Clinical REsearch During Outbreaks: generating clinical evidence during outbreaks in LMICs


Patients are at the heart of every outbreak and patient-centred research is essential to generate evidence to improve the care of individual patients and to guide the public health response to the outbreak1,2. The conduct of clinical research during epidemics poses special challenges and historically has been criticised as being cumbersome and generally inadequate. The Clinical REsearch During Outbreaks (CREDO) training curriculum will support investigators in Low and Middle Income Countries (LMICs) to generate clinical evidence during outbreaks of infectious diseases. The idea of a ‘Training Curriculum’ approach to guiding decisions about epidemic research was recommended by a group of experts attending the meeting Generating Evidence for Infectious Diseases with Epidemic Potential. This initiative is aligned with the WHO R&D Blueprint for Action to Prevent Epidemics. The CREDO training curriculum encompasses the full spectrum of activities that generate clinical evidence, from gathering good quality descriptive clinical data right through to clinical trials of experimental therapeutic interventions.


To strengthen the national capacities of LMICs to generate clinical evidence during outbreaks. The CREDO training curriculum is targeted specifically towards individuals living and working in LMICs in order facilitate networking and the sharing of resources and thus improve national response to disease outbreaks.


CREDO training consists of twelve course modules. The training is designed to be delivered in a blended format comprising face-to-face workshops and self-directed web-based learning although individual components can be undertaken.

The training package begins with materials for a two day face-to-face workshop during which participants are given an introduction to evidence-based medicine for epidemic infections and fundamental concepts of generating clinical evidence.

The training package then includes eleven web-based modules that include interactive tools to support decision making and the planning and implementation of clinical research. Each module takes approximately four hours to complete and will incorporate tools for assessment and feedback.

The CREDO training curriculum concludes with materials for a two day face-to-face workshop during which the online training is reinforced and built upon. A final educational simulation exercise (i.e. outbreak scenario) is included to enable participants to put their learning into practice.

Target audience

Our target is multidisciplinary research teams in LMICs that are susceptible to outbreaks. In order to qualify for the training, applicants must demonstrate some prior experience in clinical research and must work in a setting where clinical research is being or will be conducted.

The advantages of team training is that it most closely replicates a ‘real life’ outbreak situation where multidisciplinary teams would need to work together to mount a research response. Additionally, targeting the training at existing teams will help ensure that the learning becomes embedded and is sustained.


CREDO has been endorsed by The African Academy of Sciences.

1. Rojek, A. M. and P. W. Horby (2016). "Modernising epidemic science: enabling patient-centred research during epidemics." BMC Medicine 14: 7.

2. Rojek, A. M. and P. W. Horby (2017). "Offering patients more: how the West Africa Ebola outbreak can shape innovation in therapeutic research for emerging and epidemic infections." Philosophical Transactions of the Royal Society B-Biological Sciences 372(1721): 8.

* This report is independent research by the UK Public Health Rapid Support Team. The views expressed here are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health