Glocal Fellows 2015-2016 | UC Global Health Institute

Alfonso Silva-Santisteban MD, MPH is a physician and epidemiologist of the Unit of Health, Sexuality, and Human Development at the Universidad Peruana Cavetano Heredia (UPCH). He obtained a Masters in Public Health from the University of California Berkley in 2008. Dr. Silva-Santisteban's research has focused on HIV prevention among transgender women and on HIV surveillance among hard to reach populations in Peru and various Latin American countries.

Project

Enhancing HIV/STI testing for transgender women in Peru

Transgender women are the population most affected by the HIV epidemic in Peru and the rest of Latin America. Vulnerability to the epidemic arises from social exclusion, including lack of access to health services. Dr. Silva-Santisteban will conduct formative research to understand the barriers to HIV/STI testing and to assess the most suitable community and individual approaches to improve testing among transgender women. The information will be used to develop an intervention focused in this population.

Mentors: Dr. Jeffrey Klausner (UCLA), Prof. Ximena Salazar (UPCH), Dr. Steffanie Strathdee (UCSD)

Alfonso Silva-Santisteban

Dr. Amber Roegner, DVM, PhD, graduated from UC Davis School of Veterinary Medicine in 2014. She graduated with a B.S. in environmental engineering from Yale University in 2002 and worked in environmental consulting for several years prior to beginning the joint degree program at UC Davis with the goal of working within global health to improve water quality impacting at-risk human and animal populations. During her DVM-PhD training, she worked on an interdisciplinary project at Lake Atitlán in Guatemala, focusing on understanding and reducing human health risks associated with declining water quality and cyanobacterial blooms, including working with Guatemalan students and local communities to assess longevity and efficacy of household filters in removing pathogens and toxins of potential concern. With a PhD in Pharmacology & Toxicology, she began a 1-year postdoctoral NCRR veterinary training on aquatic models of human disease through Oregon State University, focusing on evaluating chronic and developmental risk from metabolites or bioactive compounds produced in freshwater cyanobacterial blooms. Dr. Roegner is dedicated to a career integrating novel approaches within toxicology to the field of global health, particularly in scenarios with potential for co-morbidity due to high pathogen loading or within particularly vulnerable, at-risk populations.

Project

Local solutions to health risks faced in HIV-endemic villages from cyanobacterial bloom-contaminated waters at Lake Victoria

Eutrophication of freshwaters from excessive input of nutrients from sewage and fertilizer run-off threatens drinking water, recreational waters and fisheries in many communities worldwide. These algal populations can shift toward toxin-producing cyanobacteria, often in waters with concurrent increased risk of waterborne infectious disease. Management of these blooms must include intervention and prevention strategies that prioritize human and ecological health outcomes, particularly when populations depend directly upon surface waters for potable water with no alternative water source. In addition to acute toxicoses and illness, pathogens and components of cyanobacterial blooms present developmental and chronic health risk for young and immune compromised populations. The fishing communities at Winam Bay, Lake Victoria are directly impacted by toxicogenic cyanobacterial blooms; these communities concurrently face high rates of endemic HIV. Dr. Roegner's research will focus on working with partners at Kisumu Research Station of Kenya Marine Fisheries Research Institute (KMFRI) to pilot and test the potential for native and invasive wetland plants species already harvested at the lake to reduce or remove cyanotoxins and pathogen of concern from surface waters or point of source waters. In addition, community focus groups and surveys will be carried out in conjunction with Kenya Medical Research Institute (KEMRI) within fishing and non-fishing communities to identify baseline health risks and unique challenges for communities impacted heavily by HIV. A community-based participatory model will be employed in the hopes of identifying strategies to overcome the many challenges associated with health risk from bloom-impacted waters.

Mentors: Dr. Eliška Rejmánková (UC Davis), Dr. Lewis Sitoki (KMFRI), Dr. Woutrina Miller (UC Davis), Dr. Todd Miller (University of Wisconsin Milwaukee)

afroegner@gmail.com

Emmanuel Balandya MD, PhD is a physician-scientist with medical, doctoral and post-doctoral training. He obtained his MD at the University of Dar-es-salaam in Tanzania in 2005. Since 2007, he has been faculty at the School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania. He was awarded the prestigious NIH AITRP-Fogarty Fellowship in 2008 to purse Doctor of Philosophy (PhD) studies at Dartmouth College in the United States and graduated in 2012. He subsequently joined the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School as a post-doctoral research fellow between 2012-2014. Dr. Balandya has a solid background in immunology, vaccinology and advanced biomedical physiology, and has contributed in the fields of mucosal immunology, primary HIV transmission and HIV vaccine development. He is dedicated to strengthening Tanzanian capacity in medical education and biomedical research, and currently heads the Physiology group at the Muhimbili Sickle Cell (MSC) programme, focusing on clinical and basic sciences research in sickle cell anaemia. Since 2013, he has been a scientific reviewer with the journal PLoS ONE.

Project

Characterizing the Phenotype of T and B Lymphocytes in Children with Sickle Cell Anemia in Tanzania

Invasive bacterial infections, particularly pneumococcal septicaemia and meningitis, are the leading causes of morbidity and mortality in children with sickle cell anaemia (SCA). Besides impairment in phagocytosis, defects in both cellular and humoral immunity have also been implicated in the pathogenesis of the increased risk of infection in SCA. However, there is limited global insight on the profile of the adaptive immune system in SCA, particularly from sub-Saharan Africa where SCA is most prevalent. In the current fellowship, Dr. Balandya will investigate the phenotype of both T and B lymphocytes in children with SCA at the Muhimbili Sickle Cell (MSC) programme in Dar-es-salaam, Tanzania. Insights from this study will broaden our understanding of the immune mechanisms for the increased risk of infection in SCA. This will inform optimization of targeted vaccine and other approaches aiming at reducing the morbidity and mortality caused by infections in children with SCA.

Mentors: Dr. Julie Makani (MUHAS), Dr. Teri Reynolds (UCSF), Prof. Stephen Obaro (UNMC)

ebalandya@yahoo.com

Dr. Herbert Kayiga MBChB, MMED Obs/Gyn, is a certified Ugandan Obstetrician/Gynecologist who completed his residency training in Obstetrics and Gynecology at Makerere University in 2014. Currently he is working as a Senior Scholar with “Global Partners in Surgery and Anesthesia” in the Directorate of Obstetrics and Gynecology in Makerere University College of Health Sciences. In this position, he mentors both Graduate and Undergraduate studies in research and clinical skills. Dr. Kayiga has just completed a research project ‘Criterion Based Audit in management of women with obstructed labor in Mulago hospital'. This was one study that evaluated the quality of obstetric care offered to women with obstructed labor in a low resource setting. Dr. Kayiga is a self-driven young researcher aspiring to grow in clinical research to influence my country's health with keen interest in Maternal and Newborn Health.

Project

Comparison of Vaginal to Caesarean delivery in managing women with Preterm and Term premature rupture of membranes (PROM) in Mulago National Referral Hospital: A Prospective Cohort Study

Challenged with a high patient load of up to 33,000 deliveries per year, with a maternal mortality rate of up to 503/100,000 live births in Mulago hospital as of 2014, Dr. Kayiga seeks a way to reduce this burden in the Institution. Some of the women with preterm premature rupture of membranes (PPROM) and term premature rupture of membrane (PROM) undertake caesarean delivery for indications such as severe oligohydramnios, prematurity and inability to monitor them adequately. Dr. Kayiga's research focuses on a comparison of vaginal to caesarean mode of delivery in management of women with preterm and term premature rupture of membranes in Mulago National Referral Hospital. Dr. Kayiga intends to conduct a prospective cohort of the participants and their babies from admission to their discharge from hospital. His primary outcome is perinatal mortality following caesarean and vaginal deliveries. Secondary outcomes include neonatal morbidity, maternal morbidities and mortality and also the impact of HIV on the outcome of PPROM/PROM. If vaginal delivery is as safe or safer than caesarean delivery, then more labor inductions will be conducted, reducing the overall cost of obstetric care and also decongesting the theatre queues for patients with more dire emergencies.

Mentors: Dr. Josaphat Byamugisha (Makerere), Dr. Dan K. Kaye (Makerere), Dr. Meg Autry (UCSF), and Dr. Felicia Lester (UCSF)

hkayiga@gmail.com

Jessica McCurley, MS, is a doctoral student in the SDSU/UCSD Joint Doctoral Program in Clinical Psychology and an NIH T32 Predoctoral Fellow in Cardiovascular Epidemiology at the UCSD Department of Family Medicine and Public Health. Ms. McCurley's research focuses on health disparities and psychosocial aspects of diabetes and cardiovascular disease in migrant and minority communities. Ms. McCurley has worked with migrant populations in the U.S., Guatemala, Mexico, and India, and was a Psychosocial Support and Evaluation Intern at the United States Agency for International Development (USAID) in Washington, DC in 2012. As a doctoral student, Ms. McCurley has studied stress, social support, and cardiometabolic conditions in the national Hispanic Community Health Study/Study of Latinos (HCHS/SOL), assisted with an adaptation and implementation of a diabetes prevention program for low income Mexican-American women, and conducted cultural adaptations of psychoeducation programs for the East African refugee community in San Diego, CA. She has also worked in clinical mental health service provision in San Diego and Tijuana, Mexico. Ms. McCurley is concurrently pursuing a Master's degree in Public Health and aspires to continue an academic research career in behavioral medicine and global health.

Project

Diabetes Prevention in an HIV Endemic Community in Tijuana, Mexico

Diabetes is highly prevalent in the U.S.-Mexico border region. HIV is endemic in many border cities as well and may co-occur with diabetes, resulting in significant physical and mental health burden. Little research has been conducted in diabetes prevention with migrants, deportees, and other transient individuals who cross international borders. During her fellowship year, Ms. McCurley will conduct a study of diabetes risk and protective factors in individuals accessing medical care at a walk-in clinic in Tijuana, Mexico that serves primarily migrants, deportees, and sex workers. The project will explore community-specific barriers to and facilitators of change in behaviors relevant to cardiometabolic risk (i.e., physical activity, dietary intake), preferences for prevention programs, and whether outcomes differ by HIV serostatus. Results from the study will be used to generate a brief guide to acceptable and feasible diabetes prevention recommendations for medical and behavioral health providers serving migrants, deportees, and other vulnerable groups in the border community.

Mentors: Dr. José Luis Burgos (UCSD), Dr. Adriana Carolina Vargas Ojeda (UABC), Dr. Linda Gallo (SDSU/UCSD)

jess.mccurley@gmail.com

Lauren Pincus recently received her PhD in Horticulture and Agronomy at the University of California, Davis, where she also completed a M.S. in International Agricultural Development. Ms. Pincus' dissertation research investigated soil fertility management among smallholder farmers in Uganda. She has seven years of experience working in agricultural development overseas, primarily focusing on agricultural extension and aspects of farmer education and training. Most recently she co-managed a USAID-funded horticultural development program in Uganda seeking to improve the production and marketing of indigenous leafy vegetables. Her interests include food-based nutrition interventions and nutrition-sensitive agriculture. She is trained in both quantitative and qualitative research methods and has experience conducting mixed methods studies.

Project

Agricultural Interventions to Promote Nutrition Security and Improved HIV/AIDS Outcomes in Kenya

In Kenya, it is frequently small-scale farmers and their families who suffer the most extreme forms of food insecurity and undernourishment. Without a productive farm and sustainable practices, farmers' livelihoods and food supply suffer almost immediately; likewise, without adequate health, farmers' productivity dramatically falls and places them and their children further at risk of impoverishment and a vulnerable health status. Given the complex role agriculture plays in rural residents' health and economic statuses, it is important to understand the direct and indirect pathways through which agriculture is able to create positive health changes. She will work with a team of UCSF and KEMRI researchers to implement a cluster randomized controlled trial testing the impact of an agricultural intervention on food security and HIV outcomes. Her research will investigate how the agricultural decision making of HIV+ patients influences their food security and diet. She will specifically look at women and other disempowered members of society to understand how lack of access to agricultural markets and assets differentially impact their ability to feed themselves. This fellowship project will allow Dr. Pincus to obtain a deeper knowledge regarding the linkages between agriculture and health in an East African context. She hopes to use this experience to contribute to the growing field of nutrition-sensitive agriculture.

Mentors: Dr. Kate Scow (UC Davis), Dr. Elizabeth Bukusi (KEMRI), Dr. Craig Cohen (UCSF)

lpincus@gmail.com

Dr. Maria Luisa Rolón is a binational Mexican medical graduate from Universidad Xochicalco whose research focus is on reducing harms, including HIV, associated with substance use worldwide, especially in the Mexico-U.S. border region. In collaboration with the Division of Global Public Heath at the UCSD School of Medicine and the Mexico-U.S. Border Health Commission, her work has concentrated on HIV prevention with underserved, marginalized populations including female sex workers and people who inject drugs (PWID) in Tijuana, Mexico. Dr. Rolón is also a former scholar from the TIES2 Certificate Program on Drug Addiction and Related Harms, an inter-institutional and binational collaboration funded by USAID and HED, where she developed a fotonovela on overdose prevention alongside colleagues under the mentorship of Peter Davidson, PhD (UCSD) and Karla D. Wagner, PhD (University of Nevada Reno). Recently, Dr. Rolón completed a NIH Fogarty Fellowship in the AIDS International Training Research Program (AITRP) at UCSD. As part of her training, she has been involved in an education program focused on HIV, viral hepatitis and STI prevention, harm reduction efforts, and public health-based and human rights laws to help diminish police practices that could contribute to drug-related behaviors among PWID in Tijuana, Mexico.

Project

Cuerazos: Abscesses, self-wound care and HIV-risk among people who inject drugs in Tijuana, Mexico

The GloCal Fellowship project, Cuerazos (Northern-Mexico slang for skin abscess or wound at injection-site) will be nested in Proyecto El Cuete (NIDA, PI: Strathdee), which is currently evaluating the impact of structural interventions in the legal environment that may influence drug use and HIV risk behaviors of PWID in Tijuana. Cuerazos will build upon previous work on harms associated with injection drug-use in the El Cuete cohort (Pollini et al, 2010; Strathdee et al, 2014). Our specific aims are to (1) identify sociodemographic, environmental, behavioral risk factors and HIV infection associated with skin abscesses and barriers to medical care among PWID, (2) describe skin lesions that are common characteristics of PWID reporting use of desomorphine, aka krokodil, and (3) to develop educational harm reduction visual aids with HIV prevention, abscess risk factors, proper injection-use and wound-care recommendations for PWID. We hope to reduce harms associated with injection drug use and prevent potentially fatal complications of skin-wounds and abscesses such as osteomyelitis, endocarditis and septicemia in a timely manner while improving referrals to HIV counseling, testing and access to health-care services.

Mentors: Dr. Peter Davidson (UCSD), Dr. José Antonio Hurtado Montalvo (UABC, CEUX), Dr. Steffanie Strathdee (UCSD)

mlrolon@ucsd.edu

Patricia Ferrer, PhD, graduated with a bachelor's degree in Biology from Universidad Peruana Cayetano Heredia (UPCH) and a PhD in Molecular Microbiology and Immunology from Johns Hopkins Bloomberg School of Public Health (JHBSPH). She has conducted research related to two major threats to global health: tuberculosis (TB) and malaria, working in both national (UPCH) and international (JHBSPH) settings. Her TB work focused on the molecular biology and biochemistry of the Pyrazimidase (PZase) enzyme which hydrolyzes the antibiotic pyrazinamide (PZA) to target semi-dormant M. tuberculosis. Her doctoral thesis was related to the modulation of host iron compartments critical to the development of the malaria parasite. At the beginning of 2015, she joined the Department of Parasitology at the U.S. Naval Medical Research Unit No 6 (NAMRU-6) where she works as a Postdoctoral Fellow. In the long-term, she wants to be an independent scientist in global health and conduct research according to her interests in host-pathogen dynamics, immune responses and disease prognosis and elimination.

Project

Biomarkers of Chagas cardiomyopathy identified by system biology approaches

The pathogenic mechanisms leading to Chagas cardiomyopathy (CC) are incompletely understood, but both animal and human evidence suggest that parasite persistence drives chronic inflammation, which in turn leads to myocardial damage and fibrosis, microvascular derangement and progressive cardiac dilation and failure. The specific aims of this project are: 1) to conduct a pilot study to evaluate the feasibility of using transcriptional profiling and systems biology approaches to identify novel biomarkers of CC and 2) to test the hypothesis that parasite-induced inflammation is related to cardiac biomarker up-regulation and is associated with the severity of CC. The results of this study will help us identify inflammatory responses that occur early in Chagas infection, and that are believed to be ideal biomarkers or predictors of the progression to CC. This work would reduce morbidity and mortality by allowing treatment to begin as soon as biomarkers, not signs, of CC are detected.

Mentors: Dr. Caryn Bern (UCSF), Dr. Andres “Willy” Lescano (NAMRU-6), Dr. Christian Baldeviano (NAMRU-6)

ferrerp@gmail.com

Zachary Kwena BA, MA, PhD is Social Scientist who received all his degrees from Kenyatta University. He works as a Social Scientist and investigator at Kenya Medical Research Institute's Centre for Microbicide Research based in Kisumu. He has been an investigator on a number of research studies including one on a male microbicide trial among fishermen and several other qualitative studies. He has also been involved in training, conducting and supervising qualitative data collection and analysis of data in a number of studies. He is also part of a Pan-African network on social aspects of HIV/AIDS sponsored by the Council for the Development of Social Science Research in Africa and a member of Organization of Social Science Research in Eastern Africa. His research interests include care seeking behavior, couple STI/HIV research, patient-provider interface, and social aspects of HIV.

Project

Piloting the Feasibility and Psycho-Economic Impact of Designated Time Appointment System at FACES-Supported Clinics in Nyanza, Kenya

As more patients enroll into HIV care programs, health care systems are continually being stretched resulting in long patient waiting times. Many negative outcomes such as missed income, missed lessons in the case of students, congestions that may lead to easy spread of infectious diseases, lost opportunity to fulfill socio-economic responsibilities and general service dissatisfaction, are associated with long patient waiting times at HIV care clinics. In this project, we evaluate the feasibility of scheduling HIV patients at designated times to arrive at their care clinics in order to reduce waiting time and congestion. Specifically, we aim to: (i) Assess the feasibility of using designated time appointments with respect to patients keeping time and clinic operations; (ii) Establish the difference in the time spent at the clinic between patients with designated time appointments and those on scheduled drop-in and; (iii) Examine the impact of using designated time appointments on patients' productivity, adherence to clinic visits, service satisfaction and health outcomes. This will be achieved through a cluster randomized trial, in which four HIV care facilities will be randomized to either an intervention arm, where all patients will be given specific dates and times to arrive for their clinic visits, or to a control arm, where all patients will be given a specific date, but no specific arrival time for their clinic visit as is the standard practice in most health facilities. We will sample 80 patients from each of the four clinics. We will accrue the study participants in the first two weeks and follow them up based on HIV clinic return dates for up to three visits.

Mentors: Dr. Starley Shade (UCSF), Dr. Elizabeth Bukusi (KEMRI), Dr. Emmanuel Manyasa (Uwezo)

zkwena@kemri-ucsf.org