Research

WACh Priority Areas in Focus: Gut Health and Child Survival

Global WACh Scientific Priorities develop a deeper focus on our research efforts to decrease morbidity and mortality among women, adolescents, and children. Gut Health and Child Survival is vital to understanding and improving this inter-generational health and well-being.

CaptureWhen we asked this scientific priority’s co-lead, Dr. Patricia Pavlinac, what the greatest challenge is to developing interventions for enteric and diarrheal disease, she says, “Even among children who survive diarrhea, multiple episodes of the disease and the underlying enteric infections can lead to chronic malnutrition, increased risk of lower respiratory tract infections, cognitive disabilities, and poor school performance. These consequences hold extreme economic and societal implications.”

Gut Health and Child Survival
is our response to the unmet need for programs to treat and prevent the adverse effects of enteric and diarrheal disease. We strive to ensure children survive and reach their developmental potential.

 

WACh Priority Areas in Focus: HIV Through the Lifecycle

Today we introduce our Scientific Priority Area of HIV through the Lifecycle.

Our center has cultivated expertise in HIV/AIDS since its inception, and our focus has always been on the intersection of three key populations: women, children and adolescents. While AIDS-related deaths are decreasing in children and adults, they are increasing in adolescents, which is why strategies for prevention and treatment of adolescents is a major focus of our priority area. By focusing on interventions during critical life stages for pregnant women, infants, and adolescents, we can prevent HIV from persisting throughout the duration of a person’s life and into the next generation.

This is how we will transform HIV testing and treatment approaches and achieve an AIDS free generation.

This is HIV Through the Lifecycle.

HIV main

Global WACh reaffirms research commitments; launches new Scientific Priority Areas

When Global WACh completed its fifth year in June, we took a look back at the vision and goals that catalyzed the creation of our Center in 2011. The Global Center for Woman, Adolescent, and Child health was established to pursue scientific discovery and leadership development by breaking down traditional silos that separate disciplines. In doing so, we foster collaborative approaches that emphasize the interdependent nature of woman, adolescent and child health.  We shaped our Center’s approach to research using a lifecycle perspective- one that views women, children and adolescents as interconnected populations that move along a shared life course.

It is from this this perspective that we introduce three newly articulated scientific priority areas to guide Global WACh in our mission to make scientific discoveries, cultivate leaders, and bridge disciplines to advance the tightly connected health and well-being of women, adolescents and children.

Our Scientific Priorities:

  • HIV Through the Lifecycle
  • Gut Health and Child Survival
  • Family Planning Decision Support

We’ve refined our Core identities into three Scientific Priority Areas to clearly convey how Global WACh contributes to research that accelerates health improvements and decreases unnecessary deaths of women, adolescent and children. We hope this deeper focus will enrich our collaborations and expand our capacity to contribute and implement research with meaningful effects on the health of women, adolescents, and children.

Throughout the coming weeks, we will share a post about these three Scientific Priority Areas: what their specific response to global health challenges will be, their missions and focus areas, and what their leadership is most excited about moving forward.

We look forward to sharing our continued commitment to WACh research with you!

Building evidence for HIV risk with contraceptive methods

Renee Heffron

Renee Heffron is the grant’s primary investigator.

Dr. Renee Heffron, co-director of our Global WACh Family Planning Working Group, has received new funding from the NIH to tie into the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study. ECHO enrolls participants in sub-Saharan Africa for a randomized trial of three equally safe and effective contraceptive methods: the copper T intrauterine device (IUD); injectable depo-medroxyprogesterone acetate (DMPA), also known as the Depo shot; and the Jadelle implant.

For sub-Saharan African women at risk for becoming infected with HIV, it is important to build knowledge around potential associations of specific contraceptives with HIV acquisition. A number of observational studies have examined whether or not use of hormonal methods affects the risk of HIV acquisition. Some of these studies suggest that injectable methods—particularly the Depo shot—might increase a woman’s risk of acquiring HIV infection, while other studies show no association. The World Health Organization continuously reviews the information about contraceptives and, thus far, has determined that all of the contraceptives that will be used in the ECHO Study are safe for women at risk of HIV risk infection, but that more research is needed.

contraception

Photo by echo-consortium.com

With this additional funding, ECHO will now begin to measure biological markers periodically over the three-year trial period associated with the Depo shot, the Jadelle implant, and the copper IUD. These markers include vaginal microbiome, markers of inflammation, HIV target cells, protein signatures, and transcriptome to identify differences between women using the different contraceptives.

Read the full story from ASPPH here.

Fred Hutch Science Spotlight: Reduced CMV Transmission

A collaboration between scientists at the University of Washington and the Fred Hutch Vaccine and Infectious Disease Division looks at antiretroviral use and Cytomegalovirus transmission in mothers and children in Kenya. Cytomegalovirus (CMV) is an opportunistic infection contracted by people with HIV. In Kenya, most HIV- exposed children acquire CMV within the first year of life, primarily through their mother’s breast milk. These infants with both HIV and CMV have an increased risk of disease progression, neurologic disease and death. Researchers within this collaboration evaluated the impact of highly active antiretroviral therapy (HAART) on CMV transmission and breast milk levels related to maternal HIV.

Jenn Slyker

Jennifer Slyker is the study’s primary investigator.

The Science Spotlight team at Fred Hutch selected this team’s recent study for the December issue of Science Spotlight, a monthly online publication highlighting scientific investigation. Dr. Jennifer Slyker, Global WACh Assistant Director, says in the Spotlight: “We were surprised to see an effect on CMV transmission but not on CMV DNA levels in breast milk, which we think is the major mode of CMV transmission in the first year of life. Other groups have also observed this in observational studies. Our next step is to explore maternal and infant immune mechanisms of protection.”

The research concludes new findings to suggest that starting HAART later in pregnancy may decrease infant CMV infections, by mechanisms independent of breast milk CMV levels. These data also suggest that policy changes in high-HIV burden countries for starting pregnant women on lifetime antiretrovirals could have profound implications for the epidemiology of mother-to-child CMV transmission at a population level.

Read more about the study here in the December edition of the Science Spotlight.

Gut Health and Child Survival at ASTMH

This week, members of our enteric research team are in Atlanta, Georgia for the 65th annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH). They join approximately 4,400 other researchers, government and public health officials, practicing physicians, students, and all health care providers working in the fields of tropical medicine, hygiene, and global health.

Our Healthy Growth and Development Core is dedicated to optimizing care in young children at high risk of diarrhea-associated mortality and the ASTMH annual meeting provides our team with a unique opportunity to discuss recent findings, build inspiration for our next big projects, and re-energize our commitment to reducing the worldwide burden of tropical infectious diseases to improve health around the world.

Yesterday ASTMH heard from Rebecca Brander on correlations of drug resistance in Kenyan children with acute bacterial diarrhea. Rebecca is a MPH student at the University of Washington and completed this research in collaboration with Global WACh directors Grace John-Stewart, Patty Pavlinac, and Judd Walson. Patty Pavlinac, our Health Growth and Development director, leads the Global WACh representation at the conference.

Becca at ASTMH 2

Rebecca’s study “Host and Environmental Correlates of Multi-Drug Resistance in Kenyan Children with Acute Bacterial Diarrhea” is a key area of research for addressing the prevalence in which bacterial diarrhea results in significant morbidity and mortality in children in sub-Saharan Africa. Antibiotic treatment can be a life-saving intervention, but the antibiotic resistance has rapidly emerged in this population of children, and now this intervention’s efficacy is limited. The study’s data pinpoints risk factors for antibiotic resistance in enteric pathogens, in order to inform diarrhea management recommendations and control resistance.

Click to read the entire study

2015 Global WACh-Coulter Seed Grant recipients create anesthesia device for developing countries

In 2015, a group of engineering students proposed the idea for a low-cost, portable anesthesia delivery device specifically for use in resource-poor regions. The device’s aim was to overcome the challenge individuals in low-resource settings face when crucial medical procedures are often not performed due to a lack of accessible anesthesia delivery.

A $30,000 seed grant from the Global WACh-Coulter Foundation in 2015 allowed the team to design a benchtop test circuit, including a prototype of a simplified anesthetic vaporizer. With investigative mentorship from UW faculty and anesthesiology specialists, these students are now working to create the device that will make more surgeries possible and reduce unnecessary deaths.

Read more about this ongoing project here.

Breakfast with WACh welcomes Drs. Ghayda Mirzaa and Kristina Adams Waldorf


Join us for breakfast and a lecture on Tuesday, October 11th with Drs. Ghayda Mirzaa, MD, FAAP, FACMG and Kristina Adams Waldorf, MD.

The Zika Epidemic: An Unprecedented Health Threat for Pregnant Women

October 11th, 9-10 AM
University of Washington, Harris Hydraulics Laboratory, Large Conference Room


mirzaaDr. Ghayda Mirzaa is an expert in adolescent sexual and reproductive health. He has worked for the World Health Organization in Geneva since 1993. His experience in generating knowledge and taking knowledge to action is global in scope and spans over 25 years.  A key area of his work is research on effective ways of providing sexuality education in different social, cultural and economic contexts, and then using these research findings to strengthen sexuality education programs in low and middle income countries.

convio kristinaDr. Kristina Adams Waldorf
 is an expert in adolescent sexual and reproductive health. He has worked for the World Health Organization in Geneva since 1993. His experience in generating knowledge and taking knowledge to action is global in scope and spans over 25 years.  A key area of his work is research on effective ways of providing sexuality education in different social, cultural and economic contexts, and then using these research findings to strengthen sexuality education programs in low and middle income countries.

 

For more information, please email Kate Pfizenmaier, Global WACh Program Manager, at kpfiz1@uw.edu.

SPEED study aims to better meet adolescent HIV care needs

Despite enormous expansion of HIV testing and treatment services in resource-limited settings, adolescents continue to be disproportionately affected by HIV. Lack of access to acceptable HIV testing, counseling, and treatment has been cited as a barrier to HIV care among adolescents. Additionally, health workers tasked with providing adolescent HIV services report feeling inadequately prepared to cope with the needs of this age group.

The SPEED study improves quality and accessibility of HIV care to meet the unique needs of adolescents. SPEED (Simulated Patient Encounters to promote Early Detection) uses patient actors to portray adolescent HIV patients as part of a clinical training intervention. This gives nurses and doctors in Kenya an opportunity to practice their skills diagnosing, caring for, and engaging adolescents living with HIV. The simulated encounters utilize a standardized patient script and provide opportunities for the trained actor and a faculty observer to deliver immediate feedback and support to the clinician.

Simulated patient interactions show great promise as a mechanism for health workers in low-resource settings to improve critical decision-making, patient interaction, and communication skills in working with adolescents. SPEED’s ultimate aim is for this increased provider confidence to in turn increase uptake and retention in adolescent HIV care.

a SPEED patient actor practices her case with a study nurse

a SPEED patient actor practices her case with a study nurse

Dr. Kate Wilson with the team of trained patient actors

Dr. Kate Wilson with the patient actor team

This week, SPEED has been busy training a new group of patient actors in Nairobi, Kenya. Actor training is part of the study’s first year of progress. Led by Global WACh and UW School of Nursing researcher Dr. Pamela Kohler and managed by Dr. Kate Wilson, SPEED’s interventions and analyses will be conducted over the next four years.

Making strides in HIV testing and counseling

Irene Njuguna and Jill Neary are MPH Candidates in Epidemiology at the UW School of Public Health. With mentorship from Global WACh researcher Jenn Slyker and Kenyatta National Hospital VCT Director Dr. David Bukusi, they developed a new tool to track provider initiated HIV testing and counseling for children admitted to hospitals in Kenya. Read about their work below.  

In line with the World Health Organization recommendations, the Kenya National HIV testing guidelines recommend universal provider initiated HIV testing and counseling (PITC) for all children in sub Saharan Africa who come in contact with health care facilities. However, in many settings universal PITC is not routinely implemented, with ward transfers, weekend admissions, and discharges resulting in some missed testing opportunities. This results in late diagnosis of HIV infected children, who are at high risk of mortality and do not benefit fully from HIV treatment.

This project began with the intent to intervene in this cycle of unmet HIV care needs. The team looked to Kenya’s national referral hospital: Kenyatta National Hospital (KNH). Working with the PITC team at KNH, the team established an important framework for developing easy to use, acceptable tools to track and improve PITC coverage. In partnership with the KNH pediatric ward PITC counselors, a system was developed to track each individual child admitted, confirm testing completion, identify reasons any children missed testing, and flag children requiring testing.

The tool was successfully piloted in the pediatric department, and at the end of the practicum period, the PITC team recommended that the tool also be used in the adult in-patient medical wards.

Irene PITCPITC

Jill Neary (left) and Irene Njuguna (right) with Ruth Andere: the leader of the Pediatric PITC team.

Congratulations Irene, Jill, and the entire KNH team for your accomplishment! We can look forward to hearing about the continued success of PITC at Kenyatta National Hospital.