Dr Paul Volberding addressing the GHS/CFAR retreat, identifying opportunities for GHS to support and abut the research undertaken by UCSF faculty in an international context.

1. Global Health
Research in
San Francisco
Casting the Net
Paul Volberding

2. Perspectives on Global
Health Research and UCSF
Past, Present, Future
 Pre-HIV epidemic: TB, reproductive rights, parasitic
infections, others. (Department of Epidemiology
and International Health)
 GHS: Focused program with aspirations.
Investigative group. Educational effort. HIV not a
central focus as Haile had established ARI in 1996.
 HIV: ARI established to counter perception of
fracturing, competing effort. ARI as a
loose, minimally resourced “umbrella” charged with
creating/sustaining a community of science
encompassing individual PIs and larger groups
(CFAR, CAPS, HIV/AIDS Division, GIVI
and, later, DEM).

3. Recent History
 Haile Debas steps down from GHS, Jaime
Sepulveda recruited
 Strategic planning begun immediately and to some
degree still in progress
 Research a key element of planning along with
education and other elements. Structure TBD.
 Directions open for adding to GHS research
portfolio:
 Grow within existing GHS
 Add programs to GHS (GHS as center of “federation”)
 GHS as ARI-like umbrella
 Combination of above

4. Charge to Collect
Information
 GHS Research Team appointed:
 Craig Cohen, Paul Volberding: Co-Chairs
 Colin Boyle
 Phil Rosenthal
 Jim McKerrow
 Madhavi Dandu
 Dominic Montagu
 Sarah Royce
 Caryn Bern
 Georgina Lopez
 Met to develop approach
 Produced three focused community discussions

5. GHS Research Community Discussions
 Parameters, objectives:
 Site: All at Mission Bay to reinforce as “home”
 Three meetings, each with discipline theme
 Basic sciences (drug and assay discovery, etc.)
 Clinical/translational sciences
 Population, prevention, policy and
implementation sciences
 Participants: Wide. Slant to established investigators.
All sites, schools, affiliates.
 Objectives: Open but guided dialog, ideas sought,
no input excluded.
 Summaries prepared for further consideration.

6. The Community Discussions
 Basic Science: August 28th. Genentech Hall. 25
attendees representing
UCSF, Gladstone, GB3, Cancer Center, others.
 Clinical Science: August 29th. Genentech Hall. 62
attendees representing
SOM, SOP, GHS, CTSI, Cancer Center, others.
 Population Science: September 25th. CVRI. 45
attendees representing
IHPS, orthopedics, OB/GYN, FCM, DGIM, others.

7. Guide for Community
Discussions
 Global Health Research at UCSF Community Discussion Guide
 Vertical Priorities and Horizontal Linkages (Cross-Cutting Programs)
 1. What field(s) of research does UCSF have particular strength which is/has potential for
expansion as a priority area in global health. Discuss why this particular field has promise
for expansion.
 2. What field(s) of research does UCSF not currently have considerable strength, but has
potential for expansion in global health.
 Include your perspective on why this particular field has promise for expansion.
 3. What “horizontal linkages” (e.g. implementation research, drug discovery) does UCSF
have strengths which have potential for further expansion in to global health. Discuss why
this/these horizontal linkages have promise for expansion.
 4. What “horizontal linkages” (e.g. implementation research, drug discovery) does UCSF
not have strengths which have potential for further expansion in to global health. Discuss
why this/these horizontal linkages have promise for expansion.
 5. What does UCSF lack in regards to disciplines important to global health, and what
strategies could be used to improve multi/interdisciplinary collaboration?

8. Strategic Planning:
Verticals, Horizontals

9. Take-Homes for Today’s
Consideration: Meeting 1
 The perception of a separation between that community and the clinical and translational
research programs, especially as contained within the CTSI
 Supporting graduate student and post-doctoral fellow participation in global health research
 GHS needs to approach more basic scientists to further inquire about areas of need, resources
and collaboration
 Education plays a central role in the potential expansion of global health research in the basic
science community at UCSF
 Potential value in UCSF taking the lead in rebuilding the infrastructure of basic science laboratories
at academic medical universities in resource limited settings
 Opportunity for scientists interested in global health to teach basic science abroad
 Pilot research grants directed at global health research proposals from early career stage
investigators
 Partnerships with private industry in the Bay Area
 Oncology was seen as an area where UCSF could become an international leader. It was
advocated as an important disease area with a high burden, with limited strength in many of our
comparison universities

10. Take-Homes for Today’s
Consideration: Meeting 2
 Vigorously endorsed cross-disciplinary collaboration
 The “verticals” in the clinical research discussion were already quite evolved and well-
funded
 Primary task was thought to fall on finding “horizontals” that will make a greater impact
on the community (greater return on investment)
 Critical to bridge basic science and clinical and translational research more than we
have done to date
 Education and training needs were also identified as crucial areas where investment
could yield a great competitive advantage to our efforts
 Clear that many participants were meeting for the first time
 Vertical suggestions: Oncology, tobacco control, mental health NCD, maternal/child
health
 Horizontal suggestions: Education and remote learning, health disparities, low cost point of
care tests, pathology and lab medicine, ethical and legal issues in global research

11. Take-Homes for Today’s
Consideration: Meeting 3
 Most institutions have given up the vertical /horizontal model in the 70’s
 Since UCSF has a chance to build a new model, we should offer a
“way of doing Global Health” that is different
 A key theme of UCSF is evidenced based medicine and rigorous
science. These could be a central means of differentiating our global
health research identity from competitor institutions.
 What made the UCSF response to HIV so effective? It worked because
the trans-disciplinary collaborations worked well
 UCSF expertise in HIV/AIDs grew out of both the fundamental basic
science of the university, and the ongoing active interaction of many
people in many disciplines working on HIV issues
 Focus on building the infrastructure that facilitates the kind of
interaction that made us HIV leaders.

12. Take-Homes for Today’s
Consideration: Meeting 3
 IRAC summarized as example of attempt to break down barriers and engage broader community
in dialog aimed at identifying and reducing barriers to research conduct
 Create programs that think about positive outcomes in new ways, in which interventions do not
have to be a set of numbers that often times does not tell us the whole story but set against a
larger frame of health and culture.
 Orthopedics/trauma could be a vertical given vibrant program and limited external competition
 Education, clinical / research integration, humanitarian research and policy research proposed as
possible “horizontal” linker.
 UCSF has content expertise, methodological expertise, expertise in a continuum of care
(prevention thru treatment), expertise in participatory research and community building and
engagement. We need to diffuse this expertise across disciplines, while addressing scalability
 Implementation science is important because it can identify gaps in care. UW has a PhD in
implementation sciences aimed at operation efficiencies, where they use expertise from business
and engineering schools to identify efficiencies. UCSF is a great discoverer. We just need to add in
the pragmatism of Implementation science
 Policy is addressed at UCSF in pockets- and needs to be brought together. We need to build
stronger links among ourselves and other disciplines

13. Where Next?
 Community of global health research large, broad,
complex
 Strong desire to work together and decrease isolated
efforts
 Suggestion to continue discussions with country, discipline
etc. focus
 Broad agreement that education and training crucial
 HIV as model of cross-disciplinary collaboration
 Structure of GHS as it relates to entire global research
effort evolving and needs clarification and
communication

14. Improvement Opportunities
 Time-limited community discussions with regional
or discipline focus
 Ongoing discussion group for concentrated
programs (E. Africa)
 Support TAG for new funding opportunities and
use RDO
 Convene administrative group to compare
models, influence policies
 Work with departments re: promotion barriers for
GH investigators