News

Global WACh Researchers Heading to AIDS Conference in Amsterdam, Netherlands

 

Several Global WACh researchers are heading to Amsterdam, Netherlands for the 22nd International AIDS Conference (IAS)!  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.  Below is a list of selected abstracts to be presented at the conference and the presenter.

Abstracts and presentation information will be available on the IAS website as the conference progresses.

ORAL PRESENTATIONS


Tuesday, July 24th

Dr. Jillian Pintye, PhD, RN, Senior Fellow and Trainee, Global Health

Abstract Title: Uptake of PrEP within clinics providing integrated family planning and PrEP services: Results from a large implementation program in Kenya

Session Title:  Diversities in delivery: PrEP from home to clinic


Wednesday, July 25th

Dr. Kristin Beima-Sofie, PhD, Research Scientist, Global Health

Abstract Title: Case Studies from AHISA Members

Session Title: Adolescent HIV prevention and treatment implementation science alliance

 

Dr. Keshet Ronen, PhD, Research Scientist, Global Health

Abstract Title: Food insecurity is common and associated with unsuppressed viral load in HIV-infected pregnant women in Kenya

Session Title: Occupy the epidemic: Economic inequality and HIV (Oral Poster Discussion Session)

 

POSTER EXHIBITIONS AND POSTER DISCUSSION ABSTRACTS

Dr. Kristin Beima-Sofie, PhD, Research Scientist, Global Health
Poster Title: Assessment of adolescent HIV service delivery in Kenya: The PHASE Study

Dr. Alison Drake, PhD, Assistant Professor, Global Health
Poster Title: Modeling the cost-effectiveness of repeat maternal HIV testing in Kenya and South Africa

Dr. Jillian Pintye, PhD, RN, Senior Fellow and Trainee, Global Health
Poster Title: Low awareness of pre-exposure prophylaxis (PrEP) for protection against HIV transmission among HIV-infected women in HIV-serodiscordant couples in Kenya: Results from a nationwide survey

Dr. Keshet Ronen, PhD, Research Scientist, Global Health
Poster Title: HIV disclosure to partners among pregnant women receiving HIV care in Kenya
Poster Title: Engagement in bidirectional mobile messaging to support antiretroviral therapy (ART) adherence among peripartum women in Kenya

Dr. Brandon Guthrie receives award for mHealth intervention to improve transition from pediatric to adult HIV care

Congratulations to Dr. Brandon Guthrie, PhD, MPH, Assistant Professor of Global Health and Epidemiology, who received a NIH R34 Clinical Trial Planning Grant award to develop and test a mobile health technology (mHealth) based intervention to support youth transitioning from pediatric to adult HIV care in Kenya!  He is leading a team of researchers from the University of Washington, whoinclude Drs. Jennifer Unger, PhD (Assistant Professor, Obstetrics and Gynecology), Keshet Ronen, PhD (Research Scientist, Global Health), and Kristin Beima-Sofie, PhD (Research Scientist, Global Health). The team is also partnering with Dr. Megan Moreno, MD, from the University of Wisconsin School of Medicine and Public Health Pediatrics Department, and with long-time collaborators from Kenyatta National Hospital.

Dr. Guthrie’s award for the mPACT (mHealth strategies for the Pediatric to Adult HIV Care Transition) intervention will pilot a mHealth framework that uses a combination of group peer support and one-to-one communication with a healthcare provider specially trained in youth HIV care.  Youth (ages 10-24) represent a growing proportion of people living with HIV, and they are at high risk of disengagement during the transition of care.  For youth having grown up under the care of pediatric health care providers, they can feel reluctant to lose their relationship with providers.  Youth can also face challenges as they switch to an adult provider who is not knowledgeable about the unique care needs of adolescents living with HIV, nor have the flexibility to help facilitate the transition process.Lastly, youth may not feel prepared to assume independent responsibility for their health as needed in adult HIV care.  To keep youth linked to HIV care, it is important to find ways to provide adequate support that hinges on uninterrupted and successful transition to adult care.  Continuous HIV treatment not only improves the health of people living with HIV (PLWH) and their chances of survival, it is also a highly effective strategy to prevent HIV transmission to others.

mHealth is a promising approach to engage HIV-positive patients beyond the clinic as they are capable of sending medication reminders, educational messages, and opportunities for improved patient-provider communication through mobile devices.  These features have helped PLWH adhere to their treatment and care,and improve physical and psychological well-being.  Dr. Guthrie and his team hope the mPACT intervention will enable a high degree of engagement during the critical period of transition, and tailored communication that is responsive to the concerns of youth and their health care providers.

By April 2021, the team will develop messaging content and pilot mPACT to determine its effects on youth’s transition preparedness, antiretroviral therapy (ART) knowledge, and on psychosocial topics, like stigma, depression, and social and caregiver support.  The results from this project will help the team prepare for a larger trial to assess mPACT’s impact on successful transition and clinical outcomes.  We look forward to following their progress and sharing updates!

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.

Margaret was hired in 2002 to work with Dr. Grace John-Stewart (the current Director of Global WACh) and the International AIDS Research and Training Program (IARTP).  Margaret played a crucial role in supporting Dr. John-Stewart as she began mentoring young researchers in training, such as Drs. Michael Chung, Carey Farquhar, Scott McClelland, and Judd Walson, who are all now lead investigators of their own large studies and mentor trainees!  Over the years, she has crossed paths with students and fellows who have grown within the Department and now hold faculty positions affiliated with Global WACh and KRTC: Drs. Sarah Benki-Nugent, Alison Drake, Susan Graham, Brandon Guthrie, Sylvia LaCourse, Patty Pavlinac, Barbra Richardson, Alison Roxby, Jennifer Slyker, and Jennifer Unger to name a few!

Throwback photo of Margaret (far left) with researchers who are now current DGH faculty members.

What’s next after retirement?  Margaret plans to enjoy her time off, travel, exercise, spend time with her family, and possibly explore a new career path.  Perhaps we might see Margaret again at UW, but for now, we honor her 16 years of service and contribution to the Department of Global Health.  We will miss her warm personality, stylish and colorful fashion flare, and dedication to the team in the workplace!

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. Getahun Asres, who is leading FLAME, speaks to community participants at the training in June.

FLAME brings in community faith leaders to serve as Maternal Health Advocates, and promote safe pregnancy and delivery.

Faith leaders, community members, and health care workers gathered to learn how to advocate for improved access to antenatal and delivery care for women.

A training participant shares her thoughts.

Current SCOPE Fellow and UW Doctor of Nursing Practice student, Rebekah Maldonado-Nofziger, pictured with Dr. Getahun Asres

Community members received a certificate for participating in the training.

Photo credit: Florian Dahms
Participants provided consent to being photographed.

Congratulations to Global WACh Certificate Students, Class of 2018

This year, Global WACh graduated its largest class ever of Certificate Program students. Nine students from the Schools of Nursing, Public Administration, Public Health, and Social Work presented their capstone project posters at the “Next Big Thing” annual year-end celebration in May at the UW HUB Lyceum.

Students strike a pose at Global WACh’s Next Big Thing event.

The students’ poster presentations marked the end of their academic journeys in the program.  As students completed coursework and attended monthly meetings, they received mentorship, a foundation of knowledge and skills, and hands-on practical experience in the field of global health related to women, adolescents, and children.  Each student also completed a capstone project on a topic related to woman, adolescent, and child health and created a poster to highlight the outcome of their work.  Through their capstone work, students made invaluable contributions to ongoing projects at Global WACh, local health organizations, and institutions around the world.

We wish them the best in their future endeavors and look forward to seeing how they serve as leaders in global woman, adolescent, and child health!  Read more about the students’ capstone projects below.

Alyssa Bosold, MPH, Maternal Child Health Track

“Assessing contraceptive discontinuation to inform design of a mobile health survey in Kenya”

Alyssa conducted preliminary research for Dr. Alison Drake’s Mobile Data Collection of Contraceptive Use, Behaviors, and Experiences (mCUBE) study, which aims to learn more about contraception discontinuation behaviors among women through short SMS surveys.  Alyssa reviewed existing data related to contraceptive satisfaction, discontinuation, initiation, and method switching.  Major reasons included negative side effects reported by women, such as irregular bleeding, headaches, cramping, vaginal discharge, and discomfort during sexual intercourse to name a few.  Women also reported forgetting to use contraceptives or feeling too inconvenienced by the method to take them (specific to pills and condoms); concern about effectiveness and their partner’s disapproval.  Alyssa’s findings helped informed the design of mCUBE’s SMS survey questions.

Yilin Chen, MPH, Global Health Track

“A cost analysis of Mobile WACh X study in Kenya”

Yilin estimated incremental costs associated with one-way and two-way SMS interventions in Dr. Jennifer Unger’s Mobile WACh X study, which evaluates an interactive human-computer hybrid SMS intervention to encourage pregnant women to continue antiretroviral therapy (ART) in Kenya.  ART can reduce mother-to-child HIV transmission (PMTCT).  Through a combination of interviews with health facility staff at two sites (in an urban and rural setting) and analysis of expense report data, Yilin found the average cost of the intervention per patient ranged between $29 and $45. Due to higher patient numbers, costs were cheaper in the urban health center compared to the rural center.  Yilin’s results showed that a larger share of total costs relates to system development and communication factors, such as internet costs and mobile phone minutes.  This suggests that as the Mobile WACh X model scales up, there are opportunities to lower the costs.

Chantal Donahue, MPH, Global Health Track

“Multi-level correlates influencing provider deviations from established pediatric treatment and guidelines: A systematic review and meta-analysis”

The global research network, Childhood Acute Illness and Nutrition Network (CHAIN), led by Dr. Judd Walson as the UW Site Principal Investigator, learned through household surveys conducted in 39 countries that many acutely ill children aren’t provided with evidence-based interventions when they arrive at health care facilities.  Chantal teamed up with the UW CHAIN staff to screen over 2,800 abstracts and narrow down 57 eligible publications to lay the context for writing a new manuscript.  The literature review aimed to identify factors that influence provider behaviors and how far the behavior strays from pediatric care guidelines.  Chantal helped identify 18 correlating factors, with provider training, perceived disease severity, and patient age emerging as the most commonly studied.  This summer, Chantal is hired as a research assistant to help complete the review, which will help the team conduct a meta-analysis (a statistical analysis that combines the results of multiple scientific studies) to write a manuscript for publication.

Christina DuJardin, MSW, MPH, Global Health Track

“Human trafficking in Washington State: A demographic landscape”

As a dual Public Health and Social Work graduate student, Christina viewed a global issue through a local lens.  The International Labour Organization estimates that nearly 21 million people are trapped in forced labor and forced sexual exploitation.  WA State is considered an ideal location for human trafficking due to its shared international border with Canada, abundant seaports, rural areas, and economic centers.  Christina collected national and state data to create a demographic landscape.  She found 163 human trafficking cases reported in 10 counties across WA State, with more cases likely unreported.  Christina’s finding suggests the need for a single reporting system to better collect data, and inform strategies to intervene and prevent human trafficking practices on a local and global scale.

Sheldon Halsted, MPH, Global Health Track

“Situational analysis of infant feeding and religious fasting in North Gondar, Ethiopia”

As a Strengthening Care and Opportunities in Partnership in Ethiopia (SCOPE) Fellow last Fall, Sheldon explored the intersection between infant breastfeeding and religious fasting.  Religious fasting is an integral component of the Ethiopian Orthodox tradition, with over 200 fasting days per year, which poses a risk for poor health implications for mother and baby.  From a combination of literature reviews on religious practices related to breastfeeding, research on the Ethiopian infant feeding guidelines, and interviews with religious leaders and health care workers, Sheldon concluded that an intervention that advises pregnant and lactating women to change their fasting practices is not feasible.  Instead, the intervention could focus on the importance of a nutritional diet while fasting.

Elizabeth Karman, MPH, Global Health Track

“Teaching and Assessing Communication and Interpersonal Skills for Health Care Workers: A Video Analysis and Literature Review”

In Kenya, adolescents and young adults often report poor provider-patient interaction as a barrier to HIV care linkage and retention. The Simulated Patient Encounters to promote Early Detection (SPEED) study, led by Dr. Pamela Kohler, used a novel video-recorded standardized patient training intervention to improve communication skills and quality of care by using actors to portray young patients living with HIV.  Elizabeth reviewed the simulated videos and conducted literature review to identify other existing relevant assessment tools.  She compiled a list describing 23 commonly used tools to address the assessment gap.  Her findings included frequent mismatch between skills taught and skills assessed, and that many communication skills measured were not correlated with desired outcomes (such as increased patient satisfaction or perception of empathy).  There were no tools for communication and interpersonal skills specifically for the unique challenges (i.e. cultural differences, health system capacity, and provider training curriculum) in low-to-middle income countries.  Elizabeth shared several strong recommendations that can help SPEED and other studies improve patient-provider communication.  For example, if a health system is using an existing assessment tool, consider the level of validity and standardization for reliability, and use the tool in an appropriate context.

Wamaitha Kiarie, MPA, and Kellie List, MPA

“PATH Self-injection of DMPA-SC in Uganda: Evaluating best practices for introduction and scale-up”

Wamaitha and Kellie teamed up to assist PATH’s Self-Injections Best Practices project, which focuses on how a self-injection contraception (called DMPA-SC) model can scale up nationally in Uganda.  The project previously conducted five evaluation phases of self-injection best practices.  Based on the evaluation results, Wamaitha and Kellie offered suggestions on how to best design and effectively implement self-injection programs through various family planning service delivery channels.  Their suggestions included identifying partner organizations as stakeholders and involving them in the program planning and design, offering additional time to train health educators and providers about DMPA-SC, and including feedback from adolescents (who are a primary targeted population for this program) regarding the user-face design.

Carlie Sulpizio, MPH

“Surveillance of Zika-related microcephaly in sub-Saharan Africa and Asia”

For six months, Carlie served as an intern at the Pasteur Institute in Paris, France, where she assisted the surveillance of Zika-related health complications in Sub-saharan Africa and Asia.  Her capstone projected explored whether Zika is responsible for a neurological complication, microcephaly.  Carlie developed a manual to offer researchers an overview of the global incidence of microcephaly, and a description of the clinical, laboratory, and imaging characteristics of infants with Zika-related microcephaly.  She also translated REDCap survey questionnaires from English to French, in which the Pasteur Institute planned to conduct at several health facilities this summer.

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.

The mCUBE study, funded by Grand Challenges Explorations, seeks to understand women’s contraceptive preferences and behaviors in Kenya

Written by Alison Drake, Assistant Professor of Global Health, and Claire Rothschild, Epidemiology PhD student and mCUBE Research Assistant

As mobile phone ownership is rapidly growing around the world, crowdsourcing – asking questions to solicit information from large groups of people – is an increasingly attractive way to conduct global health research. In Kenya, nearly 90% of the population has access to a mobile phone,[1] and capturing data through mobile phones may provide a low-cost and effective solution for tracking health outcomes over time.

In 2017, Global WACh’s Dr. Alison Drake, Assistant Professor of Global Health, was awarded a Gates Grand Challenges Explorations grant to explore this idea – how mobile phones might be used to understand Kenyan women’s experience using family planning over time. Women and girls face major challenges using family planning, including side effects, stigma, cost, and barriers to access. Overall, 1 in 3 women starting a modern method of contraception stop using it within 1 year, and over half stop within 2 years.[2] This phenomenon is called the “leaking bucket”[3]  in family planning coverage, making efforts to achieve universal access to family planning worldwide extremely difficult.

In partnership with PATH-Kenya, the Mobile Data Collection of Contraceptive Use, Behaviors, and Experiences (mCUBE) study is collecting information from Kenyan women using family planning in real-time through surveys distributed directly to their phone via short message system (SMS). The survey technology, developed by the Kenya-based mobile technology firm mSurvey, allows SMS questions to be personalized based on language, family planning method, and prior SMS responses.

Dr. Alison Drake and the mCUBE research team at a January 2018 training in Kisumu, Kenya

The team developed short and simple SMS surveys in four languages (English, Swahili, Luo, and Kisii) that could easily be completed in 5-10 minutes, and could capture important information on women’s experiences and challenges using family planning methods. This task was challenging, as SMS questions need to be clear and straightforward enough to ensure women can complete surveys on their own, but within a 160 character count limit. In some instances, when text is translated from one language to another, the length of the translated text can differ. The team consulted with members of the Global WACh Family Planning Working Group and staff from Global WACh’s collaborating institution, UW-Kenya, to further simplify questions as much as possible.  The mCUBE study team enrolled participants from February 2018 to April 2018 from 10 public facilities across 5 counties in Western Kenya. A total of 1,270 women were enrolled, including 12% who didn’t have their phones at the time of enrollment and completed SMS registration remotely.

mCUBE Kenya Study Coordinator, Peninah Kithao, (right) meets with research assistant, Benard Otieno (left)

Once enrolled in the study and the SMS system, women receive weekly SMS surveys about their experience using family planning over the next 6 months.  mCUBE is also using SMS to collect information about the health facilities where women and girls are seeking their family planning care. Together, this information can be connected to individual participants, providing insight into the quality of family planning services and the impact quality may have on family planning use and satisfaction.

We look forward to seeing the results of the study, with completion of follow-up anticipated in October 2018!


[1] http://www.ca.go.ke/index.php/what-we-do/94-news/366-kenya-s-mobile-penetration-hits-88-per-cent
[2] Castle S, Askew I. Contraceptive discontinuation: reasons, challenges, and solutions. FP2020, Population Council. 2016 [cited 12 September 2017]. Available from: <http://www.familyplanning2020.org/microsite/contraceptivediscontinuation>
[3] Jain AK. Fertility reduction and the quality of family planning services. Stud Fam Plann. 1989;20(1):1-16.

 

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.

Spotlight on Two Global WACh Certificate Students: Elizabeth Karman and Sheldon Halstead

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Second year MPH students, Elizabeth and Sheldon recently returned from a six-month stay in Gondar, Ethiopia as SCOPE Fellows. Both students provided invaluable support on the Faith Leaders Advocating for Maternal Empowerment (FLAME) study, which aims to validate SCOPE’s strategy of integrating local Orthodox Priests into community-level health promotion. Elizabeth visited rural health centers to assess the maternity care services available, and worked with an interdisciplinary team of Ethiopian providers and researchers to analyze and map the data collected. Sheldon assisted a University of Gondar study team with the development and implementation of qualitative baseline data collection, namely focus group discussions with religious leaders, pregnant women, and male partners. Elizabeth’s assessment data and Sheldon’s results from the discussions will be used to inform and optimize the FLAME intervention.

Elizabeth Karman_Global Healthies2017 Elizabeth’s experiences in rural Ethiopia brought her recent classroom work in maternal and child health to life.   “This area of Ethiopia has a high maternal mortality rate, and low rates of skilled delivery attendance.  However, I was reminded with each visit that simply providing services is not enough.  The community also needs to perceive the services as being appropriate, high quality, and needed. I am tremendously interested in the quality of care for women, adolescents and children in sub-Saharan Africa, and I see myself working in this field as a career.”  Her passion and interest truly transcend beyond her words.  Last week at the Department of Global Health’s 4th annual Global Healthies Award Ceremony, which recognizes student excellence and achievements, Elizabeth was the recipient of the Public Service and Direct Care award for her work as a SCOPE Fellow.

Sheldon Halstead 2Sheldon is very grateful for her SCOPE fellowship and truly believes in the power of medical and faith partnerships to improve health.   “Through living and working in country, I gained a deeper understanding of the integral role religion plays in Ethiopians’ lives and how to leverage that influence to improve health outcomes.  In the future I hope to pursue a career in program implementation.  Working on the FLAME study provided me with the invaluable experience of learning how to implement global health interventions in rural settings.”