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Global WACh Wishes Margaret Thompson, Pre-Award Grant Manager, a Happy Retirement!

 

With sadness but warmest wishes for her future, Global WACh announces Margaret Thompson’s retirement on August 1st.  She has supported the Center as the Pre-Award Grant Manager, helping faculty and trainees navigate the complex grant submission processes in pursuit of scientific discovery to benefit women, adolescents, and children around the world.  She also serves as the Program Manager of the Kenya Research & Training Center (KRTC), supporting the administrative and operational needs of the Center and its faculty members. She is a critical social presence in the workplace, assisting with the University’s Whole U “Raise The Bar” initiative last summer and hosting the annual holiday party in her home.

SCOPE trains community leaders and health workers as Maternal Health Advocates for FLAME study

In June, the SCOPE program held a training for their FLAME study in Gondar, Ethiopia. FLAME, which stands for Faith Leaders Advocating for Maternal Empowerment, is testing an intervention that brings communities together to improve access to antenatal and delivery care for women in rural Ethiopia. The training brought 122 community leaders and health workers from across the North Gondar region who will be change agents in their community and promote safe pregnancy and delivery. The study, led by Dr. Getahun Asres at the University of Gondar, will follow the work of these change agents, known as Maternal Health Advocates, over the next year to see if their outreach increases the use of lifesaving and free health services in Ethiopia.  Follow our graduate student fellows from the University of Washington on the SCOPE blog, SCOPE stories, as they work alongside our partners at the University of Gondar in implementing the program.

Dr. Jillian Pintye receives award to measure antiretroviral exposure in mothers and infants using hair samples

Dr. Jillian Pintye, PhD, RN, MPH, Senior Fellow and Trainee with Global WACh and the Department of Global Health, is a recipient of a NIH R21 Exploratory/Developmental Research Grant Award!  Her project entitled “Assessing Mother and Infant Antiretroviral Exposure Using Hair Measures” is a two-year grant that will begin in the coming weeks and end during summer 2020.  She is serving as one of two Primary Investigators with Dr. Monica Gandhi from the University of California, San Francisco (UCSF), who is a leader in the field of HIV and women, and biomarkers for antiretroviral therapy exposure.

Together, they are working with Dr. Deborah Kacanek from the Harvard School of Public Health (HSPH) to learn more about antiretroviral exposures from pregnant women to their babies.  Although antiretroviral (ARV) medication is a key strategy to prevent maternal-to-child HIV transmission (PMTCT), there is less research around the degree of transfer of ARV from mother to baby during pregnancy.  How much of the medication actually transfers to babies in utero?

To answer this question, Dr. Pintye and her team will analyze ARV concentrations from 700 hair samples collected from the NIH-funded “Surveillance Monitoring for ART Toxicities Study in HIV-uninfected Children Born to HIV-infected Women (SMARTT)” study cohort.  Some ARVs can be harmful to mothers and babies, and the adverse health outcomes varies from drug to drug.  By measuring hair concentrations, the team can find patterns of drug exposure and toxicity levels, and assess which HIV regimens are safe and effective.  ARV toxicity is a concern because it is associated with adverse birth outcomes, manifesting as stillbirths, low birth weight, or birth defects.  Lower toxicity to babies in utero reduces adverse pregnancy or other infant outcomes.

The results of this study will help inform researchers and health care providers on which regimens HIV-positive mothers should take during pregnancy.  Selecting the right medication can maximize protection for PMTCT, while minimizing toxicity to the infant and saving their lives.

Congratulations to Dr. Pintye and her colleagues for their award!  We look forward to learning what their research reveals.

You’re invited to Global WACh’s annual end-of-year celebration!

THURSDAY, MAY 17TH 
4 – 6 PM
University of Washington Husky Union Building Lyceum
4001 Stevens Way NE, Seattle, WA 98115

Kindly RSVP your attendance: https://goo.gl/forms/w6c26tU9S4HJ1kri2 

Join us in celebrating our achievements this year in research, training, and service!  Dr. Amita Gupta, MD, MHS of Johns Hopkins University will present the keynote address for our exciting one-hour program featuring speakers leading in the field of preventing mother-to-child pathogenic transmission.  Following the program, come network with Global WACh researchers and community members at our reception and poster session.  We are pleased to feature capstone projects of graduating students from the Global WACh Certificate Program.  Light refreshments will be served.

Welcome Address

Dr. Grace John-Stewart, MD, PhD, MPH
Director, Global WACh
Professor, UW Epidemiology, Global Health, Medicine, and Pediatrics

 

 

Keynote: Inclusion of pregnant women in therapeutic trials for prevention and treatment of infectious diseases. Why it really matters!

Dr. Amita Gupta, MD, MHS
Deputy Director, Johns Hopkins Center for Clinical Global Health Education
Associate Professor, Johns Hopkins School of Medicine Infectious Diseases Division

 

Caregivers as a potential source for Cryptosprodium infection in Kenyan children

Dr. Patricia Pavlinac, PhD, MSc
Assistant Professor, UW Global Health

 

 

Preventing HIV acquisition among mothers during pregnancy

Dr. Jillian Pintye, PhD, RN, MPH
Senior Fellow, UW Global Health

 

 

Herpesviruses and HIV-infection in women and their children: Emerging opportunities for intervention

Dr. Jennifer Slyker, PhD, MS
Assistant Professor, UW Global Health
Adjunct Assistant Professor, UW Epidemiology

 

 

An exoskeleton to improve walking in children with neuromuscular disorders

Jessica Zistatsis, ME
Graduate Researcher, UW Steele Ability & Innovation Lab

 

 

 

Planning to drive to the event?  Parking is available in  Pedelford Garage, which is conveniently located near the Husky Union Building (HUB).

International Women’s Day 2018: Celebrating Women in Science

On International Women’s Day, we celebrate women in science who dedicate their knowledge and expertise to improve the health of women throughout all stages of life.  Women and girls can build a healthier future for generations to come and it is important nourish, educate, and empower them.  Today, we are pleased to feature a story of one researcher’s journey to self-empowerment through her research explorations.

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In March and September of 2017, Global WACh highlighted Dr. Linnet Masese (then a Postdoctoral Fellow at the UW Department of Medicine and Clinic Section Head at the UW/University of Nairobi Research) and three published manuscripts from her study supported by Global WACh seed grant funding in 2011.  The grant award marked her entry into adolescent reproductive health research, a field she has grown to love despite the challenges accompanying clinical research on adolescents. These include long waits for ethical committee review approvals, low participant recruitment and retention, and issues around consent, confidentiality, and parental roles in supporting in the research protocol. The challenges she faced and overcame have only fueled her passion in this field.

 “I had always worked with adolescents through my church but working on adolescent reproductive health provided a distinctive avenue through which I could impact and train the girls on reproductive health matters. Besides talking about reproductive health issues, visiting high schools and universities provided a mentorship avenue. I have been able to reach out to and inspire many girls and young women. This has turned out to be an immensely rewarding experience.”

As part of her doctoral research at UW under the mentorship of Dr. Scott McClelland, Dr. Masese conducted a study to assess the incidence and correlates of chlamydia in a cohort of high-risk women in Mombasa, Kenya. Their research demonstrated that the incidence of chlamydia infection among young women under 25 years in Mombasa who reported transactional sex was 27.6/100 person-years, meaning 1 in every 4 young women acquired chlamydia during the study period.  They presented their findings to visiting faculty from the University of Nairobi (UoN) in 2011.  One of the faculty members, Dr. Grace Omoni asked if she had ever considered expanding her research to the general population of adolescents and young women, given the startlingly high incidence among high-risk women.  Because young women in Kenya bear the greatest burden of sexually transmitted infections (STIs), Dr. Masese took this question to heart.

“Luckily, this was around the time Global WACh put out its first call for the Integrated Health Seed Grant proposals!”

With Dr. McClelland’s help, she drafted a full proposal to conduct a study employing qualitative and quantitative methods to understand the feasibility of screening for STIs among female students (age 15-24 years) in high schools and colleges. The qualitative component included in-depth interviews and focus group discussions among adolescents, young women, parents of adolescents, and institutional leaders. The quantitative component involved STIs urine screenings of young women. After the proposal was awarded, Dr. Masese initiated the qualitative work as soon as ethical approval was granted.

Complexities around parental notification, confidentiality, and stigma soon arose. Dr. Masese demonstrated her ability to listen, understand, and consider everyone’s viewpoints and still meet her research goals.  In brief, she found that young women were willing to be screened for STIs and parents were willing to allow their adolescent daughters to be screened.  School settings, however, were not a preferred testing location, due to stigma. Therefore, sample collection and testing were conducted at the UW/UoN Clinic at Ganjoni and the UW Research Laboratory in Mombasa respectively.  With some adolescents and young women divided on their willingness to share test results with their parents, Dr. Masese worked with the Kenyatta National Hospital Ethics and Research Committee to determine the best, straightforward approach—to share results with parents only if their daughters gave verbal consent to do so.

Following the qualitative phase, she helped developed a school-based recruitment strategy linked to a clinic-based intervention, which successfully screened 451 girls and young women for STIs using a urine nucleic acid amplification test. The overall prevalence of STIs in this population was 5.8%.  Self-reported unprotected sex was associated with a 6-fold higher odds of having an STI.  Overall, Dr. Masese’s study and subsequent publications suggest that expanded school-based interventions are possible and can be a way to encourage adolescents and young women to seek STI screening, care, and support.  The results also suggest that STI screening interventions are feasible and acceptable when conducted in collaboration with students, parents, and influential members of the community.

Following the success of the study and gain of valuable research experience, Dr. Masese received funding in 2014 from the Fogarty International Center through the Northern Pacific Global Health Fellowship for a new adolescent study.  In this study, she used a method called “capture-recapture” to estimate the population size of girls 9-13 years who were not enrolled in school.  This population is important to follow in vaccination planning, as they would be missed by a school-based HPV vaccination program.  To further inform vaccine preparedness, Dr. Masese and her team will also quantify prevalence and correlates of high-risk HPV infection in 13-17 year old girls, both in and out of school.

Dr. Masese says she is excited about adolescent reproductive health research and hopes to continue working and impacting young people in Kenya and other parts of the world.  As she offers gratitude to Global WACh for helping her start her research career path, we show gratitude to her and all extraordinary women researchers for striving to improve life for themselves and for all women.

Dr. Jennifer Slyker Receives Funding Award from National Institute of Health

Jenn Slyker

Dr. Jennifer Slyker, PhD, MSc, Assistant Professor of Global Health and Adjunct Assistant Professor of Epidemiology, received a R21 National Institute of Health Exploratory/Developmental Research Grant Award to support on-going research on the risk factors and mechanisms of sexually-transmitted infections (STIs) and HIV/AIDS.  Dr. Slyker’s project titled “Cytomegalovirus (CMV) as a cause or co-pathogen in cervicitis” aims to determine whether CMV, a common virus that replicates in cervical tissue, contributes to cases of “non-specific” cervicitis and persistent cervical inflammation.

Cervicitis is usually caused by STIs and if left untreated, can lead to more serious infections of the uterus, infertility, and adverse pregnancy outcomes.  Cervicitis attributed to a “specific” bacterial infection can be easily treated.  However, up to 40% of women with cervicitis do not have a specific bacterial infection that can be identified. Understanding which bacteria or viruses contribute to these “non-specific” cases will help researchers understand better the basic biological processes of the condition and develop new treatments.

Dr. Slyker and her team plan to use data and specimens from a 20 year cohort of more than 2,000 female sex workers in Mombasa, Kenya led by Dr. Scott McClelland (Professor of Medicine, Epidemiology, and Global Health).  This long-term observational cohort has been invaluable in STIs and HIV/AIDS research at the University of Washington.  If CMV is found to be an important contributor to cervicitis, clinical trials can determine if antiviral medication is effective in treating non-specific cervicitis and cervicitis that does not respond to conventional treatment.

We congratulate Dr. Slyker for her award and look forward to learning how the study findings could benefit the large percentage of women globally with non-specific cervicitis!  The study is expected to end in 2020.

Global WACh Announces the 2017 Seeds for Change Recipients

Formerly known as the Small Change Awards, the Seeds for Change Awards are small infrastructure grants given to improve clinical care, patient satisfaction, workforce empowerment, and health service delivery for programs befitting the health of women, adolescents and children in resource-limited settings.  Global WACh partners with awardees in the spirit that small changes can have a big impact.

Applicants submitted proposals that outlined a low-cost solution to address gaps in patient care at their sites.  A panel of reviewers scored the proposals and selected ideas that demonstrated the most feasible, significant changes.  We are pleased to announce and congratulate six outstanding proposals to improve patient experiences and outcomes for women, adolescents, and children as winners of the Seeds for Change Award for 2017!

Institution  Awardee Award Purpose
Kenya Medical Research Institute, Research Care and Training Program
Nairobi, Kenya
Eliud Akama $990 An exclusive breastfeeding room for working mothers to promote optimal growth of their infants and workforce empowerment
Kenyatta National Hospital
Nairobi, Kenya
Dr. James Mburu Kang’ethe $947 A queue management system to improve high patient flow and ease of access to all HIV service delivery points
Kenyatta National Hospital, Comprehensive Care Clinic
Nairobi, Kenya
Dr. Manasi Kumar $424 Arts and craft supplies, games, hygienic items, and digital equipment as tools to better engage with young patients in a HIV peer support group
Pandi-Pieri Health Centre, HIV Care Clinic
Kisumu, Kenya
Jeniffer Muhanji $997 Diagnostic set for accurate patient diagnostics and furniture for a more comfortable patient experience
Migori County Hospital
Migori, Kenya
Dr. Joyce Wangari Ng’ang’a $900 A comfortable play therapy room for recovering ill and/or malnourished children and their caregivers
Rabuor Subcounty Hospital
Kisumu County, Kenya
Maureen Akinyi Ochieng $900 Comfortable seating, medicine storage shelves, and partitions between family planning and maternal-child health service areas to improve patient satisfaction

In the coming weeks, we look forward to sharing photos and updates from our recipients!  Click here to read more about this year’s award recipients and recipients from previous years.

The Seeds for Change Awards are supported through private donations from people like you. You can make a gift on our website’s Seeds for Change Award page or give through the UW Combined Fund Drive that supports more than 5,000 nonprofits in the UWCFD campaign (Charity 1481904).

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 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).