is shifting towards the sustainability of continuing research in Africa. Further partnerships and research collaborations to support similar grants are needed as demand is high and the current programme has been shown to be highly successful and impactful. Additional funding opportunities are being explored and a new Open Lab initiative focussing on young career scientists working in infectious diseases is currently under way, with projects expected to commence in 2024.

Additional material

Online Supplementary Document

Acknowledgements

The authors thank the principal investigators from the projects: Patricia Alupo, Laura Benjamin, Pilly Chillo, Chilungamo Chingwanda, June Fabian, Julia Goedecke, Muzamil Olamide Hassan, Robert Kalyesubula, Alex Kayongo, Bruce Kirenga, Sarah Kraus, Abel Makubi, Fredirick Mashili, Lisa Micklesfield, Jennifer Moodley, Winters Muttamba, Saraladevi Naicker, Annettee Nakimuli, Nixon Niyonzima, Ntobeko Ntusi, Dike Ojji, Jackson Orem, Iqbal Parker, Ingrid Peterson, Alta Schutte, Tecla Temu, Daniel Yilma. The authors also thank all the colleagues, both past and present, who were involved in the Africa NCD Open Lab, along with Mike Strange, Pauline Williams, Sally Gatsi, Agbor Ako, Annie Stylianou, the scientific advisory board for their contributions, and the South African Medical Research Council and UK Medical Research Council for funding, support, and project management of second call projects (via the Newton Fund), in particular Richard Gordon and Candice Roux. Medical writing support was provided by Alex Coulthard, BSc, of Apollo, OPEN Health Communications (London, UK), funded by GSK, in accordance with Good Publication Practice 3 guidelines (www.ismpp.org/gpp-2022).

Data availability: All data generated or analysed during this study are included in this published article and its Online Supplementary Document.

[1] Funding: Funding for this article was provided by GSK.

[2] Authorship contributions: All authors contributed to the conception or design, acquisition of the data, and data analysis or interpretation. All authors contributed to the development and writing of this manuscript, and approved the final submitted version.

[3] Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: all authors are employees of GSK and may hold stock options.

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Correspondence to:
Juliet Addo, PhD
Global Health, Strategy and Operations, GSK
980 Great West Road, Brentford, Middlesex
UK
[email protected]