By: Jenna Udren, MPH, HVTN Core, Seattle, WA, USA
The conference venue is large, with a capacity of well over 500 people. It buzzes with discussion and laughter. On the stage, a group of young researchers feels both their excitement and nervous energy. They talk with each other, review their notes, and look out at the growing audience. Here, at the May 2018 HVTN Full Group Meeting, the Research and Mentorship Program (RAMP) Scholars are about to culminate months of work on their research projects, and give voice to perspectives for which the Network has been yearning.
RAMP is an HVTN-sponsored and run program for African American and Latinx medical students designed to increase participation of these populations in HIV prevention research. The program’s goal is to develop future physician-scientists from these communities who pursue careers in the search for a safe and effective HIV vaccine. To achieve this goal, HVTN created this program to provide outstanding mentorship, training and support for U.S. medical students in an introductory experience with HIV vaccine research. These students, under the mentorship of HVTN-affiliated investigators, conduct research projects in areas aligned with the HVTN scientific agenda. Scholars can conduct short-term projects of 2-4 months, or long-term projects of 9-12 months. The awards are currently funded by the NIAID/DAIDS, with past support from the National Institute of Mental Health and other funders as well.
RAMP started in 2010 in response to discussions by the Legacy Project. The Legacy Project aims to increase clinical trial enrollment among the U.S. populations most affected by HIV, particularly African Americans and Latinx people. At the same time, HVTN leaders saw the importance of increasing diversity in their own ranks. They also were increasingly concerned with ensuring future generations of researchers would continue the work of the Network.
The need was there, but how could the Network respond? To gain some concrete guidance, Legacy Project staff convened a panel of experts who discussed the greatest needs and how the HVTN could make a difference. The panel included leading researchers of color, including former U.S. Surgeon General Dr. David Satcher, leading HIV prevention research scientist Dr. Cynthia Gómez, and Dr. George Ayala, now the executive director of the MPact Global Action for Gay Men’s Health and Rights (formerly known as MSMGF). The panel concluded that HVTN needed a pipeline of investigators of color to assume leadership positions, but none existed into which the Network could tap. Several HIV-focused research programs existed at the time, but they were working with young professionals who had already made their key career decisions. If HVTN wanted a pipeline, it would have to create its own. The panel recommended working with medical students who were still exploring their career options. This inherently risky approach could take years to bear fruit.
“[HVTN leaders] agreed with the committee that the change we were looking for, it was not going to be quick, it was not going to be short-term, but…it would take a longer-term commitment to introduce people [to HIV vaccine research],” says Steven Wakefield, HVTN director of External Relations and RAMP Scholar Program leadership team member leader, who led Legacy Project efforts at that time.
“It was exciting to watch the enthusiasm of this group of Black and Latinx professionals regarding something that could happen that would change the pipeline.”
It was a natural fit for HVTN’s Training Program, which has expertise in developing and mentoring young researchers, and ran two programs focused on attracting, training and keeping young scientists in HIV vaccine work. It also followed that the newly engaged program staff used a deliberate, evidence-based approach to design RAMP.
“It was important to figure out how to do it the right way… to get a better understanding of the issues underlying the lack of diversity among clinical investigators, and the factors that have both contributed to, and detracted from career development of African Americans and Latinx investigators,” says Danna Flood, HVTN’s director for Training, Evaluation and IT, and RAMP Scholar Program leadership team member leader.
In 2010, HVTN worked with Dr. Neva Pemberton, then a graduate student, to conduct qualitative research with several African-American and Latinx HIV/AIDS researchers to determine the factors that led to their interest and success in the field. The results showed that mentors played a key role in keeping them engaged and progressing.
RAMP Scholar Program Leadership team members convened an Advisory Committee for RAMP program development consisting of leading African American and Latinx investigators, medical students, and community leaders. The Committee met over several days to review the formative research and provide guidance on designing a responsive program. As a result, mentorship became a primary focus of RAMP. RAMP leaders also wanted to ensure the program provided a reasonable wage for scholars along with full travel and supply costs so that they could fully devote time to their projects and not have to work other jobs. This is especially important in the U.S., where 77% of African American and 57% of Latinx medical students expect to graduate with more than $150,000 of education debt(1).
To ensure high quality mentorship in areas relevant to HVTN science, existing HVTN investigators were invited to participate in the program. These mentors would help the Scholars develop their research projects in areas relevant to HIV vaccine science. They would also guide them through all parts of the research process while introducing them to their clinical sites and the life of a physician-scientist. Mentors were given an opportunity to attend training on cultural responsiveness and ongoing skill-building in mentorship. Program staff also organized additional professional development activities for Scholars throughout the year.
With a data-informed program model, mentors, and funding in hand, the Network solicited applications for and awarded its first group of Scholars in early 2011. The six selected Scholars came from medical schools all over the U.S. They worked with mentors at locations representing the global reach of the Network, from Boston and San Francisco in the US to Cape Town, South Africa and Lima, Peru. Likewise, their projects spanned a variety of topics, from highly technical laboratory projects to qualitative research to assessing recruitment strategies for transgender participants.
For the Scholars, the experience was nothing short of deeply affecting. All of the Scholars reported high levels of satisfaction with the program and their mentorship. After their RAMP experience, Scholars reported tremendous gains in their knowledge of responsible conduct of research, the role of social science in HIV vaccine trials, and career opportunities in the field. They also learned many necessary skills to conduct original research.
In a post-program survey, one Scholar wrote, “The mentorship I have received has been outstanding and has changed my career path completely(2).”
Based on these and similar positive results in subsequent cohorts of Scholars, HVTN leaders continue to enthusiastically support RAMP. In fact, the ninth cohort of Scholars will be awarded in early 2019. With each new group of Scholars awarded, the benefits to a variety of stakeholders – HVTN leaders, Scholars, mentors, community members and clinic staff – are evident.
“I don’t think we fully realized the impact scholars’ research projects would have on the science and operations of the Network. Scholars, with help from mentors, are asking important research questions. Their results inform future research and the conduct of our trials. Scholars present and discuss their research findings with luminaries in the HIV prevention field. Clinical trial sites learn how to effectively reach specific populations in their communities, and as a result, they modify how they educate, recruit and retain study participants, which improves study outcomes.” says Danna Flood.
Mentors have had some of the most transformative experiences with Scholars, and now are among the biggest advocates for the program.
“[Mentors] thought they were going to bring in someone where they were providing added value to that individual, but the individual’s work provided added value and allowed the Mentor to answer a question they didn’t anticipate at the beginning of the research,” says Wakefield.
Dr. Michele Andrasik, HVTN Director of Social Behavioral Sciences and Community Engagement and a RAMP mentor, remarked that her RAMP Scholar’s project laid the foundation for an ongoing process to analyze and publish social behavioral data coming from HVTN trials. This has a major impact in the field, and for Scholars’ professional success.
“These students who don’t know anything about our work come out with a huge knowledge base of HIV prevention and vaccine research. [Mentors are] contributing to Scholars’ success in their fields by getting them published, and teaching them the skills needed for data analysis and moving data into a publication. It’s just a win-win across the board for these young Scholars and for us as an organization because we’re getting our data out there,” says Dr. Andrasik.
As the program and its more than 50 alumni mature, RAMP leadership and staff are now turning their attention to measuring long-term effects of the program on the Scholars and their careers. For the last four years, alumni Scholars filled out a yearly survey to describe where they are in their careers, long-term goals, and opinions about the ongoing impact of the program. For these young professionals, many of whom are still in their medical training or early stages of their career, their ultimate path remains to be decided. Whether HIV vaccine research will be part of that path is uncertain, even though they are aware that opportunities are available to them. Despite this, the majority of Scholars report that they are involved in research and personal or professional efforts related to HIV. Even years after their RAMP experience, Scholars indicate that the experience solidified their career goals or changed their goals entirely to include research or work with highly affected populations. They indicate that RAMP affected their ability to be culturally responsive professionals, and that it was an important learning and life experience.
In a typical comment, a Cohort 6 scholar recently stated, “RAMP made me realize how exciting it can be to be part of ground breaking research and reinforced my desire to continue to be involved in research throughout my career as a physician.”
While the program has helped to identify several individuals who will likely take up the mantle of HVTN work, these results indicate its effects are, as predicted, an ongoing introduction of a community of professionals to HIV vaccine work. This introduction and dedicated mentorship then produces a web of positive effects, and can sow the seeds that could lead them to HIV prevention work over the course of their careers.
Dr. Stephen De Rosa, one of the directors of the HVTN Laboratory in Seattle and four-time RAMP mentor, sums it up: “We’ve always questioned whether mentees will go directly into HIV vaccine research, but RAMP positions them to be involved in HIV-related research. Students don’t always get that in medical school or in medical training, and it encourages increased involvement in research of all types.”
Dr. Andrasik indicates RAMP could have further benefits in communities. “To have just one more provider who isn’t coming in with preconceived notions about HIV, who now understands the impact of HIV on her community and the people that she’s working with, is huge. There’s no way we can ever measure that impact. If we can do that for little pockets of communities across the U.S… we’ve successfully increased our efforts to prevent HIV in the community, both in the Latinx and the African American community.”
Back at the Full Group Meeting Plenary, the plenary chairs bring the audience to quiet attention, and begin to introduce the talented Scholars on the stage. The Scholars step up to the microphone to present their projects. The audience, and an entire Network, stops to listen.
 Dugger RA, El-Sayed AM, Dogra A, Messina C, Bronson R, Galea S. The color of debt: racial disparities in anticipated medical student debt in the United States. PLoS One. 2013;8(9):e74693.
 Sopher CJ, Adamson BJ, Andrasik MP, Flood DM, Wakefield SF, Stoff DM, et al. Enhancing diversity in the public health research workforce: the research and mentorship program for future HIV vaccine scientists. Am J Public Health. 2015;105(4):823-30.
Jenna Udren is the RAMP Scholar Project Manager in the Training Unit at HVTN Core, Seattle, WA, USA.