Research

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 specimen, saliva is an alternative method 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.

Last week, 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 enjoying a delicious dinner together.  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 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.

Successful staff training for PrIYA and PrIMA, HIV-prevention projects

We love receiving updates from our research partners in Kenya!  Last week, two HIV-focused projects, led by the Kenyatta National Hospital, Global WACh, and International Clinical Research Center (ICRC), held successful staff trainings in Kisumu, Kenya.  Both projects emphasize the use of oral pre-exposure antiretroviral prophylaxis, or PrEP, among adolescent girls and women who are at the greatest risk of HIV infection.  PrEP is a daily anti-HIV medication that a person who does not have HIV takes to prevent infection.  If taken daily as prescribed, PrEP is highly effective in stopping the HIV virus from taking hold and spreading throughout the body.


PrEP Implementation for Young Women and Adolescents (PrIYA) seeks to programmatically evaluate PrEP implementation, and determine best practices for providing PrEP to young women and adolescent girls in Maternal and Child Health (MCH) and Family Planning Clinics.  At the training, PrIYA study staff discussed their successes and challenges after four months of providing PrEP clinical services, such as prescribing and counseling for the drug, follow-up care, and blood spot testing to measure drug levels to over 3,000 women.  They also discussed their experiences to establish data tracking systems and improve ways to procure PrEP for their patients.  More information on PrIYA is available here.

PrEP Implementation for Mothers in Antenatal Care (PrIMA) is a cluster-randomized trial in 20 MCH clinics that follows women during their pregnancies through nine months postpartum to assess HIV incidence and other outcomes among those who use PrEP and those who do not.  Offering PrEP to women at the greatest risk of HIV may maximize effectiveness, safety, and cost-effectiveness.  In anticipation of the study’s launch in October, forty new PrIMA staff members received training on the study procedures.

PrIYA_PrIMA Training 1

We look forward to sharing more updates as both studies progress.  Stay tuned for future posts!

Study achieving optimal neurodevelopmental outcomes in HIV-Infected Infants

HIV infection can result in neurodevelopmental impairment in children. We do not yet understand the extent to which effective antiretroviral therapy (ART) prevents these delays, but Global WACh researcher Dr. Sarah Benki-Nugent’s recent study, conducted in collaboration with researchers at the University of Nairobi, has provided insight to help answer this question. Their study focused on HIV-infected infants in Nairobi Kenya who received ART from the time of infancy and compared their developmental milestone attainment to HIV-unexposed infants.

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Sarah Benki-Nugent, MS, PhD, is the study’s lead investigator and Acting Assistant Professor at University of Washington Department of Global Health

Most HIV-infected infants in their study were extremely ill at the time of HIV diagnosis and many were first identified in the hospital. Unfortunately, late diagnosis continues to be common in Africa and UNAIDS has recently estimated that only about half of HIV-infected children are receiving treatment.

The study found that overall, HIV-infected infants had later age at attainment of milestones compared to unexposed infants. However, infants who had better responses to treatment had better developmental outcomes. Benki-Nugent and Kenyan research collaborator Dalton Wamalwa say, “We still don’t’ know how children will do in the long-term; however, this data suggests that effective response to ART provided some benefit, even in a group of infants who were very sick when first diagnosed.”

The study suggests that early HIV diagnosis and successful treatment are likely key factors in retaining cognitive and motor neurodevelopment in HIV-infected children. It is also likely critical, Dr. Benki-Nugent says, to provide additional strategies, such as parenting support for early childhood development alongside HIV treatment to help children reach their full potential.

Click here to read more about the researcher’s work recently featured in Infectious Disease Advisor.

Certificate capstone brings together experts in adolescent health to understand early gender socialization

In fulfillment of her Global WACh Certificate Capstone, Marina Plesons worked with a team of adolescent, sexual, and reproductive health professionals from the WHO, USAID, Gates Foundation, and the David & Lucille Packard Foundation to write a commentary for the Journal of Adolescent Health. The paper considers the implications for action and research of the Global Early Adolescent Study’s formative qualitative research on gender socialization.

GEASThe Global Early Adolescent Study (GEAS) aims to understand the factors in early adolescence that predispose young people to subsequent sexual health risks, and conversely promote sexual and reproductive health and well-being. In her capstone presentation last week, Marina commented on the fact that ages 10-14 are among the most critical for human development, but are a comparatively poorly understood life stage. This work thus serves to investigate the social processes that shape young people’s health and development, especially as this relates to gender norms informing adolescent sexuality.

Gender inequities are a key underlying determinant of the sex-specific differentials in morbidity and mortality of adults, and adolescents. Gender inequities manifest in different ways, such as discriminatory laws, policies, and socio-cultural practices or unequal power, access, and control over resources. At the root of inequities are gender norms and attitudes, which prescribe different status, power, access, and behaviors (including in relationships) according to culturally appropriate expectations for males and females. If we understand how gender norms for young adolescents are enforced, reinforced, challenged, and accepted, then we can be better address these in programs and interventions to improve adolescent and adult health.

Marina’s contributions to the paper included key themes in which gender norms and attitudes manifest in the lives of young adolescents, their peers, and their families in a number of countries. The team then extrapolated seven key programmatic and policy recommendations for ways that the global community can promote gender equitable norms and attitudes in early adolescence.

We can expect the paper to be included as part of a Journal of Adolescent Health special supplement this year, featuring the results from Marina’s work. We look forward to sharing when it is released!

Throughmarinaout her capstone and internship with the WHO, Marina also worked closely with her faculty advisor, Dr. Donna Denno.

Marina Plesons is an MPH candidate in the department of Global Health, and President and Co-founder of Health Advocacy Innovations, Inc.

Global WACh Seed Grant recipient publishes at PLOS One

As part of our commitment to meaningful research collaborations, Global WACh offers Integrated Health Seed Grants: one-year of seed funding for pioneering research to improve the health of women, adolescents, and children. The proposals we award recognize a global focus on community advocacy and innovative exploration.

Dr. Linnet Masese is a Postdoctoral Fellow at the University of Washington Department of Medicine

In 2011 we awarded the seed grant to Dr. Linnet Masese, who at the time was a doctoral student at the UW Department of Epidemiology, and Clinic Section Head at the UW/University of Nairobi Research Site in Mombasa. Her original proposal was to explore the feasibility of Chlamydia trachomatis screening among adolescents and young women in Kenya. However, with nucleic acid amplification testing locally available at the UW Research Laboratory in Mombasa, she expanded the study to include screening for Neisseria gonorrhoeae and Trichomonas vaginalis. We are thrilled to report that the first of three papers from this study titled “Barriers and Facilitators of Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya” was recently published in PLOS One.

Dr. Masese’s work centers around one of the earliest reproductive health challenges faced by young women as they become sexually active: the risk of sexually transmitted infections (STIs). Young women bear the greatest burden of STIs as they face significant barriers to STI screening. Through focus group discussions and in-depth interviews, Dr. Masese and her study team identified the barriers to STI screening among adolescent girls and young women in Mombasa, Kenya (PLoS One paper). Based on findings from this qualitative study, they developed a screening intervention for adolescent girls and young women in Mombasa (manuscript submitted to STD).

As a center dedicated to fostering new discovery and career development, we couldn’t be happier to support this research achievement in Mombasa and we look forward to following the improvements in sexual health education and STI screening as a result of your work.

WACh Priority Areas in Focus: Family Planning Decision Support

Our third and final Scientific Priority Area hones in on the life-saving ability of family planning services. Women face significant barriers to finding a contraception method that fits their unique needs, or gaining access to support to make informed reproductive decisions.

By providing new support and data collection tools, we can bring the health care system closer to women and their families, bring their health concerns to the attention of decision makers, and reduce the unmet need for family planning.

We can provide Family Planning Decision Support.

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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.

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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.

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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.