SPEED study aims to better meet adolescent HIV care needs

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

a SPEED patient actor practices her case with a study nurse

Dr. Kate Wilson with the team of trained patient actors

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.

Making strides in HIV testing and counseling

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.

Global WACh Announces 2016 Small Change Awards  

We believe that small changes have the power to make a big difference. The Global WACh Small Change Awards are given to improve the patient experience in low and middle income countries by improving clinical care, patient satisfaction, workforce empowerment, and health service delivery for programs befitting the health of women, adolescents and children. Our applicants described their vision for a small change at their site, our panel reviewed the ideas, and the highest quality proposals demonstrating tangible change were chosen. We are pleased to announce and congratulate eight outstanding proposals as winners of the Small Change Award for 2016!

Institution Awardee Award Purpose
Aymba Clinic, Gondar, Ethiopia Getnet Mequanint $952 Beds and bedside cupboards for Aymba’s maternal waiting room.
Karen Health Centre, Nairobi County Teresa Nderi $1000 A freshly-painted waiting area, new exam-room curtains, and a fetal heart monitor.
Kenyatta National Hospital, Kenya Pediatric Studies Hellen Okinyi $964 Pulse oximeters, pediatric ambu bags, and nebulizers to better accommodate a high volume of patients.
Kenyatta National Hospital, Kenya Pediatric Studies Daisy Chebet $960 Diagnostic sets and pediatric blood pressure cuffs for the pediatric HIV care clinic.
Kenyatta National Hospital, Pediatric Intensive Care Unit Dr. Rashmi Kumar $900 Bedside cupboards, a nurse desk, and filing cabinet to decongest the small PICU.
Kenyatta National Hospital, Department of Mental Health Dr. Josephine Atieno Omondi $900 A child reflection room for engaging children aged 5-12 and preventing their boredom, anger, or disruption.
Kisumu East District Hospital Sally Nyaboke Mogire $1000 A computer, printer, and USP device for rapidly accessing digital HIV test results.
Seattle Somali Health Board Ahmed Ali $639 A laptop and scanner for keeping digital health records and accessing web materials.

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

Scroll down to learn about two of our awards, and read a full summary of each of our award recipients here.

Spotlight on Kisumu East District Hospital

Among our award recipients is Sally Nyaboke Mogire of Kisumu East District Hospital (KEDH) in Kisumu, Kenya. Sally is a PMTCT nurse at KEDH’s pediatric HIV care unit. This unit faces the difficult challenge of delayed time in receiving HIV DNA results. It takes about 8 weeks to get the final results, due to the difficulty of transporting results from a central laboratory located 60km away. This is especially hazardous for HIV-infected children and adolescents who need urgent antiretroviral therapy for survival and healthy outcomes. KEDH identified a need for accessing a web-based tracking tool for clinics, which can send results within 1-2 weeks. Sally requested a computer and printer to take advantage of the digital HIV result system. Global WACh is excited to partner with KEDH as they begin to provide faster, safer, and more complete care of children affected by HIV.

Spotlight on Aymba Clinic

Another small change award recipient will provide pregnant women travelling long distances with a comfortable place to wait to  deliver their babies. Genet Mequanint of the University of Gondar recognized transportation difficulties as one of the biggest detriments to women accessing the Aymba Clinic in Gondar, Ethiopia to safely deliver their babies. The Aymba clinic serves a rural, agrarian community of approximately 54,000, spread over a large area with very poor transportation. The Small Change at Aymba is beds and bedside tables to be used in the maternal waiting room for comfort and prolonged stay. This environment will improve the chance that a woman receives timely ANC services, delivers at a healthy facility, and utilizes a skilled attendant to ultimately reduce the risks of death and infection associated with childbirth. We’re proud to support this small change in helping to encourage more families to seek and receive comprehensive maternal, newborn, and child healthcare.

Pregnant mothers gather for a monthly focus group discussing ANC in the maternal waiting room at Aymba

Pregnant mothers gather for a monthly focus group discussing ANC in the maternal waiting room at Aymba

Congratulations to all!

Success for CATCH at Nairobi Innovation Week

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

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.

Global WACh Family Planning Study Completes its First Day of Training

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

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.

Global WACh Toto Bora Trial aims to reduce childhood mortality

Toto Bora-01

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 website:

The Next Big thing: Adolescent Health

You’re invited to our end of year celebration showcasing the achievements of Global WACh students, faculty, grantees, and scholars around the world.

2016 Next Big Thing_Flyer

Keynote Speaker: Dr. Bruder Stapleton, Chair of the Department of Pediatrics

Other Speakers include Drs. Minnie Kibore, Meghan Moreno, Pamela Kohler and Anthony Roche.

Event Details:

Thursday, June 2nd 2016
Foege Auditorium, University of Washington
3720 15th Avenue NE
Seattle, WA 98105

Current Topics and Methods in Microbiome Research Workshop

E. coli bacteria

Event Date & Time:

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

Preparing for an Emerging Zika Virus Epidemic


Join us for an expert panel drawn from public health, medicine, and bioengineering to discuss what we know, what we don’t know, and how to prepare


The University of Washington Global Center for the Integrated Health of Women, Adolescents and Children (Global WACh) is pleased to host an expert panel discussion to disseminate up-to-date information about Zika virus, its public health impact locally and globally, and what the general public and health care professionals need to know about preventing infection and minimizing the risk of birth defects due to Zika virus infection in pregnancy.

Event Details:

Friday, May 6, 2016


Hogness Auditorium

Health Sciences Building, UW Medical Center


This panel discussion is open to the public and seeks to provide factual information to the general community as well as to health care professionals and researchers.


What should I know before I travel to a region where Zika virus is currently spreading?

What do pregnant women need to know?

What should I do if I think I might have Zika virus?

What are the facts about Zika virus and birth defects?

Could Zika virus come to Seattle?

How is Zika virus currently diagnosed and what is needed to improve diagnostics?

What is the potential for pandemic spread?

What are the possible control measures?

Is a vaccine possible?

Is Zika virus sexually transmitted?


We have assembled a panel of experts to address topics including the public health response to Zika virus, infection control measures, implications of Zika virus infection in pregnancy, and current and future approaches to diagnosing Zika virus infection.

The expert panel will include:

Jeffery Duchin, MD

Health Officer of Public Health, Seattle & King County Professor, University of Washington


John Lynch, MD MPH

Medical Director of Harborview Medical Center Infection Control Associate Professor, University of Washington

Headshot portrait of Dr. John Lynch, infectious diseases.

Ghayda Mirzaa, MD

Seattle Children’s Research Institute, Center for Integrative Brain Science, Acting Assistant Professor, University of Washington



Alyssa Stephenson-Famy, MD

Maternal Fetal Medicine Specialist, Assistant Professor, University of Washington


Paul Yager, PhD

Professor, Bioengineering Department Chair University of Washington


For more information please email

Global WACh Now Accepting Applications for Small Change Awards

Download the 2016 instructions and application here: GlobalWACh-Small-Change-RFA

Deadline: May 1, 2016

Small Changes With Big Impact

Life saving equipment purchased by Homa Bay Hospital with funds from the 2015 Small Change awards.

The University of Washington Center for Integrated Health of Women, Adolescents, and Children (Global WACh) aims to contribute to scientific discoveries, nurture leaders, and foster collaborative approaches to improving the health and well-being of women, adolescents, and children.  As part of this commitment, Global WACh supports Small Change Awards that empower local front-line care providers to identify targets for clinical improvement, compete for support, and advocate for their patients.  Small Change awards improve the patient experience in limited and middle income countries by improving clinical care, patient satisfaction, workforce empowerment, and health service delivery for programs benefiting the health of women, adolescents and children.

Eligibility Requirements (Applicants must meet requirements to apply)

  • Applicant is employed by a current UW partner organization in a low resource setting
  • Applicant is a staff or faculty member working in a health program or clinical setting that serves women, adolescents or children

**NEW THIS YEAR: Low resources sites/programs located in the USA are now eligible for Small Change Awards

Types of resources funded

Proposals must address unmet needs and improve the experience of women, adolescents, and children receiving healthcare services.

Potential topics may include but are not restricted to the following:

  • Infrastructure improvements to existing structures (paint, furniture, signage) and associated labor costs
  • Electronics (telephones, tablets, computers, AV)
  • Medical equipment (stethoscopes, scales)
  • Youth-friendly clinic improvements (play areas, toys)
  • Patient educational materials

Proposals that will not be considered:

  • Consumable supplies (gloves, gowns, notebooks etc.)
  • Items that will not be retained at the site (e.g., giveaways to patients)
  • Items and supplies that are already provided through government programs (e.g., mosquito nets)
  • Ongoing salary support for staff

Funding Available

Awards of less than $1000 USD are strongly encouraged and will be given preference due to the scope of the award.

Visit the Small Change webpage for more details.