Veronica Njie-Carr

Raising the Gambian Research Bar

Our Researcher: Veronica Njie-Carr, PhD, RN, ACNS-BC, FWACN

By Dan Mezibov

Illustration of a woman looking through a microscopeIt is the smallest nation on the African mainland and one of the poorest in the world. Located along the West African coast, its dense population – projected to reach nearly 3 million by 2025 – continues to face rising heart disease, diabetes, and other noncommunicable diseases, serious obstacles to maternal and women’s health, and an insufficient supply of health care providers.

Gambia’s research capacity to deal with these challenges is “weak,” notes a recent report from the Global Challenges Research Fund, following 24 years of dictatorship that destroyed much of the government’s infrastructure, including research. In 2016, the former British colony returned to a democratic government, and the transformational changes that resulted have stimulated new opportunities for research in academic, health care, and other institutions.

To continue that growth, UMSON’s Veronica P.S. Njie-Carr, PhD, RN, ACNS-BC, FWACN, associate professor, has been awarded $1.18 million from the Fogarty International Center of the National Institutes of Health to strengthen capacity in health research ethics and methodology in the country. The Fogarty International Center supports and facilitates global health research conducted by U.S. and international investigators, builds partnerships between health research institutions in the United States and abroad, and educates the next generation of scientists to address global health needs.

As part of the five-year project, faculty from UMSON and from the University of The Gambia (UTG); the Medical Research Council, Gambia Unit; and the University of Maryland School of Medicine (UMSOM) will collaborate to extend the work of the University of Maryland, Baltimore President’s Global Impact Fund (PGIF) to develop a research ethics and methods certificate program in Gambia as a foundation for subsequent expansion to a master’s program. Njie-Carr serves as co-principal investigator (PI) with UMSOM’s Henry Silverman, MD, MA, professor, and UTG’s Jainaba Sey-Sawo, PhD.  

The PGIF seed grant supported the beginning work on developing Gambia’s capacity efforts, such as holding virtual workshops and conducting surveys to gather data for the Fogarty grant application. The Fogarty award will fund tuition and fees for the health professionals, research committee members, and scholars in the certificate and master’s programs in addition to professional development programs for trainees, such as mentoring, grant writing, regional conferences, and travel to the United States to observe best practices. The PIs on the project will also serve as faculty, educating others to ensure the project’s sustainability.

“We are keenly cognizant of the importance of utilizing best evidence in caring for patients to promote positive outcomes,” Njie-Carr says. “Gambian health professionals and academics will undoubtedly benefit from the Fogarty award as the country strengthens its research enterprise and capacity development efforts.”

Njie-Carr, a member of the Gambian diaspora, teaches, mentors, and supervises academic faculty, nurse leaders, and graduate nursing students in UTG’s Department of Nursing, where she is a consultant on curricula and research activities. Her interest in supporting the next generation of academic scholars led to her work in building capacity in low-to-middle-income countries, where she has a strong track record developing, implementing, and evaluating education and research programs.

“We live in a culture where people think if you ask questions, you’re not smart enough,” Njie-Carr explains, adding that many young Gambians have never had an opportunity to be mentored. The PGIF and Fogarty awards, she says, will help build a cadre of new researchers “with the guidance, support, and mentorship to go higher and rebuild a research enterprise with scientific integrity and rigor.”

More Highlighted Research

Managing HIV Care in Real Time

By Dan Mezibov

Since their debut a decade ago, smartphones have offered users more than just a few new conveniences. For many patients with chronic illnesses, the technology is providing an innovative array of tools to help better manage their care.  
But few smartphone interventions have been the product of randomized controlled trials that are the gold standard for research, and rarer still are studies using smartphones to improve the health of older adults.
After her recent review of smartphone studies targeting the care of patients with HIV/AIDS, University of Maryland School of Nursing Associate Professor Veronica Njie-Carr, PhD, RN, ACNS-BC, FWACN, found none related to aging women and HIV.
“I care about eliminating health disparities by working with women of African heritage who are aging with HIV,” says Njie-Carr about her study “A Self-Management Technology-Enhanced CARE Intervention to Improve HIV Health Status and Quality of Life.” Working with 16 HIV-positive women over the age of 50 who are of African descent, Njie-Carr is leveraging smartphones and web-based technologies to help these patients manage their HIV symptoms, stay motivated to remain in treatment, and engage in social supports that are critical to optimal daily functioning.
The population Njie-Carr is working with experiences the highest rate—42 percent—of people infected with HIV, Njie-Carr explains. Moreover, because HIV treatment has generated longer life expectancies—from 55 years in the 1990s to beyond 70 currently—nearly half of people living with HIV are aged 50 and older. As a result, “we now must address the long-term effects of living with HIV and treat the disease as a manageable chronic illness,” Njie-Carr says.

HIV care is challenged by a mix of chronic conditions among older adults—including frailty, fatigue, cardiovascular and kidney disease, diabetes, arthritis, and neurological and cognitive declines—that often occurs alongside HIV and interferes with daily treatment and the ability to perform daily life functions. Of critical concern, too, is the inability of many HIV patients to remain in regular care after they are diagnosed because of limited access, low income, poor social supports, and limited knowledge of the disease.    
“My overall goal,” Njie-Carr says, “is to develop a replicable, culturally relevant intervention to empower women of African descent with the tools, support, and information they need to age well with HIV.”
With $12,000 of initial funding from a two-year UMSON Dean’s Research Scholar Award, the study will employ written content, customized videos, virtual chat rooms, and synchronized group sessions that can be accessed using an app or online. The effort has completed its first phase by assembling focus groups and a 10-member Community Advisory Board of stakeholders, including Baltimore metro-area patients, clinicians, researchers, and technology experts who are informing all aspects of the study’s content. After using the intervention at their own pace for three weeks and providing feedback to optimize it, participants will be compared to a control group that does not receive the intervention but instead engages in weekly telephone support about health status and progress.  
Designed as a supplement to the regular care patients receive from their providers, the study aims not only to prevent transmission and promote health, but also to help patients monitor their moods and progress, as well as link them to clinician support and other community resources. Spirituality is a key strength in women of African heritage, Njie-Carr says, pointing out that tips and tools for self-reflection and maintaining a positive mood will be among the intervention’s features.   
“We’re helping these women manage their care, on their own, with more autonomy as they go about their daily lives,” Njie-Carr says. “And I think that’s powerful.”