Research

DeWorm3 Project launches deworming activities at trial sites to improve nutrition and health

Over 1.5 billion people, including 835 million children, in the world’s poorest communities are infected with soil-transmitted helminths (STH), commonly known as intestinal worms, and are in need of deworming medications.  A single deworming pill is a safe and effective solution to combat worm infections that interfere with the body’s nutritional intake and impair developmental growth, especially in children.  Periodic mass deworming protects a community by removing or reducing the worm burden of infected community members, thereby decreasing the risk of new individuals becoming infected.  In 2016, Dr. Judd Walson (Department of Global Health), in collaboration with the Natural History Museum London and the University of Washington, launched the DeWorm3 Project to test the feasibility of interrupting transmission of STH using intensified mass drug administration strategies.  DeWorm3 is a cluster randomized trial comparing community-wide deworming efforts of individuals of all ages to standard-of-care deworming of school-age children at schools.  Findings from the clinical trial and accompanying implementation science research can support the development STH program guidelines and innovative delivery strategies.  Deworming activities launched in 2018 in trial sites in Benin, India, and Malawi.

Dr. Arianna Means (left) and the Benin site study team at a meeting in Comè in April 2018.

Study teams from each site conducted complete community censuses to describe the demographics of local populations, followed by a series of field surveys to assess the prevalence and intensity of STH infections within each community.  During the initial assessment phases, site teams collected and analyzed more than 77,000 stool samples for intestinal worms.  As sites prepared to administer early rounds of mass deworming treatment to community members, teams collaborated with local health workers to educate communities about the importance, benefits, and safety of deworming.  To date, DeWorm3 distributed over 396,000 doses of deworming treatment to participants.

The project is also collecting data on additional factors, such as costs and organizational readiness of existing educational and health system infrastructures, as part of DeWorm3’s implementation science scope of work that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. DeWorm3’s evidence will inform national and global policies and practices regarding opportunities to deliver community-wide mass drug administration within routine health programs.  Keep up with the latest DeWorm3 news and find study protocols on the Natural History Museum London website.  Read the latest publications in the PLoS NTDs DeWorm3 collection.

The University of Washington team includes collaborators across the Departments of Global Health and Epidemiology, Global WACh, and the International Clinical Research Center (ICRC).  Meet the team below:

Dr. Judd Walson – Principal Investigator; Professor, Global Health and Medicine
Dr. Arianna Rubin Means – Implementation Science Lead; Acting Assistant Professor, Global Health
Dr. Kristjana Ásbjörnsdóttir – Trial Protocol and Data Integrity Lead; Acting Assistant Professor, Epidemiology
Marie-Claire Gwayi-Chore – Research Assistant; PhD Student in Global Health Implementation Science
Sean Galagan – Data Reporting Manager
Mira Emmanuel-Fabula – Data Quality Manager
Dr. Barbra Richardson – Study Statistician; Research Professor, Biostatistics and Global Health [Adjunct]
Dr. Deborah Donnell – Statistician; Affiliate Associate Professor, Global Health
Dr. Katherine Thomas – Statistician; Director of Biostatistics Core at ICRC

 

Can community pharmacies in Kenya improve early access to antenatal and HIV prevention care? Dr. Melissa Mugambi awarded NIH Diversity Award to explore feasibility

In setting with high HIV prevalence, early antenatal care (ANC) visits are vital to optimize HIV testing and prevention services to reduce maternal and pediatric mortality and morbidity.  Late ANC attendance limits timely identification and delivery of HIV prevention services including pre-exposure prophylaxis (PrEP) among pregnant women at high risk for HIV infection.  To fill this gap, researchers are looking for ways to encourage pregnant women to seek ANC early and improve maternal and child health outcomes.  In Kenya, community pharmacies, also known as drug shops or chemists, are playing an increasingly important role as sources of over-the-counter sexual and reproductive health products, including urine pregnancy tests and HIV self-testing kits. These pharmacies offer important and under-utilized access points to ANC and HIV prevention care for women and have the potential to inform a new innovative PrEP delivery model.

Dr. Melissa Mugambi (Assistant Professor, Department of Global Health, Implementation Science Program) received a National Institutes for Health (NIH) Diversity Supplement Award to lead a study on the feasibility of engaging community pharmacy providers in the distribution of pregnancy tests and subsequent referral of pregnant women to ANC, in order to promote early access to ANC and PrEP.

World TB Day 2019: Global WACh’s emerging research contributes to global efforts to end TB

World TB Day, held each year on March 24, aims to raise public awareness about the devastating health, social, and economic consequences of tuberculosis (TB) and to step up efforts to end the global TB epidemic.  The theme of World TB Day 2019 – “It’s Time” – urges global health organizations and government leaders to accelerate the TB response and ensure access to care.

Global WACh researchers are working hard to discover more effective diagnostic, treatment, and prevention measures for a TB-free world.  They are collaborating with investigators on a number of studies, including HIV/TB immunopathogenesis and protection in infants and pregnant women, improved TB screening and novel non-sputum based diagnostics in HIV-infected and HIV-uninfected children and adults, and implementation of TB prevention in adolescents.  Continue reading for a summary of studies and a collection of publications.

Global WACh Researchers Share Latest Science at CROI 2019

Last week, Global WACh researchers participated in the Conference on Retroviruses and Opportunistic Infections (CROI) held in Seattle from March 5-7, 2019.  The annual conference brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases.  Our researchers shared their latest findings on testing for HIV, human papillomavirus (HPV), tuberculosis (TB), and on PrEP delivery practices.  Continue reading for highlights and a list of accepted posters by Global WACh researchers.

ATTACH Team Shares Findings at the Inter-CFAR Sub-Saharan Africa Symposium 2019

Global WACh’s ATTACH team shared scientific findings at the annual Inter-CFAR Sub-Saharan Africa Symposium from January 31st to February 2nd, 2019 in Nairobi, Kenya.  The annual symposium incorporates career development activities targeted to the needs of early career investigators, hold keynote talks addressing scientific topics of interest for African HIV research, and identify novel future research directions.  The team’s research posters generated a lot of interest in how adolescents transition from pediatric to adult HIV care, and opportunities to discuss overcoming challenges.

Global WACh Student Researchers Feature Posters at the 2019 Global Healthies

Photo credit: UW School of Public Health

On January 23rd, the University of Washington Department of Global Health held its annual Global Healthies Opportunities Fair and Poster Competition, which seeks to strengthen connections and start new collaborations for better global health impacts.  It was an exciting evening with a large presence of Global WACh faculty, staff, students and colleagues engaging around our Center’s research and training opportunities.

This year, 12 Global WACh research assistants and Certificate students competed in the poster competition across four distinct categories (Discovery and Development, Education and Training, Implementation and Application, and Public Health Service and Direct Care).  Research assistant, Danae Black (PhD Candidate in Epidemiology), had the winning poster in the Public Service and Direct Care category!  Her research unveiled new data in an area not well studied—the burden of tuberculosis (TB) and utilization of TB preventative therapies for HIV-infected adolescents in Kenya.  These therapies entail daily oral medication taken for up to six months without interruption to effectively prevent TB.  Danae’s findings identified frequent medication shortages across 101 HIV care facilities, meaning that a large number of patients exposed to TB have started therapy, but few have completed it.  The gaps leave patients, whose immune systems are weakened by HIV, at higher risk of developing potentially severe forms of TB.  The impact of Danae’s findings can help researchers better understand the current TB prevention efforts in Kenya and find ways to systematically improve health outcomes in this vulnerable population.

We are so proud of all our student researchers and their achievements.  Well done!

Global WACh Shares Novel Research Findings at International Conferences

Over Fall quarter, Global WACh researchers shared novel research findings from our three scientific priority areas (HIV Through the Lifecycle, Family Planning and Decision Support, and Gut Health and Child Survival) at several international conferences: The HIV Prevention for HIV Conference (HIVR4P), Union World Conference on Lung Health, and American Society of Tropical Medicine & Hygiene (ASTMH) Continue reading for conference highlights and photos!

Global WACh Attends 2018 AIDS Conference in Amsterdam

The International Aids Society hosted the 22nd International AIDS Conference (AIDS 2018) in Amsterdam from July 23-27, 2018.  This year, the conference objectives focused on advancing knowledge of HIV through research findings, promoting evidence-based HIV responses tailored to key populations, activating and galvanizing political commitment and accountability, addressing gaps in and highlighting the critical role of HIV prevention, as well as spotlighting the epidemic and HIV response in Eastern Europe and Central Asia.

Global WACh faculty, staff, student research assistants, and international collaborators had a strong presence at the conference to share and discuss a number of selected abstracts.  In total, 12 members attended, with four selected abstracts for oral presentations and seven poster abstracts at AIDS 2018.  Some members participated in the pre-conference event, the 10th Workshop on HIV Pediatrics from July 20-21, where eight selected poster abstracts were featured.

Global WACh researchers at the HIV Pediatrics Workshop, a pre-conference event to the International AIDS Conference in Amsterdam. Pictured from top left to right: Grace John-Stewart, Anjuli Wagner, Danae Black, Kristin Beima-Sofie, Irene Nujunga. From bottom left to right: Cyrus Mugo and Dr. Keshet Ronen

 

Global WACh Researchers Head to 2018 AIDS Conference!

 

Several Global WACh researchers are heading to Amsterdam, Netherlands for the 22nd International AIDS Conference (AIDS 2018)!  Many are also attending the pre-conference Workshop on HIV Pediatrics. Whether attending as invited speakers or participants, we’re pleased that our researchers have a presence at IAS, the largest conference on any global health or development issue, and provides a unique forum for the intersection of science, advocacy, and human rights.  Global WACh is proud to support global leaders who are committed to positively impact the lives of women, adolescents, and children.  See the full list of selected abstracts here.

Study to make HIV testing informational videos and use saliva-based HIV testing in children launched in Kenya

Most people assume HIV testing involves blood.  While blood is the most commonly used, saliva is an alternative specimen to test and diagnose HIV in adults and adolescents.  Benefits of saliva-based testing include the ease of collecting samples and increased acceptability of HIV testing.  One example of a saliva-based test is OraQuick, a device used to collect and rapidly test saliva.

The OraQuick test strip collects saliva from patients’ upper and lower gums, then is inserted into a tube to test for HIV.  The saliva reacts to liquid in the tube and travels up the stick.  If only the upper line appears, the test is negative. If both lines appear, the test is positive.

Saliva-based testing has produced very good results in adults; however, very few studies have evaluated this method among children Considering the ease of collecting saliva compared to drawing blood using a finger prick (ouch!), saliva-based testing is a good alternative for this population in need of early HIV testing, diagnosis, and care.

Last week, Global WACh and the University of Nairobi launched a new study to address this need.  Led by Post-Doctoral Fellows, Drs. Anjuli Wagner and Irene Njuguna, the Saliva Testing and Video Information to Expand Uptake of Pediatric Testing (STEP-UP) project aims to validate the OraQuick test in children ages 18 months to 12 years old.  The project will also develop and evaluate the effectiveness of video pre-test information session prior to HIV testing.  Both strategies aim to increase pediatric HIV testing in outpatient clinics in Kenya, where high patient volumes make it difficult for healthcare staff to offer adequate HIV counseling to every client.

The STEP-UP study team completed a training to learn about OraQuick and how to perform the test.  The team had a great time participating in team building exercises, practicing collecting saliva from one another, and ending the training with a team dinner.  Check out photos below!

The STEP-UP study team from UW and the University of Nairobi

Lukio fills in questionnaire answers to a mobile data collection tool called Open Data Kit (ODK), while the OraQuick reaction is taking place in the background.

Tamasha practices using the OraQuick test kit, placing the test strip in the reaction fluid.

Tamasha practices using the OraQuick test kit, placing the test strip in the reaction fluid.

The study team will start recruiting participants this month in multiple clinics in Kisumu, Siaya, and Homa Bay counties in Kenya.  They hope to test 1,050 children for HIV and the HIV video consultation in 150 participants.  The team will also include a series of focus group discussion about patient and health care workers’ perceptions about using the OraQuick test and video consultation.  The STEP-UP project is anticipated to end in August 2019.