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.
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.
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.
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
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.
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
Dr. 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.
Dr. 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 email@example.com.
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
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.
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.
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.
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
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.
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
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.
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
May 26, 2016 – 8:30am to 5:00pm
Check-in begins at 8am. The workshop starts at 8:30 and continues until 5pm.
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.