Research

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.

Success for CATCH at Nairobi Innovation Week

Last week at Nairobi Innovation Week, members of the CATCH study team spent three days showcasing their innovative visions for pediatric HIV care. This was an important opportunity for the team to highlight the successes and findings of CATCH: Counseling and Testing for Children at Home.

The CATCH study accomplishes what’s in its name by “catching” children ages 12 and under who have fallen through the cracks in HIV diagnosis systems. CATCH offers parents infected with HIV the opportunity to have their children tested, both in clinics or in the home. HIV-infected children are then linked to an HIV care clinic of choice, which ensures that children can receive much needed care. CATCH has been working and gathering data since the start of 2014, with funding for seven different sites in Nairobi and one in Western Kenya.

Throughout the three-day event, CATCH presented posters, modeled pediatric test kits, and engaged visitors with their approaches and ideas about HIV testing in children. “There was a great amount of enthusiasm for the translation of research findings into policy, particularly from senior University of Nairobi visitors and local media,” said Anjuli Wagner, a postdoctoral fellow in the Department of Global Health and member of the study team.

Each day, members from the CATCH team, including Anjuli Wagner, Cyrus Mugo, and Verlinda Otieno spoke with over 40 individuals interested in continuing to be part of the discussion about CATCH’s work. The team also visited with nearby stands and discovered valuable new connections with other pediatric health advocates.

CATCH team members tabling at Nairobi Innovation Week

CATCH team members tabling at Nairobi Innovation Week

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We’re sending CATCH our congratulations for their engagement and innovation in Nairobi!

For more information about CATCH, take a look at this animated depiction of the project.

Global WACh Family Planning Study Completes its First Day of Training

The unmet need for contraception in Kenya in the postpartum period, or months following childbirth, is high.  This unmet need contributes to poor maternal and child health outcomes, and impedes women’s empowerment.

Mobile WACh XY is a two-arm randomized controlled trial (RCT) comparing the effect of bidirectional SMS dialogue vs. control on highly effective contraceptive use at 6 months postpartum among  individual women and couple dyads in Nyanza Province, Kenya.  The study builds upon the experience of other Global WACh mHealth studies using a text messaging platform that pushes automated messages containing critical information at crucial times and allows users to respond and converse with a health professional about their individual needs.  Mobile WACh XY differentiates itself in the family planning arena by including an emphasis on male partner involvement and couple communication. Male partners need to be invited to participate in the study, given the desire to include men while continuing to promote women’s reproductive autonomy.

Mobile WACh XY team poses for a photo on their second day of training

Mobile WACh XY team poses for a photo on their second day of training

The XY team is led by Drs. Elizabeth Harrington, Jennifer Unger and John Kinuthia.  This Global WACh study team completed its first week of training in Kisumu, Kenya last week.

Over the next 6 months they will enroll 220 women in the study, and up to 220 men—depending on female participants’ preferences.  Information gathered will provide insight into the effectiveness of an mHealth strategy to help meet women’s and couples’ postpartum contraceptive needs, and have policy implications for postpartum family planning programming.

Congratulations to everyone involved!  We look forward to sharing your progress.

Global WACh Toto Bora Trial aims to reduce childhood mortality

Toto Bora-01

Toto Bora, an expression meaning “healthy baby” in Kiswahili, enrolled its first pediatric patient today in a research trial aimed at reducing childhood morbidity and mortality in the months after a hospitalization.

In sub-Saharan Africa, childhood mortality remains unacceptability high.  Children who are hospitalized and subsequently discharged are a group of children at particularly high risk, yet few interventions exist for the post-discharge period. A recent trial found that the mass drug administration of azithromycin reduced childhood mortality by half among children in Ethiopia in communities receiving the intervention.  The Toto Bora team, led by Drs. Judd Walson, MD, MPH and Patricia Pavlinac, PhD MS, believes that children being discharged from hospital represent an accessible high-risk population in which targeted use of this broad-spectrum antibiotic may have dramatic impact.

In this double-blind, placebo-controlled trial, children discharged from hospitals in Kisii and Homa Bay counties of Kenya are randomized to a 5-day course of azithromycin or placebo and followed for six months to determine the efficacy of azithromycin in reducing post-discharge morbidity and mortality. Stool, nasopharyngeal swabs, and blood samples are also being collated from children to evaluate the effect of the intervention on enteric and nasopharyngeal infections, malaria, the gut microbiome, and systematic inflammation. The emergence of antibiotic resistance among treated individuals and their primary caregivers will also be assessed and cost-effectiveness analyses performed to inform policy decisions.

The Toto Bora Trial began enrollment on June 28, 2016 and is estimated to be complete data collection in June 2019.   Congratulations to this Global WACh team for launching this important study to generate evidence on effective interventions to reduce childhood mortality in Kenya!

Read more about Toto Bora on the clinicaltrials.gov website: https://clinicaltrials.gov/ct2/show/NCT02414399

Current Topics and Methods in Microbiome Research Workshop

E. coli bacteria

Event Date & Time:

May 26, 2016 – 8:30am to 5:00pm

Check-in begins at 8am. The workshop starts at 8:30 and continues until 5pm.

Location: 

Seattle Children’s Research Institute, Westlake Conference Room

West 8th Building (2001 8th Ave)

Seattle, Washington (link to Google Maps)

Information about getting to the workshop can be found here

Goal: The goal of the workshop is to share ongoing microbiome research being conducted by the University of Washington and partnering institutions and in doing so, to identify synergies and shared interests to strengthen research and build new collaborations.

Speakers from the University of British Columbia, the Forsyth Institute, University of Washington, Fred Hutchinson Cancer Research Center, Children’s Hospital, and Institute for Health Metrics and Evaluation will present short talks and engage in panel discussions on topics including:

  • The gut microbiome and its role in enteric health and disease
  • The oral microbiome and its role in oral health and disease
  • The genital microbiome and its role in sexual and reproductive health
  • Statistical methods for microbiome data
  • Research priorities for women, adolescents, and children: thinking across the host microbiome

The workshop agenda can be found here.

Please register for the workshop here

Preparing for an Emerging Zika Virus Epidemic

mosquito

Join us for an expert panel drawn from public health, medicine, and bioengineering to discuss what we know, what we don’t know, and how to prepare

 

The University of Washington Global Center for the Integrated Health of Women, Adolescents and Children (Global WACh) is pleased to host an expert panel discussion to disseminate up-to-date information about Zika virus, its public health impact locally and globally, and what the general public and health care professionals need to know about preventing infection and minimizing the risk of birth defects due to Zika virus infection in pregnancy.

Event Details:

Friday, May 6, 2016

3:00-5:00PM

Hogness Auditorium

Health Sciences Building, UW Medical Center

 

This panel discussion is open to the public and seeks to provide factual information to the general community as well as to health care professionals and researchers.

 

What should I know before I travel to a region where Zika virus is currently spreading?

What do pregnant women need to know?

What should I do if I think I might have Zika virus?

What are the facts about Zika virus and birth defects?

Could Zika virus come to Seattle?

How is Zika virus currently diagnosed and what is needed to improve diagnostics?

What is the potential for pandemic spread?

What are the possible control measures?

Is a vaccine possible?

Is Zika virus sexually transmitted?

 

We have assembled a panel of experts to address topics including the public health response to Zika virus, infection control measures, implications of Zika virus infection in pregnancy, and current and future approaches to diagnosing Zika virus infection.

The expert panel will include:

Jeffery Duchin, MD

Health Officer of Public Health, Seattle & King County Professor, University of Washington

 Duchin

John Lynch, MD MPH

Medical Director of Harborview Medical Center Infection Control Associate Professor, University of Washington

Headshot portrait of Dr. John Lynch, infectious diseases.

Ghayda Mirzaa, MD

Seattle Children’s Research Institute, Center for Integrative Brain Science, Acting Assistant Professor, University of Washington

Mirzaa

 

Alyssa Stephenson-Famy, MD

Maternal Fetal Medicine Specialist, Assistant Professor, University of Washington

Stephenson-Famy

Paul Yager, PhD

Professor, Bioengineering Department Chair University of Washington

Yager

For more information please email globalwach@uw.edu

Spotlight on Global WACh Seed Grant Recipient Deepa Rao

We took a few moments to catch up with Dr. Deepa Rao, an Associate Professor in the Department of Global Health and recipient of a Global WACh integrated health seed grant.  Dr. Rao’s grant funding was awarded to explore the impact of domestic violence and depressive symptoms on preterm birth in South India.  India has a very high domestic violence rate in addition to having the highest number of maternal deaths, preterm birth, and under 5 mortality in the world.  Global WACh viewed this proposal as an opportunity to understand more about the relationship between the two.

“We need to look at the person holistically and realize a mother’s mental health is connected to their baby’s health and it’s not a solely biological process. In my training I’ve always seen the social, interpersonal connected to the biological.”

Dr. Rao was awarded $25,000 to estimate the prevalence of depressive and PTSD symptoms in pregnant women in South India and examine the effects of these symptoms on birth outcomes.  Dr. Rao’s team also conducted interviews with key informants to gather information on how therapeutic techniques could be adapted to be culturally relevant.

Deepa Rao

The study was conducted at two different hospitals, and involved 150 Indian women over the age of 18 who were in their second or third trimester of pregnancy. All of the women were married, had some education, and about nine percent were employed outside of the home. Twenty-one percent of them reported clinically significant depressive symptoms and PTSD.

Her findings, to be published in an upcoming paper entitled The Impact of Domestic Violence and Depressive Symptoms on Preterm Birth in South India, showed that both psychological abuse and clinically significant depressive symptoms were associated with preterm birth. In addition, her team found that maternal depressive symptoms and experience of psychological abuse were strongly associated with each other. During the study, female research assistants asked questions about home situations that could shed light on whether or not the women had suffered abuse. Several women had.

Dr. Rao points out that current policy initiatives focus predominantly on physical abuse, and psychological abuse may be overlooked through these initiatives. She emphasized the need for future research to focus on understanding the psychosocial causes of preterm birth to better target interventions and improve maternal child health in limited resource settings.

Our Lifecycle Approach to Research

At Global WACh our mission is to make scientific discoveries, cultivate leaders, and bridge disciplines to advance the tightly connected health of women, adolescents, and children. Global WACh approaches research, activities, and programs through a “lifecycle lens” that views target populations as interconnected instead of independent groups.

What exactly do we mean by “lifecycle lens?”  We sat down with Global WACh Director, Grace John-Stewart, MD, PhD, MPH to explain what it is and why it is important in the global health context.

Historically, global health research focused on women, adolescents, and children separately, or examined the maternal-child relationship. Within the last decade, however, adolescents have emerged as a critical population to understand and engage in order to improve health worldwide.  With the proliferation of adolescent health research and programs, Global WACh uses a lifecycle lens in which research explores potential impact and benefits throughout the lifecycle, from pregnancy, to neonate, to child, to adolescent, to next generation reproductive health.

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Dr. John-Stewart’s research career in mother-to-child HIV transmission involved linking pediatricians with obstetricians and caring for mothers and infants together, with studies to optimize outcomes in both. The questions surrounding how to prevent women and children from getting HIV led to recognizing adolescence as a critical area on which to focus. Adolescents in the pre-reproductive phase need to be incorporated into the lifecycle model – prevention and treatment of children can improve adolescent health and adolescent engagement can improve health in their later life and in the next generation.

Grace2_web

Grace John-Stewart MD, PhD Global WACh Center Director

“If we do something for women, could we have benefits for them that also benefit their children? If we do something for children, are there ways in which we benefit them moving into adolescence and later life? We’re trying to think about it together.”

 

Global WACh has three main core focuses of research: Infectious Diseases, Healthy Growth and Development, and Family Planning. All of these areas have elements that directly relate to the lifecycle. For example, healthy, planned pregnancies lead to healthy babies who, when provided with adequate infant nutrition and other interventions, can experience better health outcomes later in life.

Dr. John-Stewart acknowledges it is a challenge incorporate all three populations into any one study, but Global WACh wants researchers to think about how their work in any one of these populations could be linked to the other populations as they develop and implement studies.

“You have to understand the implications of actions in one area for the other, and if you can articulate that it’s good. If you’re doing a study on maternal depression, for example, not every time do you have to measure the child outcomes, but you may speculate or infer how this could benefit both the mother and child.”

You can read more about Global WACh’s mission, vision, and the work that we do here.

 

 

WACh Research Racks Up Awards at IAS Conference

In late July, Global WACh sent several team members to Vancouver for the 8th Annual IAS Conference on HIV Pathogenesis Treatment and Prevention. Our researchers presented posters highlighting woman, adolescent, and child health and Kristjana Asbjornstottir, Irene Njuguna, and Keshet Ronen took home awards recognizing their excellent work!

Kristjana received the The IAS/ANRS Lange-Van Tongeren Prize for Young Investigators for her project Immune Activation ped HIV.

Kristjana with Dr. Beyrer from Johns Hopkins and Dr. Delfraissy from ANRS France who presented her with the award
Kristjana with Dr. Beyrer from Johns Hopkins and Dr. Delfraissy from ANRS France who presented her with the award

Kristjana shared her thoughts about winning this prestigious award saying:

Giving a talk at IAS was an incredible opportunity in itself, and having our work recognized through the Young Investigator award on top of that is an enormous honor. I think it highlights the particular attention that was paid to pediatric research at the conference this year. Lots of UW research was featured in various tracks and sessions.

Irene Njuguna was the recipient of the CIPHER Award (Collaborative Initiative for Paediatric HIV Education and Research) which is granted to provide funding for research that addresses priority gaps in pediatric HIV. Without treatment, 50% of HIV infected children will die by the age of two so early diagnosis and treatment is crucial.

The Financial Incentives to increase HIV testing in children (FIT) study that Irene and the team have been working with wants to test to see if small financial incentives will increase HIV testing for children of HIV infected adults who are already in care.

This award is a result of hard work from the team, and I feel honored to be part of this team. This would not be possible without the excellent mentorship from Grace John-Stewart, Jennifer Slyker and Anjuli Wagner.

All of our Global WACh members gave poster presentations for the conference, and Keshet Ronen won an award for Best Poster for her research on Lower ANC Attendance and PMTCT Uptake in Adolescent versus Adult Pregnant Women in Kenya.

keshet_poster

Keshet Ronen and her award winning poster

Let’s hear it for our award winning Global WACh team!