This application seeks funding for a D43 training grant to support a world-first rheumatic heart disease (RHD) research training program in Uganda. There has been little innovation globally in RHD prevention, early detection, and management since the mid-1900’s. Additionally, the majority of evidence guiding current practice was generated in high-income countries and may not translate directly to the contemporary burden of disease in low- and middle-income countries (LMICs). The Impact Mentored Research-Training Program will leverage existing resources and ongoing RHD clinical trials from a decade-long RHD research and training collaboration between Makerere University, the Uganda Heart Institute (UHI), Cincinnati Children’s Hospital Medical Centre (CCHMC) and Children’s National Hospital (CNH) to build capacity to tackle RHD where the burden is the highest. Our overarching objective is to equip and nurture emerging research leaders and professional scholars in Uganda to generate high-quality contemporary evidence on RHD across the lifespan and to create an enduring research training center on the African continent that will rapidly advance progress towards the elimination of the disease in a generation; a bold, but achievable goal. This application will provide critical support for the training, and research activities needed to realize this vision. The program will be led by Dr. Nelson Sewankambo, a Professor of Medicine and Former Dean of the Makerere University School of medicine, who has led several NIH and non-NIH research capacity building grants in Uganda and sub-Saharan Africa. Co-directing this program are the co- Directors of the Rheumatic Heart Disease Research Collaborative in Uganda (RRCU), Drs. Emmy Okello (UHI) and Andrea Beaton (CCHMC). Long-term degree training at Master’s, PhD and Career development fellowship levels will be offered, with primary coursework to occur in Uganda at MakCHS. CNH will provide both e-learning seminar and in-person immersive experience in the US to strengthen clinical trials capacity and improve trainee’s knowledge of gender parity and sex- and gender considerations in health research. Additionally, recruitment will target trainees from the regional centers to build National RHD capacity and ensure at least 50% of our trainees are women. Short-term trainings, seminars, webinars and workshops will be offered to degree and non-degree trainees to further strengthen institutional and national RHD- research capacity and to identify promising candidates for degree programs. A Steering Committee and the Training Advisory Committee (TAC) comprised of leading researchers with expertise in our objectives will both offer expert advice to the Impact Directors to ensure success of the trainees and the overall program by producing high-quality and locally relevant research. This success will translate into improving guidelines and policies for RHD care in Uganda and the region, training the next generation of excellent African researchers to address RHD prevention, early detection, and management.

Project narrative Despite the very high burden of rheumatic heart disease (RHD) in Uganda and most sub-Saharan African countries, there has been very little investment in research training and research. The proposed plan, the Impact Mentored Training Program, will train multidisciplinary health professionals at Makerere University College of Health Sciences to conduct RHD-related research with a special emphasis on clinical trials capacity building. Additionally, Impact will address the “double gender gap” in RHD research including (1) under-representation of women in research in Africa and (2) the dearth of sex- and gender-based analysis in RHD.