Glocal Fellows 2016-2017 | UC Global Health Institute

Aileen Chang, MD, is an early career dermatologist interested in HIV-related dermatology, Kaposi sarcoma, socioeconomic and cultural determinants of health, and role of technology in bridging access gaps. In Botswana, Dr. Chang led the creation and implementation of a mobile learning project that increases access to health information at point-of-care, now fully adopted by the University of Botswana, and has helped to provide regionally relevant dermatology training modules for medical students. She has clinical experience in Botswana, India, China, and Navajo Nation. Dr. Chang was a 2010-2011 Doris Duke Clinical Research Fellow, during which time she studied cutaneous lupus treatment outcomes. She received her MD from the University of Pennsylvania and completed her dermatology residency at the University of Pennsylvania.

Project

Improving the diagnosis and treatment of Kaposi sarcoma in Uganda

Kaposi's sarcoma (KS), one of the most common AIDS-defining cancers in the pre-antiretroviral therapy (ART) era, continues to be amongst the most common HIV-associated malignancies despite ART and represents a significant HIV-associated comorbidity. Dr. Chang's research will focus on improving diagnosis and treatment of Kaposi sarcoma by: 1) Exploring point-of-care polymerase chain reaction diagnostics for KS, 2) Using rapid case ascertainment to describe the characteristics of patients who develop KS after ART, and 3) Characterizing the PD-1 pathway in KS lesions from patients who have failed standard chemotherapy.

Mentors: Dr. Toby Maurer (UCSF), Dr. Andrew Kambugu (IDI), Dr. Jeff Martin (UCSF)

aileen.ychang@gmail.com

Dr. Brooke S. West, PhD, is a medical sociologist whose research focuses on the structural determinants of HIV/STI and substance use among marginalized populations. Dr. West has a MA in Sociology from Cornell University and her doctorate, a joint degree in sociology and public health, is from the Mailman School of Public Health at Columbia University. Her mixed methods research has examined HIV risk environments among drug-using fishermen in Malaysia, as well as HIV prevention and intervention approaches among female sex workers in India and migrant market place workers in Kazakhstan. She has also assessed changes in the HIV epidemic among injection drug users in 96 large US cities over time. Dr. West is currently a postdoctoral fellow in the Division of Global Public Health at UCSD.

Project

Venues and Risk Networks: Substance Use and HIV/STI among High Risk Women

Despite a low national HIV prevalence, incidence is rising among vulnerable populations along the US-México border, especially high risk females. In Tijuana, HIV sequencing data indicates that the local epidemic is characterized by multiple new viral introductions, bridging across risk groups, and phylogenetic clustering among women. This suggests that interventions with high risk women could reduce HIV/STI incidence by tapping into their connections to other high risk groups. Using field observations and survey data on venue affiliations, the proposed research will assess underlying HIV/STI transmission dynamics by identifying venues where high risk networks converge (e.g. bars, shooting galleries, street intersections) and examining how the physical features of these venues (e.g. type, location, policies, safety) and affiliation network patterns (i.e. people's connections to these places) drive substance use, HIV/STI risk behaviors and infection. Incorporating detailed venue information into two-mode network analysis involving high risk female injectors will enhance research on local pathogen transmission patterns and inform targeted public health efforts aimed at reducing HIV/STI incidence.

Mentors: Dr. Steffanie Strathdee (UCSD), Dr. Ietza Borjorquez-Chapela (COLEF), Dr. Shari Dworkin (UCSF)

bswest@ucsd.edu

Elizabeth O'Hara, Pharm.D. is a U.S. trained pharmacist that specializes in global health. She received her doctorate from the Medical University of South Carolina and has completed two years of clinical residencies and two years of post-doctoral fellowships. She has been based in Kenya for the last three years, first with Purdue's global health program and most recently with the Afya Bora Global Health Leadership Fellowship. She has been involved in clinical care, teaching, creating innovative clinic designs, and research with vulnerable populations having worked extensively in non-communicable diseases (NCDs), maternal neonatal and child health (MNCH), commodity supply chain management, and community strategies for group care. As an Afya Bora Fellow she worked with healthcare providers across Kenya, Tanzania, Uganda, and Botswana on pressing topics in clinical care, leadership, and policy that affect the region. Dr. O'Hara's primary research interest is looking at innovative designs that shift the current provider-centric model of care to more patient-centric community and public health strategies addressing some of the unique barriers and vulnerabilities seen in various marginalized populations in East Africa with specific interest in improving care strategies for women who use heroin.

Project

Exploring female people who inject drug's (PWID) perceptions and experiences of methadone Opioid Substitution Therapy (OST) and barriers to linkage in care: a qualitative study

Kenya's heroin use has been increasing over the last two decades and despite recent increases in service provision, women heroin users are not accessing risk-reduction services at the same rate as their male counterparts. Dr. O'Hara's study will use qualitative methods to understand the specific perceptions of and barriers to accessing methadone and other risk-reduction services for women who use heroin in the resource-constrained setting of Nairobi, Kenya. This work is both significant and innovative as it will for the first time in Kenya, focus on the needs and experiences of female drug users to advance our knowledge and identify gaps to strengthen harm reduction services. The ultimate aim this research will support is to identify key targets for intervention to develop and test strategies that will shape public policy and increase women's engagement in therapy to help them overcome drug addiction.

Mentors: Dr. Steffanie Strathdee (UCSD), Dr. Tim Rhodes (London School of Hygiene and Tropical Medicine), Dr. David E. Bukusi (Kenyatta National Hospital)

egohara13@gmail.com

Huan Vinh Dong, MS, is a second year medical student at in the Charles R. Drew University - David Geffen School of Medicine at UCLA program, where he holds leadership in groups such as the Asian Pacific American Medical Student Association (APAMSA), MedGLO (LGBT Health group), and the Infectious Diseases Interest Group. Prior to medical school, Huan graduated with a double B.A. in Integrative Biology and Theatre/Performance Studies from the University of California, Berkeley. He values his creative side as he has used theatrical and communication skills for health education purposes in Tanzania and Vietnam, as well as Kaiser Permanente's Educational Theater of Northern California, and the Berkeley Free Clinic. Mr. Dong obtained his Master's in Human Nutrition and Metabolic Biology from the Institute of Human Nutrition of Columbia University's College of Physicians and Surgeons, where he conducted some work to assess metabolic effects of chronic viral infections like HIV and HCV. He believes that the future solutions to global public health issues lie within the strength of institutional collaborations.

Project

Cephalosporin Resistance in Commensal Oropharyngeal Flora

Globally, antimicrobial resistance is an increasing concern in our efforts to prevent severe clinical sequelae of untreated infections. Neisseria gonorrhoeae (NG), one of the world's most prevalent sexually transmitted infections with over 100 million new cases each year, is currently gaining resistance to our last line treatment with third-generation cephalosporin class treatments. President Obama and the United States Center for Disease Control and Prevention has listed antimicrobial resistant NG as one of the Top 3 Most Urgent Public Health Threats. Opportunities exist for increased surveillance of antimicrobial resistance in global regions such as South-East Asia, where resistant strains have been historically reported. Mr. Dong's investigation will assess community antibiotic usage as well as the antimicrobial resistance profile in non-pathogenic bacterial flora, an environment in which incident infectious organisms like NG could easily gain resistant genetic materials. He will partner with Hanoi Medical University (HMU), where previous work surveying antibiotic usage has shown some unnecessary usage as well as increased resistance in other common pathogens like E. coli and S. pneumoniae. He hopes that his project will inspire others to do similar work in various regions globally, which may help us better understand the ecology of antimicrobial resistance of even the 'non-pathogenic' bacteria.

Mentors: Dr. Jeffrey Klausner (UCLA), Dr. Le Minh Giang (HMU), Dr. Nguyen Vu Trung (HMU)

HVDong@mednet.ucla.edu

Javier Cepeda, MPH, PhD received both his degrees in epidemiology of microbial diseases from Yale University. His research focuses on the public health impact of the intersection of bloodborne pathogens (e.g. HIV, Hepatitis C Virus), substance use, and incarceration. He received a predoctoral fellowship from the National Institute on Drug Abuse to examine how these overlapping epidemics affected the post-incarceration risk environment among people who inject drugs in St. Petersburg, Russia. He also received a postdoctoral fellowship from a National Institute of Allergy and Infectious Diseases-funded training grant at the Johns Hopkins Bloomberg School of Public Health. During his time there, he collaborated with a diverse team of experts on the Johns Hopkins-Lancet Commission on Drug Policy and Health. Additionally, he has worked on developing new analytical tools to detect liver disease progression in a cohort of people who inject drugs chronically infected with hepatitis C in Chennai, India.

Project

Cost Analysis of a Police Education Program in Tijuana, Mexico

Dr. Cepeda's project will focus on evaluating the costs of an innovative police education program (PEP) "Proyecto Escudo" (Project Shield, PI: Strathdee) in Tijuana, Mexico. The objective of the PEP is to determine the efficacy of the police education program on a cohort of police officers' occupational safety procedures assessed by incidence of needlestick injuries. The PEP will also evaluate any changes in police officers' attitudes towards drug users and behaviors that might increase risk of HIV transmission in people who inject drugs (i.e. confiscation of syringes). The specific aims of the GloCal project are threefold: 1) collect cost data related to the PEP intervention 2) perform a cost analysis and assess changes in cost as the PEP is scaled up 3) calculate the budgetary impact of the PEP if scaled up across the state of Baja California. Findings from this study will be used to inform a cost-effectiveness analysis of the intervention and examine population-level benefits of its impact on reducing HIV incidence among people who inject drugs in Tijuana.

Mentors: Dr. Natasha Martin (UCSD), Dr. Gudelia Rangel (COLEF), Dr. James Kahn (UCSF)

jacepeda@gmail.com

Katelyn M. Sileo, MPH, is a doctoral student in the University of California San Diego and San Diego State University Joint Doctoral Program (JDP) in Global Health. Ms. Sileo has worked on NIH and PEPFAR-funded behavioral research on HIV/AIDS in sub-Saharan Africa for more than seven years. This experience has developed Ms. Sileo's expertise in research design and the implementation and evaluation of theory-driven interventions to increase engagement in HIV care and reduce HIV risk behaviors. She has consulted for UNICEF, and is a NIDA T32 Pre-Doctoral Fellow in HIV/AIDS and substance abuse. Using both quantitative and qualitative research methods, Ms. Sileo's independent research explores psychosocial and structural barriers to HIV and reproductive health services for underserved populations. Her main research interests in global health are related to the syndemic of substance abuse, HIV/AIDS, and gender inequity in sub-Saharan Africa.

Project

Substance use and engagement in HIV care among Ugandan fishermen: A syndemic approach

Ugandan fishermen are significantly more likely to be infected with HIV/AIDS than the general adult population and meet the national and global recommendations for immediate initiation of antiretroviral treatment (ART) upon HIV diagnosis for high risk populations. However, high rates of alcohol and drug use among fishermen pose a significant challenge to Uganda's scale up of ART access in this population. Furthermore, substance use may exist in a larger syndemic of other co-occurring psychosocial problems common in high risk HIV settings. HIV stigma, gender norms that reduce men's care seeking and increase risky behaviors, and depression may interact with substance use to further diminish engagement in HIV care. Ms. Sileo's study will examine factors influencing engagement in HIV care among fishermen living with HIV in Uganda using a syndemics framework. Using mixed methods, Ms. Sileo's study specifically explores the independent and synergistic effects of substance use, HIV stigma, gender norms, and depression on Ugandan fishermen's engagement in HIV care.

Mentors: Dr. Susan Kiene (UCSD/SDSU), Dr. Jennifer Wagman (UCSD), Dr. Rhoda Wanyenze (MakSPH), Dr. Glenn Wagner (RAND Corporation/UCLA)

katelyn.sileo@gmail.com

Patricia Ong'wen, MBChB, MPH, is a medical doctor and a research officer working with Kenya Medical Research Institute (KEMRI) - Research, Care and Training Program (RCTP). She received her MBChB from Moi University and MPH in Epidemiology from the University of California Berkeley. Her research work has been in the area of adolescents and HIV. Dr. Ong'wen has evaluated adherence to clinic appointments among HIV-infected adolescents in the Nyanza region of Kenya and worked as a co-investigator of a study that investigated the patterns of disclosure, levels of stigma and social support among HIV-infected adolescents in Kenya. In addition, she has worked on a project that seeks to adapt a successful intervention for youth and their social networks to build social support and improve disclosure, ultimately improving health outcomes. Beyond the fellowship training, Dr. Ong'wen would like to continue working with adolescents and design more innovative interventions to prevent HIV infection and improve the outcomes of adolescents living with HIV.

Project

Social network recruitment strategy for improvement of HIV testing among adolescents in the Nyanza region of Kenya

Dr. Ong'wen's research project seeks to constructively use peer pressure and social networks that exist within adolescents to mobilize them for HIV testing. The study aims to investigate the feasibility of friendship-based social network recruitment in mobilizing adolescents for HIV testing and counseling. Respondent-driven sampling will be used to recruit where the seeds will be index adolescents who come to the health facilities for any service, irrespective of their HIV status. Trained adolescent-friendly mobilizers will be stationed at strategic locations within the health facilities and will be used to mobilize the adolescents and issue the referral cards. The research team will measure the proportion of adolescents ages 15-19 years accepting referral cards and the proportion of adolescents who come for testing with referral cards. To determine the effectiveness of social network recruitment, the team will compare the number of adolescents ages 15-19 years receiving HIV testing in the selected facilities pre- and post-rollout of the intervention.

Mentors: Dr. Craig Cohen (UCSF), Dr. Elizabeth Bukusi (KEMRI), Dr. Hilary Wolf (Georgetown)

pat.ongwen@gmail.com

Siana Nkya Mtatiro, MSc, PhD, completed both her bachelor's degree in microbiology and chemistry and her master's degree in molecular biology at the University of Dar es Salaam. She has a vision of building capacity for genetic studies in Tanzania, particularly in the area of health, with the aim of discovering interventions that can be accessible within and outside of the country. She has worked with the Muhimbili Wellcome Programme on a genetic disorder known as sickle cell disease (SCD). In 2009 she started working on the genetics of fetal haemoglobin, a major modulator of SCD. A main goal of Dr. Mtatiro's PhD research was to determine genetic factors influencing the levels of fetal haemoglobin in individuals with SCD in Tanzania. This study has built a platform to pursue further research in other SCD phenotypes with the aim of developing interventions and improving health care for the patients with SCD. Dr. Mtatiro has worked in a close collaboration with King's College London and the Wellcome Trust Sanger Institute in Cambridge, UK. She also holds an academic position at the Dar es Salaam University College of Education, which is a constituent college of the University of Dar es Salaam. Furthermore, she works on MUHAS newborn screening program for sickle cell disease.

Project

Detailed investigation of genetic patterns in sickle cell disease patients with extreme fetal hemoglobin levels

Dr. Mtatiro's research is centered on understanding the genetic patterns of individuals with SCD who exhibit extreme levels of fetal hemoglobin (HbF). Clinical studies have shown that mortality and disease severity are reduced in SCD patients who are able to produce significant amounts of fetal hemoglobin (HbF). Normally, at birth, HbF levels account for 80% of the total hemoglobin. This rapidly declines to 1% HbF within two years of life, an age when a child becomes more prone to diseases. However, some individuals continue to synthesize HbF at high levels (>1%) throughout their adulthood. It has been established that most of these individuals have inherited genetic variants that are associated with HbF, a condition also termed as hereditary persistence of fetal hemoglobin (HPFH). HbF is a quantitative trait and thus influenced by a wide array of loci with small but significant effects. So far, three primary loci namely; BCL11A, HMIP and HBG have been reported to contribute up to 50% of HbF variation in Europeans, and much less in African populations. Therefore, identification of additional variants; both common and rare, will enhance the ongoing efforts of development of interventions for individuals with SCD. One approach that has been used to define such variants is to compare genetic patterns of individuals with high levels of HbF with those with low levels of HbF (extreme phenotypes). This approach will be adopted for this study of individuals with SCD with extreme HbF levels in Tanzania.

Mentors: Dr. Karin Gaensler (UCSF), Dr. Stephan Menzel (KCL), Dr. Julie Makani (MUHAS)

smtatiro@blood.ac.tz

Towfida Siddiqua, MS, PhD, is currently an Assistant Scientist at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). As one of the five female scientists from the developing world, she received the "Gro Brundtland Award 2016" for her academic performance and investment in the field of sustainable development and public health nutrition. Dr. Siddiqua received her B.S. and M.S. in Biochemistry and Molecular Biology from the University of Dhaka, Bangladesh. She obtained her Ph.D. from the University of California, Davis in Nutritional Biology with a Designated Emphasis in International and Community Nutrition in 2013. Her doctoral research explored effects of vitamin B12 supplementation during pregnancy and lactation on maternal and infant B12 status, breast milk and immune function. Her education and experiences have sparked awareness in global health which is directly applicable to her current research career. Her research interests include maternal and infant nutrition, micronutrient deficiencies in developing countries, epigenetics, and the relationship between nutrition and infection.

Project

Potential for impaired gut health and systemic inflammation to affect estimates of total body vitamin A stores as assessed by the retinol isotope dilution technique

The retinol isotope dilution (RID) technique provides a quantitative estimate of total body vitamin A (VA) stores, and is considered to be the most sensitive biomarker for evaluating the effectiveness of public health interventions to improve VA status in low-income countries (LICs). However, high prevalence of inflammation may result in overestimation of total body VA stores. Since subclinical inflammation is prevalent among young children in LIC, it is critical to understand whether this condition affects the estimate of VA stores using the RID technique. It is also possible that subclinical inflammation impairs gut health, and thereby reduces absorption of the oral dose of [13C10]-retinyl acetate. The proposed study is nested within an ongoing research project designed to develop a simplified equation to estimate total body VA stores using the RID technique in a group of infants with or without inflammation. The purpose of the study is to assess whether impaired gut health is associated with inflammation and reduced responsiveness (reduced fraction of isotope dose in plasma (area-under-the-curve)) to an oral dose of [13C10]-retinyl acetate.

Mentors: Dr. Marjorie Haskell (UC Davis), Dr. Shaikh Meshbahuddin Ahmad (icddr,b), Dr. Tahmeed Ahmed (icddr, b)

towfida@gmail.com