Glocal Fellows 2018-2019 | UC Global Health Institute

June P. Barrera, DVM, is a graduate from UC Davis School of Veterinary Medicine. During her veterinary education, Dr. Barrera participated in international research projects and training in Uganda, Tanzania and Rwanda to assess One Health issues, like food security and zoonoses, in agricultural and pastoral communities living in close proximity to wildlife. Passionate about One Health, Dr. Barrera’s short-term goal is to investigate drivers that increase emerging zoonotic risk in communities with a high wildlife-livestock-human interface. By understanding the ecology of such an interface, effective global health policies and practices can be developed to contain and limit emerging zoonoses. She also aims to ultimately make global healthcare more sustainable by promoting and encouraging the public to practice preventive health measures not only for themselves, but also their animals, particularly food animals.

Project

Viral Sharing Between Animals & Humans: Implications for Spillover in Tanzania

About 75% of emerging infectious diseases (EIDs) with pandemic/epidemic risk originate in animals, both wildlife and domestic. Because the frequency and environmental conditions in which humans and animals interact affect disease ecology, critical animal-human-environment interfaces pose a threat to global health. To tease apart how animal, human and environment interactions influence the risk of EIDs, Dr. Barrera will assess the prevalence of viruses associated with pandemic risk in Tanzanian livestock. Viruses will be identified using consensus PCR and whole genome sequencing. Dr. Barrera will also investigate viral spillover between animals and humans by cross-referencing the viruses detected in her livestock samples with those previously identified in humans and wildlife sampled in the same region. By enhancing our understanding of viral transmission and disease risk at high wildlife-livestock-human interfaces, this study will provide a more comprehensive surveillance of EIDs.

Mentors: Jonna Mazet, DVM, MPVM, PhD (UC Davis), Rudovick Kazwala, DVM, MVM, PhD (Sokoine University of Agriculture), Dr. Subhash Morzaria , BVSc, MSc, PhD, CIBiol, MRCVS (FAO)

jbarrera@ucdavis.edu

Jaeson Calla, PhD, is a postdoctoral fellow at UPCH as well as a postdoctoral researcher in the UC San Diego School of Medicine. He obtained his Masters in Biochemistry and Molecular Biology at UPCH and his PhD in Infectomics and Molecular Pathogenesis at the Center for Research and Advanced Studies of the National Polytechnic Institute (CINVESTAV) in Mexico City. Dr. Calla’s early research focused on identifying new microbiological and molecular methods to diagnose Mycobacterium tuberculosis. His later graduate research was devoted to identifying mechanisms of gene regulation in organisms causing infectious parasitic disease. During the past few years, Dr. Calla has been conducting research on malaria, under the supervision and mentoring of Dr. Elizabeth Winzeler, aimed at identifying biomarkers of Plasmodium vivax infection in the human host cells as well as discovering new compounds that might prevent and eliminate malaria. His scholarly work has been supported by Medicines for Malaria Venture (MMV).

Project

Universal biomarkers for Plasmodium vivax exoerythrocytic infection

Using dual RNAseq of flow-sorted infected cells, hundreds of upregulated human genes have been identified during infection by the model rodent malaria parasite, Plasmodium berghei. In order to determine whether these genes are also upregulated during infection with human pathogens, Dr. Calla’s research team plans to follow a group of fifteen proteins (receptors and surface membrane proteins), using HC04 cells and P. vivax sporozoites obtained from mosquitoes fed on blood from Peruvian P. vivax patients. Results will show if these human proteins can distinguish P. vivax infected from uninfected cells. The in vitro infection process will be developed in the “Satellite Laboratory” located in Iquitos, Peru, under the supervision of Dr. Joseph Vinetz (UC San Diego) and Dr. Dionicia Gamboa (UPCH). Through in vitro infection, the 20 most promising antimalarial compounds with potent activity across the entire parasite lifecycle will be evaluated; these were identified from phenotypic screens at UC San Diego under the supervision of Dr. Elizabeth Winzeler.

Mentors: Elizabeth Winzeler, PhD (UC San Diego), Dionicia Baziliza Gamboa Vilela, MSc, PhD (UPCH), Joseph Vinetz, MD (UC San Diego)

jcalla@ucsd.edu

Rebecca (Becky) DeBoer, MD, MA, is a fellow in medical oncology and a Global Cancer Fellow at UCSF. She received her BA in Human Biology from Stanford and joint MD/MA in Medical Humanities and Bioethics from Northwestern. As a medical student she conducted a qualitative study in India about cancer treatment decision-making and research participation, which ultimately inspired her master’s thesis, “The Ethics of Global Cancer Care and Control.” She completed internal medicine residency at the University of Chicago and clinical ethics fellowship at the MacLean Center for Clinical Medical Ethics. After residency she worked as an oncology clinician at Butaro Hospital in Rwanda with Partners In Health for two years. She remains involved in oncology capacity-building projects in Rwanda and is now also working in Tanzania with the MUHAS-UCSF Cancer Collaboration. During her GloCal fellowship she looks forward to conducting ethics and implementation research in Rwanda and Tanzania.

Project

Improving shared decision-making about palliative cancer therapy for HIV-related Kaposi sarcoma and other malignancies in Tanzania and Rwanda

Most cancer patients in sub-Saharan Africa present with advanced, incurable disease, and ensuring access to effective palliative chemotherapy and radiation is an important part of equitable cancer care. However, decisions about treatment of incurable disease are complex. At Ocean Road Cancer Institute (ORCI) in Tanzania and Butaro Hospital in rural Rwanda, physicians and nurses have identified decisions about palliative cancer therapy as among the most difficult clinical and ethical challenges they face on a day-to-day basis. The first aim of this project is to describe the experiences and beliefs related to decision-making about palliative cancer therapy among oncology physicians, nurses, and patients at ORCI and Butaro, comparing decisions about treatment of HIV-related Kaposi sarcoma with other cancers. The second aim is to develop and implement a decision tool targeted at providers that will facilitate shared decision-making at ORCI, Butaro, and comparable low-resource settings.

Mentors: Katherine Van Loon, MD, MPH (UCSF), Nazima Dharsee, MMed, MSc, MD (MUHAS), Anita Ho, PhD (UCSF)

rebecca.deboer@ucsf.edu

Nyawira Gitahi-Kamau, MD, MPH is a young scientist whose research interest focuses on public health areas of HIV prevention and treatment, health system strengthening and emerging global health issues such as antimicrobial resistance. Her previous research carried out during her master’s degree looked at socioeconomic determinants of HIV disease progression among HIV discordant couples. She has been able to participate in various implementation science projects such as an evaluation of the adolescent HIV package of care in Kenya and the translation of research to policy in the country including adoption and roll-out of pre-exposure prophylaxis and guidelines for HIV prevention among adolescent key populations among others. She is a medical doctor (MBChB) from the University of Nairobi with a postgraduate degree in public health from Moi University. She is currently pursuing a PhD in global health from the Institute of Tropical Medicine and Infectious Disease (ITROMID), affiliated with KEMRI.

Project

Evaluation of treatment outcomes after life skills provision among perinatally HIV-Infected adolescents receiving care in Kenya

Globally, HIV-related deaths fell by almost 40% between 2005-2016 for all age groups except adolescents. Adolescents are at a challenging developmental stage psychologically. Their needs for autonomy and independence and their evolving decisional capacity intersect. This makes it challenging to attract and sustain adolescents’ focus on maintaining their health, particularly for those with chronic illnesses like HIV. Transition by HIV infected adolescents from pediatric clinics to adult care requires attainment of certain life skills that enable the HIV positive adolescents to navigate the health care system successfully as adults. This includes the ability to cope with stigma, self-care and drug adherence as well as day-to-day routine activities. There is a need to evaluate the effect of life skills among HIV infected adolescents. This study will focus on evaluating these outcomes in a low resource setting and provide evidence on associated virological and psychological outcomes.

Mentors: Carol Camlin, PhD, MPH (UCSF), Elizabeth Bukusi, MBChB, MD, MPH, PhD (KEMRI), Colette (Coco) Auerswald, MD, MS (UC Berkeley)

gnyawira@gmail.com

Nelson Kalema, MBChB, MMed, MAS, completed his residency training in Internal Medicine at the College of Health Sciences, Makerere University in Kampala, Uganda, with support from the NIH-funded HIV/TB COHRE Program administered by the Joint Clinical Research Center. Between 2015-2017, a D43 HIV/TB Implementation Science grant supported Dr. Kalema to obtain additional Master’s Degree Training in Clinical Research (TICR Program) in the Implementation Science track, at the University of California, San Francisco. Previously, he has collaborated and published with UCSF faculty on TB research that sought to assess the performance of novel TB diagnostic tests, treatment strategies and outcomes in patients who presented with presumed TB at the Mulago National Referral Hospital. Currently, Dr. Kalema is a research fellow at the Infectious Diseases Institute (IDI) working with stakeholders in the Outreach Program to identify key implementation science gaps/bottlenecks, opportunities and strategies in HIV/TB Prevention and Care.

Project

Mapping and Understanding Gaps in the latent TB cascade of care - provision of isoniazid preventive therapy to persons registering for HIV care in Uganda: The MUG study.

Dr. Kalema’s study will focus on Mapping and Understanding Gaps (MUG) in the latent TB cascade of care in HIV-positive persons linked to HIV care facilities in Uganda. While a third of the 34 million HIV-positive persons in the world are estimated to be co-infected with latent TB and 19 times more likely to develop active TB disease than their non-HIV counterparts, only 8.3% received the WHO-endorsed isoniazid preventive prophylaxis in 2015. The same year, TB accounted for approximately 30% of HIV-related deaths, mostly in Africa where 21 out of 30 high HIV-TB burden countries did not report on isoniazid preventive therapy (IPT) provision. IDI is leading efforts to improve IPT provision to HIV-positive persons initiating care at ART facilities in Uganda. Initial reports indicate limited success and uptake is still unclear. Dr. Kalema proposes to use mixed-methods to quantify and describe quality gaps in the latent-TB cascade of care and use implementation science frameworks (TDF/CFIR) to understand and propose future interventions.

Mentors: Adithya Cattamanchi, MD, MAS (UCSF), Aggrey Semeere, MBchB, MMed, MAS (Makerere Univeristy), Mari Armstrong-Hough, PhD, MPH (Yale)

nkalema@idi.co.ug

Archana Siddaiah, MD, completed her medical school training at the Mysore Medical College and Research Institute. Due to her interest in the field of public health, post-graduation she went on to pursue Community Medicine from the All India Institute of Medical Sciences wherein she undertook roles of an administrator, researcher, and academician. Her main areas of interest include maternal and child health, adolescent health, and health systems research. Previously Dr. Siddaiah worked with the public health systems of India in improving existing adolescent reproductive and sexual health. In 2017 she was selected for the South East Asian Union/MSF SORT IT (Médecins sans Fronterès Structured Operational Research and Training IniTiative) course and successfully completed it. Currently, she is working as faculty member and is mentoring a Fulbright Fellow from Wake Forest University. In the long run she is interested in the development, implementation, and dissemination of ideas for addressing global health issues especially in low income communities.

Project

Feasibility and Effectiveness of Training Health Workers in providing Primary Mental Healthcare to Adolescents in Rural South India

Research has shown that mental health problems such as anxiety, depression, and suicidal tendencies among adolescents are increasing. In India, the adolescent population, aged 10-19 years, constitutes around 20.9% of the total population. Suicide ranks among the three leading causes of mortality among young people. Adolescents face many barriers in obtaining mental health services from the existing hospitals, including scarcity of psychiatrists. Health workers play an important role in providing mental health services in the community using standard diagnostic tools. To address the challenge of mental illness in resource constrained settings, the World Health Organization has developed a tool called Mental Health Gap Action Programme (mhGAP). Dr. Siddaiah’s research involves training health workers to use this tool to detect and manage some of the common mental health problems among adolescents. This should help in scaling up the existing health services available to adolescents.

Mentors: Maria Ekstrand, PhD (UCSF), K Srinivasan, MD (SJRI), Veena Satyanarayana, PhD (National Institute of Mental Health and Neurosciences)

archanapink@yahoo.com