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Global WACh’s Gut Health & Child Survival researchers at the 2017 ASTMH Conference

GutHealthChildSurvivalTeam

From November 5th-9th, researchers from the Global WACh Gut Health and Child Survival team attended the 66th American Society of Tropical Medicine and Hygiene (ASTMH) Conference in Baltimore, Maryland.  ASTMH is the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and improving global health.  At the conference, our researcher gave oral presentations and shared research findings, which support the global goal towards eliminating tropical diseases and saving lives.  Meet our researchers and learn about their work below!

Symposium_ASTMH 2017

The team’s co-leaders, Dr. Judd Walson and Dr. Patty Pavlinac, along with Kirk Tickell, participated in a symposium session centered on mechanisms of post-discharge mortality and interventional targets.  Hospital discharge represents a critical time period where highly vulnerable children can access interventions to reduce the risk of dying.  The talk presented evidence from the ongoing work of Global WACh’s Childhood Acute Illness and Nutrition Network (CHAIN) and the Toto Bora trial in Kenya, which is testing the efficacy of certain antibiotics in reducing illnesses and the risk of death among children after hospital discharge.  In a separate talk at ASTMH, Dr. Walson presented on the DeWorm3 Project, a global effort to test the feasibility of eliminating soil-transmitted helminths, a type of intestinal worm, using intensified mass drug administration strategies.  Dr. Pavlinac also presented data from a study in Kenya in which stool was collected from children and caregivers to identify potential sharing of gut pathogens that can cause diarrhea and malnutrition, such as Cryptosporidium. This study found evidence of household transmission of Cryptosporidium infection, which highlights the need for interventions to target both children and caregivers to achieve maximal benefit.

Arianna Rubin Means_ASTMH 2017Dr. Arianna Rubin Means, PhD, works on the DeWorm3 Project with Dr. Walson. The World Health Organization (WHO) estimates more than 1.5 billion people are infected with STHs worldwide.  Dr. Rubin Means shared a review of strategies that community-based public health programs used to increase treatment coverage for health campaigns, such as child immunizations and drug administration for neglected tropical diseases, and evaluate their influence on improving coverage.  The review revealed the strategies with the highest influence of coverage included community-based delivery programs, and programs managed by community members or NGOs.  These findings support the DeWorm3 project’s model to administer community-wide deworming drugs to people of all ages.  DeWorm3 will perform within existing STH elimination programs in Asia and Africa in partnership with governments, research institutes, and global disease experts.

Stephanie Belanger_ASTMH 2017Stephanie Tornberg-Belanger, MS is a Research Assistant for the CHAIN study and PhD Student in the Department of Epidemiology.  Prior to recruiting patients, multiple CHAIN study sites in Bangladesh, Kenya, Pakistan, and Uganda underwent a baseline assessment of inpatient antibiotic prescription practices.  Stephanie and her team aimed to determine if sites followed the study’s prescription guidelines.  Their findings revealed that 82% of sites followed prescription guidelines, and emphasize the need for new or existing diagnostics to improve antibiotic stewardship.

 

 

Rebecca Brander_ASTMH 2017Rebecca Brander, MPH, is a PhD Epidemiology student and a Research Assistant for the Toto Bora trial.   Her study poster focused on linear growth faltering, or stunting (low height-for-age ratio), among young children 0-59 months old with moderate-to-severe diarrhea.  According to WHO, stunting in early life impairs growth and development, and can lead to negative socioeconomic and health consequences in adulthood.  Rebecca’s study identified critical windows of opportunity for nutritional interventions in early life and during hospitalization for diarrhea.  Younger children, particularly under the age of 3 months; children suffering from severe diarrhea and malnutrition who may be at the highest risk of stunting; and children not considered stunted during their diarrhea period, but at risk of stunting from other causes, may all be most likely to benefit from nutritional interventions.

 

Emily Deichsel_ASTMH 2017Research Assistant to the ABCD trial and PhD Epidemiology student, Emily Deichsel, MPH, presented a poster on the role of maternal and infant diarrhea in early childhood stunting (low height-for-age ratio) among HIV exposed, uninfected (HEU) children. The study followed and collected data from the HIV-infected mothers and their HEU newborns for 12 months after birth.  17% of HEU children were stunted at 12 months old and 8% were stunted at 2 weeks old.  Emily’s study concluded that mother and infant diarrheal episodes and household crowding were risk factors for stunting among HEU children. By identifying children at risk of stunting and intervening early, these infants may have the opportunity for better health throughout all stages of life.

 

Dorothy Mangale_ASTMH 2017CHAIN Research Coordinator, Dorothy Mangale, MPH, presented a poster on the high frequency of HIV exposure among malnourished children with acute illness in western Kenya. This study highlighted the overlapping burden of HIV-exposure and malnutrition which suggests that HIV and malnutrition programs need to address the two conditions simultaneously. With the absence of nutritional management guidelines of HIV exposed, uninfected (HEU) children, and lack of consideration of HIV exposure in malnutrition guides there is a crucial need to integrate nutritional programs with HIV services.

 

 

 

 

 

Congratulations to the team for contributing their successful research discoveries that work towards the goal of improving child survival!

Global WACh Seed Grant Recipient Publishes in More Journals

Linnet MaseseEarlier this year, we featured Dr. Linnet Masese, then a Postdoctoral Fellow at the University of Washington’s Department of Medicine, as well as a 2011 Global WACh Integrated Health Seed Grant recipient.  Dr. Masese has conducted meaningful research collaborations around the risk of sexually transmitted infections (STIs) among adolescents and young women in Kenya and the barriers they face to STIs prevention, care, and support.  The first of three papers (“Barriers and Facilitators of Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya”) from her study supported by seed funding was published in PLOS One in January 2017.  We are thrilled to announce the remaining two papers were recently published in scientific journals.

In the paper titled, “Parents’ and teachers’ views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study,” Dr. Masese and her study team focus on the acceptability of STI screening in schools for adolescent girls.  Parents and teachers can play crucial roles to influence adolescents’ reproductive health choices, thus, the study team felt it was important to understand parents’ and teachers’ attitudes towards sexual health education.  Through focus group discussions and in-depth interviews, the team discovered a great need to improve parent-adolescent communication around sexual health, to lessen the taboo nature of discussing sex.  Based on findings from this qualitative study, parents and teachers’ views on the acceptability of school-based STI screening suggest that expanded interventions are possible in this community. Data from this study may assist the work of other researchers and program planners with an interest in STI screening and adolescent sexual health.  This paper is published in Reproductive Health.

Based on findings from the first two papers, Dr. Masese and her team developed a screening intervention.  In the third paper, published in Sexually Transmitted Diseases,  (“Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya: Feasibility, Prevalence, and Correlates”), they recruited adolescent girls and young women from high schools and universities to pilot a clinic-based STI screening.  After attending information sessions, a substantial number of interested young women were willing to undergo the screening, many of whom were university students and did not need parental consent.  The study results highlight the strength of using school-based sensitization as a way to encourage adolescents and young women to seek STI diagnosis and care at health clinics.  While the clinic-based STI screening intervention suggested an effective school-based approach to decrease barriers for STI screenings among young women, younger adolescents continue to face the barrier of parental consent for screenings.

Both studies highlight the need to tailor or design reproductive health services to meet the needs of adolescents and young women.  Dr. Masese and her study team’s research achievements conclude school-based STI screening is feasible and acceptable when conducted in collaboration with students, parents, and teachers.  We congratulate Dr. Masese and her team for their excellent work, and look forward to learning how their work informs new approaches to improve sexual health education and STI screenings.

Global WACh goes to Paris to share research findings at the annual International Aids Society (IAS) Conference

 

Last week, Global WACh researchers shared their study results with HIV/AIDS experts across the globe at the International AIDS Society Conference in Paris, France.  Check out highlights from Global WACh studies on family planning misconceptions among postpartum adolescents, low retention of women enrolled in Option B+ in Mozambique, financial incentivization for pediatric HIV testing, and a cost analysis for young adults seeking free HIV testing services below. Their studies contribute to HIV science and the global effort to eliminate HIV/AIDS worldwide.

Paris

Drs. Irene Njuguna (right) and Anjuli Wagner (left) visit the Eiffel Tower in between sessions at the IAS Conference 2017

Invited Talks from Global WACh Members  

Dr. Alison Drake was an invited plenary speaker at the 9th Annual Pediatric HIV Workshop. She gave a presentation entitled A Last Barrier to eMTCT: Acute HIV Infection in Pregnancy and Breastfeeding.”

Dr. Anjuli Wagner was an invited panelist at a CIPHER satellite session in a discussion on “The role of implementation science in pediatric and adolescent HIV”.

Dr. Grace John-Stewart gave a talk on “mHealth interventions for ensuring effective Prevention of Mother to Child Transmission” at the IAS mHealth and Global HIV Response Workshop.

Poster Presentations from Global WACh Scholars and Researchers:

Dr. Alison Drake: “Desire to prove fertility and contraceptive misconceptions delay family planning and condom use until after pregnancy among Kenyan adolescents”

AlisonAdolescent women in Kenya are experiencing a high risk of unintended pregnancies and HIV infection. Dr. Alison Drake and her team hoped to better understand these misconceptions, and reveal their impact on HIV prevention and family planning decisions. The team surveyed postpartum HIV-free adolescents at two maternal-child health clinics in Western Kenya. Despite familiarity with contraception methods, many adolescents held misconceptions on the social acceptability of using them. Many believed that long-term methods increased the risk of HIV infection and transmission. Should they become HIV-positive, some feared harmful side-effects by combining medication with the birth control hormones. Family Planning Health Care Workers (FP HCW) were also surveyed on their perception of contraception effects and benefits. FP HCW did not feel supported in training and experience, and lack of staff to manage more patients. Overall, the team found that adolescent’s perception of contraception is shaped by social norms and misinformation from their community. The study suggests the need for innovative strategies to encourage dual method use (condom and another method), utilize of mobile health tools, improve HCW training and experience, and integrate family planning in prenatal care.

Dr. Irene Njuguna, “Financial incentives to increase pediatric HIV testing in Kenya (FIT STUDY): A randomized trial

IreneChildren with HIV infection have a high risk of dying if they are not diagnosed and treated early. Finding older children with HIV is challenging because there aren’t built-in health systems for systematic HIV testing of exposed children once PMTCT is completed. Reasons why parents don’t have their children tested include fear or denial that their children may be infected and financial burdens. The FIT Study will determine whether small cash incentives can motivate HIV-infected parents to test their children for HIV. Irene Njuguna, PhD Epidemiology student, presented FIT’s pilot research poster at the conference. The pilot study recruited 60 HIV-infected mothers with children of unknown HIV status, who were randomly assigned a cash incentive valued at $5, $10, or $15USD. 72% of women completed HIV testing for their children, which was significantly higher than unincentivized testing rates in a previous study in the same region (14%). Dr. Njuguna is now leading a trial evaluating incentive efficacy, which is enrolling 800 HIV-infected caregivers and will compare testing rates between no incentive and $1.25, $2.50, $5 or $10.

 

 

Anjuli Wagner, “Can Adolescents and Youth in Kenya Afford Free HIV Testing Services? A Cost Analysis”

AnjuliAlthough free HIV testing services may be available to adolescents and young adults (AYA), non-medical costs related to travel and time off school or work may pose as barriers for AYA to actually access such services.  Anjuli Wagner, post-doctoral fellow worked with a team from the University of Washington, University of Nairobi, and Kenyatta National Hospital to identify those costs and the possible burden they cause to AYA. The study interviewed 189 AYA aged 14-24 who completed free HIV counseling and testing at Kenyatta National Hospital. The team discovered 62% of AYA paid for non-medical costs, such as transportation and meals during their HIV test visit. Most AYA are students and unemployed, and 42% reported missing at least half a day of school to accommodate travel time and HIV testing services. The results suggest achieving universal HIV testing among AYA may require interventions to reduce their burden of indirect costs.

 

 

 

Keshet Ronen, “SMS messaging to improve adherence to PMTCT/ART: perspectives on HIV-related content among peripartum HIV-infected women in Kenya”

KeshetKeshet Ronen, PhD, research scientist, presented data on SMS messaging preferences among pregnant and postpartum women with HIV. There is growing evidence that SMS can be used to improve HIV treatment adherence and retention in care, but there has been concern about risks of HIV status disclosure through phone messages. In formative work for an ongoing clinical trial that evaluates the impact of SMS messaging on HIV treatment and prevention of mother-to-child transmission, Mobile WACh-X, 10 focus group discussions were conducted with 87 peri-partum women to explore their preferences regarding SMS containing overt HIV-related language or language that may bring attending to the recipient’s HIV status (e.g. ‘HIV’, ‘ART’, ‘infection’, ‘medication’). Some women desired overt messages regarding their HIV medications and the option to ask overt questions using the mHealth system, while some women, especially those who had not disclosed their status or shared their phone, preferred to receive and send only covert messages. Based on these findings, the Mobile WACh-X system was designed to provide all three options and allow women to choose. In the ongoing trial, most participants who have disclosed their status or own their own phone chose either overtly HIV-related SMS (65% of participants) or the option to send overt messages to the system (10% of participants).