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

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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!

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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!

Study to make HIV testing informational videos and use saliva-based HIV testing in children launched in Kenya

Most people assume HIV testing involves blood.  While blood is the most commonly used specimen, saliva is an alternative method to test and diagnose HIV in adults and adolescents.  Benefits of saliva-based testing include the ease of collecting samples and increased acceptability of HIV testing.  One example of a saliva-based test is OraQuick, a device used to collect and rapidly test saliva.

The OraQuick test strip collects saliva from patients’ upper and lower gums, then is inserted into a tube to test for HIV.  The saliva reacts to liquid in the tube and travels up the stick.  If only the upper line appears, the test is negative. If both lines appear, the test is positive.

Saliva-based testing has produced very good results in adults; however, very few studies have evaluated this method among children Considering the ease of collecting saliva compared to drawing blood using a finger prick (ouch!), saliva-based testing is a good alternative for this population in need of early HIV testing, diagnosis, and care.

Last week, Global WACh and the University of Nairobi launched a new study to address this need.  Led by Post-Doctoral Fellows, Drs. Anjuli Wagner and Irene Njuguna, the Saliva Testing and Video Information to Expand Uptake of Pediatric Testing (STEP-UP) project aims to validate the OraQuick test in children ages 18 months to 12 years old.  The project will also develop and evaluate the effectiveness of video pre-test information session prior to HIV testing.  Both strategies aim to increase pediatric HIV testing in outpatient clinics in Kenya, where high patient volumes make it difficult for healthcare staff to offer adequate HIV counseling to every client.

Last week, the STEP-UP study team completed a training to learn about OraQuick and how to perform the test.  The team had a great time participating in team building exercises, practicing collecting saliva from one another, and enjoying a delicious dinner together.  Check out photos below!

The STEP-UP study team from UW and the University of Nairobi

Lukio fills in questionnaire answers to a mobile data collection tool called Open Data Kit (ODK), while the OraQuick reaction is taking place in the background.

Tamasha practices using the OraQuick test kit, placing the test strip in the reaction fluid.

Tamasha practices using the OraQuick test kit, placing the test strip in the reaction fluid.

The team will start recruiting participants this month in multiple clinics in Kisumu, Siaya, and Homa Bay counties in Kenya.  They hope to test 1,050 children for HIV and the HIV video consultation in 150 participants.  The team will also include a series of focus group discussion about patient and health care workers’ perceptions about using the OraQuick test and video consultation.  The STEP-UP project is anticipated to end in August 2019.

Successful staff training for PrIYA and PrIMA, HIV-prevention projects

We love receiving updates from our research partners in Kenya!  Last week, two HIV-focused projects, led by the Kenyatta National Hospital, Global WACh, and International Clinical Research Center (ICRC), held successful staff trainings in Kisumu, Kenya.  Both projects emphasize the use of oral pre-exposure antiretroviral prophylaxis, or PrEP, among adolescent girls and women who are at the greatest risk of HIV infection.  PrEP is a daily anti-HIV medication that a person who does not have HIV takes to prevent infection.  If taken daily as prescribed, PrEP is highly effective in stopping the HIV virus from taking hold and spreading throughout the body.


PrEP Implementation for Young Women and Adolescents (PrIYA) seeks to programmatically evaluate PrEP implementation, and determine best practices for providing PrEP to young women and adolescent girls in Maternal and Child Health (MCH) and Family Planning Clinics.  At the training, PrIYA study staff discussed their successes and challenges after four months of providing PrEP clinical services, such as prescribing and counseling for the drug, follow-up care, and blood spot testing to measure drug levels to over 3,000 women.  They also discussed their experiences to establish data tracking systems and improve ways to procure PrEP for their patients.  More information on PrIYA is available here.

PrEP Implementation for Mothers in Antenatal Care (PrIMA) is a cluster-randomized trial in 20 MCH clinics that follows women during their pregnancies through nine months postpartum to assess HIV incidence and other outcomes among those who use PrEP and those who do not.  Offering PrEP to women at the greatest risk of HIV may maximize effectiveness, safety, and cost-effectiveness.  In anticipation of the study’s launch in October, forty new PrIMA staff members received training on the study procedures.

PrIYA_PrIMA Training 1

We look forward to sharing more updates as both studies progress.  Stay tuned for future posts!

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 Now Accepting Applications for Seeds for Change Awards

Download the 2017 Application Form

Applications are due on Wednesday, September 27th, 2017


The Karen Health Centre in Kenya replaced their fetal scope with a modern doppler in their antenatal care clinic using funds from their 2016 Seeds for Change Award.

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 Seeds for Change Awards (formerly known as Small Change Awards) that empower local front-line care providers to identify targets for clinical improvement, compete for support, and advocate for their patients. These awards aim to improve the patient experience in resource-limited settings 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 both 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

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 Seeds for Change webpage for more details.

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.

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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).

Study achieving optimal neurodevelopmental outcomes in HIV-Infected Infants

HIV infection can result in neurodevelopmental impairment in children. We do not yet understand the extent to which effective antiretroviral therapy (ART) prevents these delays, but Global WACh researcher Dr. Sarah Benki-Nugent’s recent study, conducted in collaboration with researchers at the University of Nairobi, has provided insight to help answer this question. Their study focused on HIV-infected infants in Nairobi Kenya who received ART from the time of infancy and compared their developmental milestone attainment to HIV-unexposed infants.

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Sarah Benki-Nugent, MS, PhD, is the study’s lead investigator and Acting Assistant Professor at University of Washington Department of Global Health

Most HIV-infected infants in their study were extremely ill at the time of HIV diagnosis and many were first identified in the hospital. Unfortunately, late diagnosis continues to be common in Africa and UNAIDS has recently estimated that only about half of HIV-infected children are receiving treatment.

The study found that overall, HIV-infected infants had later age at attainment of milestones compared to unexposed infants. However, infants who had better responses to treatment had better developmental outcomes. Benki-Nugent and Kenyan research collaborator Dalton Wamalwa say, “We still don’t’ know how children will do in the long-term; however, this data suggests that effective response to ART provided some benefit, even in a group of infants who were very sick when first diagnosed.”

The study suggests that early HIV diagnosis and successful treatment are likely key factors in retaining cognitive and motor neurodevelopment in HIV-infected children. It is also likely critical, Dr. Benki-Nugent says, to provide additional strategies, such as parenting support for early childhood development alongside HIV treatment to help children reach their full potential.

Click here to read more about the researcher’s work recently featured in Infectious Disease Advisor.

Certificate capstone brings together experts in adolescent health to understand early gender socialization

In fulfillment of her Global WACh Certificate Capstone, Marina Plesons worked with a team of adolescent, sexual, and reproductive health professionals from the WHO, USAID, Gates Foundation, and the David & Lucille Packard Foundation to write a commentary for the Journal of Adolescent Health. The paper considers the implications for action and research of the Global Early Adolescent Study’s formative qualitative research on gender socialization.

GEASThe Global Early Adolescent Study (GEAS) aims to understand the factors in early adolescence that predispose young people to subsequent sexual health risks, and conversely promote sexual and reproductive health and well-being. In her capstone presentation last week, Marina commented on the fact that ages 10-14 are among the most critical for human development, but are a comparatively poorly understood life stage. This work thus serves to investigate the social processes that shape young people’s health and development, especially as this relates to gender norms informing adolescent sexuality.

Gender inequities are a key underlying determinant of the sex-specific differentials in morbidity and mortality of adults, and adolescents. Gender inequities manifest in different ways, such as discriminatory laws, policies, and socio-cultural practices or unequal power, access, and control over resources. At the root of inequities are gender norms and attitudes, which prescribe different status, power, access, and behaviors (including in relationships) according to culturally appropriate expectations for males and females. If we understand how gender norms for young adolescents are enforced, reinforced, challenged, and accepted, then we can be better address these in programs and interventions to improve adolescent and adult health.

Marina’s contributions to the paper included key themes in which gender norms and attitudes manifest in the lives of young adolescents, their peers, and their families in a number of countries. The team then extrapolated seven key programmatic and policy recommendations for ways that the global community can promote gender equitable norms and attitudes in early adolescence.

We can expect the paper to be included as part of a Journal of Adolescent Health special supplement this year, featuring the results from Marina’s work. We look forward to sharing when it is released!

Throughmarinaout her capstone and internship with the WHO, Marina also worked closely with her faculty advisor, Dr. Donna Denno.

Marina Plesons is an MPH candidate in the department of Global Health, and President and Co-founder of Health Advocacy Innovations, Inc.

Global WACh Seed Grant recipient publishes at PLOS One

As part of our commitment to meaningful research collaborations, Global WACh offers Integrated Health Seed Grants: one-year of seed funding for pioneering research to improve the health of women, adolescents, and children. The proposals we award recognize a global focus on community advocacy and innovative exploration.

Dr. Linnet Masese is a Postdoctoral Fellow at the University of Washington Department of Medicine

In 2011 we awarded the seed grant to Dr. Linnet Masese, who at the time was a doctoral student at the UW Department of Epidemiology, and Clinic Section Head at the UW/University of Nairobi Research Site in Mombasa. Her original proposal was to explore the feasibility of Chlamydia trachomatis screening among adolescents and young women in Kenya. However, with nucleic acid amplification testing locally available at the UW Research Laboratory in Mombasa, she expanded the study to include screening for Neisseria gonorrhoeae and Trichomonas vaginalis. We are thrilled to report that the first of three papers from this study titled “Barriers and Facilitators of Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya” was recently published in PLOS One.

Dr. Masese’s work centers around one of the earliest reproductive health challenges faced by young women as they become sexually active: the risk of sexually transmitted infections (STIs). Young women bear the greatest burden of STIs as they face significant barriers to STI screening. Through focus group discussions and in-depth interviews, Dr. Masese and her study team identified the barriers to STI screening among adolescent girls and young women in Mombasa, Kenya (PLoS One paper). Based on findings from this qualitative study, they developed a screening intervention for adolescent girls and young women in Mombasa (manuscript submitted to STD).

As a center dedicated to fostering new discovery and career development, we couldn’t be happier to support this research achievement in Mombasa and we look forward to following the improvements in sexual health education and STI screening as a result of your work.

WACh Priority Areas in Focus: Family Planning Decision Support

Our third and final Scientific Priority Area hones in on the life-saving ability of family planning services. Women face significant barriers to finding a contraception method that fits their unique needs, or gaining access to support to make informed reproductive decisions.

By providing new support and data collection tools, we can bring the health care system closer to women and their families, bring their health concerns to the attention of decision makers, and reduce the unmet need for family planning.

We can provide Family Planning Decision Support.

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