Over 1.5 billion people, including 835 million children, in the world’s poorest communities, are infected with soil-transmitted helminths (STH), commonly known as intestinal worms, and are in need of deworming medications. A single deworming pill is a safe and effective solution to combat worm infections that interfere with the body’s nutritional intake and impair developmental growth, especially in children. Periodic mass deworming protects a community by removing or reducing the worm burden of infected community members, thereby decreasing the risk of new individuals becoming infected. In 2016, Dr. Judd Walson (Department of Global Health), in collaboration with the Natural History Museum London and the University of Washington, launched the DeWorm3 Project to test the feasibility of interrupting transmission of STH using intensified mass drug administration strategies. DeWorm3 is a cluster randomized trial comparing community-wide deworming efforts of individuals of all ages to standard-of-care deworming of school-age children at schools. Findings from the clinical trial and accompanying implementation science research can support the development of STH program guidelines and innovative delivery strategies. Deworming activities launched in 2018 in trial sites in Benin, India, and Malawi.
The Strengthening Economic Evaluation for Multi-sectoral Strategies for Nutrition (SEEMS-Nutrition), a new three-year project funded by the Bill & Melinda Gates Foundation and directed by Dr. Carol Levin (Health Economist and Associate Professor, Global Health), aims to fill an information gap on costs, cost-effectiveness, and benefits of scaling up food system strategies in resource-constrained areas combating malnutrition. In the spirit of multi-sectoral collaboration, the SEEMS-Nutrition project is working in partnership with the Global Alliance for Improved Nutrition (GAIN), International Food Policy Research Institute (IFPRI), International Livestock Research Institute (ILRI) Helen Keller International (HKI), and Results for Development (R4P). Since launching in November 2018, the team is working hard to prepare the project for success. Their findings will allow program implementers and policymakers to make informed decisions about which nutrition interventions to prioritize to address healthy food systems, dietary intake, and improved nutritional status. Such interventions can help improve maternal and child health outcomes by promoting optimal dietary and feeding practices during critical windows of time when nutritional needs are the greatest.
In setting with high HIV prevalence, early antenatal care (ANC) visits are vital to optimize HIV testing and prevention services to reduce maternal and pediatric mortality and morbidity. Late ANC attendance limits timely identification and delivery of HIV prevention services including pre-exposure prophylaxis (PrEP) among pregnant women at high risk for HIV infection. To fill this gap, researchers are looking for ways to encourage pregnant women to seek ANC early and improve maternal and child health outcomes. In Kenya, community pharmacies, also known as drug shops or chemists, are playing an increasingly important role as sources of over-the-counter sexual and reproductive health products, including urine pregnancy tests and HIV self-testing kits. These pharmacies offer important and under-utilized access points to ANC and HIV prevention care for women and have the potential to inform a new innovative PrEP delivery model.
Dr. Melissa Mugambi (Assistant Professor, Department of Global Health, Implementation Science Program) received a National Institutes for Health (NIH) Diversity Supplement Award to lead a study on the feasibility of engaging community pharmacy providers in the distribution of pregnancy tests and subsequent referral of pregnant women to ANC, in order to promote early access to ANC and PrEP.
World TB Day, held each year on March 24, aims to raise public awareness about the devastating health, social, and economic consequences of tuberculosis (TB) and to step up efforts to end the global TB epidemic. The theme of World TB Day 2019 – “It’s Time” – urges global health organizations and government leaders to accelerate the TB response and ensure access to care.
Global WACh researchers are working hard to discover more effective diagnostic, treatment, and prevention measures for a TB-free world. They are collaborating with investigators on a number of studies, including HIV/TB immunopathogenesis and protection in infants and pregnant women, improved TB screening and novel non-sputum based diagnostics in HIV-infected and HIV-uninfected children and adults, and implementation of TB prevention in adolescents. Continue reading for a summary of studies and a collection of publications.
Dr. Jennifer Unger, MD, MPH
Dr. Keshet Ronen, PhD
As more households in low-income countries own a mobile phone than have access to electricity or adequate sanitation, health care providers are progressively utilizing mobile health (mHealth) platform approaches to provide guidance and support to patients between clinic visits. Evidence shows mobile short message service (SMS) programs improve HIV and maternal-child health outcomes, but there is less understanding about the types of messages that engage recipients and the mechanisms that lead to changes in health behavior. We are pleased to announce that Drs. Jennifer Unger (Assistant Professor, OB/GYN and Global Health) and Keshet Ronen (Clinical Assistant Professor, Global Health) are the principal investigator and co-investigator, respectively, of a UW Royalty Research Fund award to analyze participant messages, and yield an understanding of how recipients use these systems and how care seeking is impacted by SMS conversations.
Last week, Global WACh researchers participated in the Conference on Retroviruses and Opportunistic Infections (CROI) held in Seattle from March 5-7, 2019. The annual conference brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. Our researchers shared their latest findings on testing for HIV, human papillomavirus (HPV), tuberculosis (TB), and on PrEP delivery practices. Continue reading for highlights and a list of accepted posters by Global WACh researchers.
Global WACh’s ATTACH team shared scientific findings at the annual Inter-CFAR Sub-Saharan Africa Symposium from January 31st to February 2nd, 2019 in Nairobi, Kenya. The annual symposium incorporates career development activities targeted to the needs of early career investigators, hold keynote talks addressing scientific topics of interest for African HIV research, and identify novel future research directions. The team’s research posters generated a lot of interest in how adolescents transition from pediatric to adult HIV care, and opportunities to discuss overcoming challenges.
Congratulations to Dr. Patty Pavlinac (Assistant Professor, Global Health) and her team of co-investigators, who received a competitive UW Royalty Research Fund award to study antibiotic resistance in E.coli, Salmonella, and Shigella among children in limited-resource settings. Dr. Pavlinac is co-director of Global WACh’s Gut Health and Child Survival scientific priority and is an emerging expert in pediatric enteric disease epidemiology. This new one-year project will be an extension of her ongoing research in diarrheal disease and antibiotic therapy in sub-Saharan Africa. This close examination of the genetic determinants of antibiotic resistance among recently hospitalization children in Kenya offers much needed insight into documenting the burden, risk factors, and transmission of antibiotic resistance in Kenya.
Antibiotics have revolutionized the treatment of common bacterial infections and currently play a crucial role in reducing childhood mortality. However, the alarming increase in antibiotic resistance among bacteria is becoming a global concern and it threatens to undo progress made in childhood survival. In this new project, Dr. Pavlinac and her study team will genetically characterize the antibiotic resistance patterns of bacteria isolated from the stool of Kenyan children who were recently discharged from hospitals, a population at high risk of death and re-hospitalization, as part of the ongoing NIH-funded Toto Bora trial (PI: Dr. Judd Walson). Information on prevalent resistance genes in E. coli, Salmonella, and Shigella could reveal transmission patterns of antimicrobial-resistant pathogens that spread to vulnerable communities and windows of intervention opportunities. The findings will be important to inform clinical management and strategic planning policies to reduce the burden of antibiotic-resistant infections in Kenya and across sub-Saharan Africa.
Dr. Pavlinac’s team includes a multidisciplinary team of investigators, Dr. Olusegun Soge (Assistant Professor, Global Health and Medicine), Dr. Judd Walson (Professor, Global Health, Medicine, Pediatrics, and Epidemiology [Adjunct]), Dr. Ferric Fang (Professor, Laboratory Medicine; Director, Clinical Microbiology Laboratory at Harborview Medical Center), Dr. Benson Singa (Research Scientist, Kenya Medical Research Institute [KEMRI]), and Research Assistants Stephanie Belanger (PhD Candidate in Epidemiology, UW) and Doreen Rwigi (MS Student in Microbiology, KEMRI).
Dr. Grace John-Stewart, MD, PhD
Dr. Cheryl Day, PhD
Principal Investigators, Drs. Grace John-Stewart (Global WACh Director; Professor, Global Health, Epidemiology, Medicine, and Pediatrics) and Cheryl Day (Assistant Professor, Emory University School of Medicine, Microbiology and Immunology) received a NIH/NIAID R01 award that supports research to discover changes in immune mechanisms and markers of the Mycobacterium tuberculosis (Mtb), the pathogenic bacteria that causes tuberculosis (TB), in children exposed to or infected with HIV. As the number of TB cases rise in parallel to the HIV/AIDS pandemic in developing countries, there is an urgent need to understand the complex biological interaction between Mtb and HIV, particularly children with immune systems weakened by HIV. The World Health Organization estimates that there are over one million new cases of TB and 239,000 TB-related deaths every year.
Drs. Anjuli Wagner, PhD (left) and Irene Njuguna, PhDc (right)
Congratulations Drs. Anjuli Wagner (Postdoctoral Research Fellow, Global Health) and Irene Njuguna (PhDc Epidemiology; Infectious disease researcher, Kenyatta National Hospital)! They received a CFAR International Pilot Award for their project entitled, “WhatsApp focus group and respondent-driven sampling: novel approaches to engage diverse adolescents,” which aims to test new technology-based approaches to engage adolescents who do not typically seek HIV preventative and treatment services. This one year project will take place in Nairobi, Kenya in collaboration with Kenyatta National Hospital.