GloCal Fellows 2012-2013

Kassandra Harding is a doctoral student of the Graduate Group in Nutritional Biology at the University of California, Davis. She is also pursuing a designated emphasis in the Program in International and Community Nutrition. The unique challenges associated with devising effective, sustainable, and culturally acceptable interventions to improve nutrition among diverse populations have led her to pursue a career in global health. From study design to the everyday challenges of implementation at the field level, she enjoys solving the puzzles of global health research. Upon completing her doctoral training, she aims to collaborate with international organizations to conduct novel clinical and translational research to address nutritional problems in disadvantaged populations.

Project

Lipid-based nutrient supplement and iron/folic acid tablet intake among pregnant and lactating women in Bangladesh

In developing countries burdened with a high prevalence of stunting among children, nutritional supplementation during pregnancy has been studied as one approach to improve prenatal nutrition and intrauterine growth to ultimately improve growth outcomes in children. In order to understand the effectiveness of lipid-based nutrient supplements (LNS) in this programmatic context, it is necessary to identify the barriers and facilitators to LNS consumption. With the support of the UCGHI GloCal Health Fellowship, Ms. Harding will assess environmental, cultural, and personal factors that influence rural Bangladeshi women's consumption of LNS and iron and folic acid (IFA) tablets provided by an established community health and development program. With several perinatal nutrition supplementation programs presently rolling out in rural Bangladesh, it is crucial to define and address factors that will impact the success of these programs.

Mentors: Dr. Christine Stewart (UCD), Dr. Tahmeed Ahmed (ICCDR, B), Dr. Lia Fernald (UCD)

klharding@ucdavis.edu

Hilary Wolf is a Board Certified Pediatrician who is in her final year of pursuing a 3-year ACGME accredited Adolescent Fellowship at UCSF. In addition, last year Dr. Wolf joined the Reproductive Infectious Disease (RID) Fellowship in order to further pursue her specific interests and goals in conducting research with HIV+ adolescents in Kenya. Dr. Wolf is most interested in adolescent reproductive and global health. Dr. Wolf first worked with underserved HIV+ adolescents in Washington, DC as a case manager through an AmeriCorps program. She first pursued her interest in global health during medical school, at Albert Einstein, through a research fellowship in Lima, Peru. During her Pediatric residency at Mount Sinai, she continued to pursue her interest in global health but narrowed her focus to reproductive health research in adolescents. She performed a primary data collection project with Ugandan adolescents assessing their knowledge regarding STI's and contraception and their willingness to use contraception.

Project

An Investigation of Causes of Lost to Follow-up among HIV Positive Adolescents in Kisumu Kenya

Dr. Wolf's multi-disciplinary collaborative group, based at the Kenya Medical Research Institute in Kisumu, Kenya and at UCSF will employ qualitative methods to explore: (1) the multi-level determinants why adolescents become lost to follow-up (LTFU) in Kisumu, Kenya and (2) the role the secondary school environment plays among HIV+ adolescents who are LTFU. Methods: conducting: (1) focus groups (FGs) with HIV+ adolescent peer educators who work with LTFU adolescents and are in care, (2) semi-structured interviews with HIV+ adolescents who are LTFU, and (3) semi-structured interviews with student-nominated teachers and administrators from local secondary schools. The purpose of these interviews and focus groups will be to better understand the barriers adolescents have in accessing HIV care and how the school environment may affect adolescents' ability to positively or negatively access and remain in care. Implications: Information regarding the multi-level determinants of LTFU among adolescents and specifically of the school-based environment will inform the development of interventions to improve the retention of Kenyan adolescents in healthcare.

Mentors: Dr. Craig Cohen (UCSF), Dr. Collete Auerswald (UCSF), Dr. Bonnie Halpern (UCSF)

hilarywolf@gmail.com

Damalie Nakanjako, MBChB, MMed, PhD is a lecturer in the School of Medicine at Makerere University College of Health Sciences (MaKCHS). She recently completed the prestigious 5-year Sewankambo Clinical Research Scholarship at the Infectious Diseases Institute, MaKCHS. She has authored several publications in the area of HIV, tuberculosis and global health. Dr. Nakanjako is a clinical leader with a strong research background in the areas of immune activation and sub-optimal immune reconstitution among HIV-infected adults in Africa. She has received several awards and titles including: a Wellcome Trust-funded post-doctoral fellowship in infection and immunity hosted at Uganda Virus Research Institute and Makerere University; awards from the Annual Conference on Retroviruses and Opportunistic Infections (CROI); International Mentored Scientist Award at the Gladstone Institute of Virology & Immunology; and the International Scholar award in 2007 and Young Investigator Award in 2011. She currently holds a University of California, San Francisco Center for AIDS Research grant. In addition, Dr. Nakanjako is mentoring masters and doctoral students in her field of expertise.

Project

The role of regulatory T-cells in suboptimal CD4 recovery in HAART-treated African cohort

Dr. Nakanjako's current project is to understand the role of regulatory T cell dysfunction in suboptimal immune recovery among antiretroviral-treated adults in Africa. Responding to the clinical finding that 40% of the projects HAART-treated patients exhibit suboptimal CD4 T-cell recovery, she has used flow cytometry to study changes in T-cell immune activation and T-cell immunosenescence (cellular exhaustion) among suboptimal responders to suppressive HAART. Her current project will build on and extend previous results by exploring the possibility that suboptimal regulatory T-cell (Treg) function is a major driver of the immune activation and the ensuing immunosenescence. Findings could inform future immune-based therapeutic interventions designed to maximize immune reconstitution on HAART as well as be useful in securing additional funding for large scale testing.

Mentors: Dr. Warner Greene (UCSF), Dr. Yukari Manabe (Johns Hopkins), Dr. Harriet Mayanja-Kizza (MaKCHS)

dnakanjako@idi.co.ug

Maricianah Atieno Onono, MBChB, MSC is a KEMRI research officer and also the KEMRI-RCTP Nyanza Research Coordinator. Dr. Onono received her MBChB from the University of Nairobi and her MSC in clinical research from the University of Liverpool. Dr. Onono has been a co-investigator and study coordinator on various operational and implementation research studies within KEMRI with a bias towards health system and its affiliated operations in rural districts in south Nyanza worst hit by the HIV pandemic. To date she has overseen ten large multi-site studies in diverse issues of HIV/AIDS, PMTCT, Family Planning, AIDS stigma and Gender Based Violence. Dr. Onono plays a key role in translating many research findings into routine clinical practice through innovative approaches to HIV program implementation, emphasizing rapid scale-up of HIV and TB, family planning (FP) and prevention of mother-to-child (PMTCT) services to improve access while maintaining quality. Dr. Onono has played a key role in planning, designing, implementation and evaluation of FP and PMTCT services program including the facility level training, mentorship and supervision, task-shifting, defaulter identification and follow up systems, linkages and referral networks all aimed at improving the quality of integrated maternal and reproductive health services outcomes.

Project

PMTCT failure audit: The role of HIV/AIDS stigma in PMTCT failure

In an era where there are effective PMTCT strategies and virtual elimination of HIV and AIDS in children is feasible, every pediatric HIV infection occurring is a tragedy. Dr. Onono's research project will provide evidence on the role that stigma at the health facility and/or household level plays in PMTCT failure in the context of an apparently functioning and accessible health services in terms of PMTCT coverage, and how this can lead to local solutions in reducing MTCT. The study is a mixed methods, matched case control study utilizing both quantitative and qualitative methods. In addition to doing a case control study, her team will also conduct key informant interviews and focus group discussions with health care workers to ascertain if health care worker stigma may be associated with PMTCT failure. The nexus between pregnant HIV positive women and systems fundamentally impacts the degree to which a pregnant HIV positive woman and her unborn baby are able to benefit from prevention and treatment interventions. The proposed stigma study exploring this interface is thus extremely timely, relevant and pertinent in averting PMTCT failure.

Mentors: Dr. Craig Cohen (UCSF), Dr. Elizabeth Bukusi (KEMRI), Dr. Glenda Gray (PHRU)

maricianah@yahoo.com

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