Glocal Fellows 2019-2020

James Ayieko, MBChB, PhD, is a research scientist at Kenya Medical Research Institute (KEMRI). He holds a bachelor’s degree in Medicine and Surgery (MBChB) from Moi University (Kenya), MPH in Epidemiology from the University of California, Berkeley and a PhD in Epidemiology from the University of Antwerp (Belgium). His research interest is in the optimization of the HIV care cascade and use of antiretroviral therapy (ART) to end the HIV epidemic. In the past, he has worked as a coordinator in an HIV care and treatment program in western Kenya called Family AIDS Care and Educational Services (FACES) before joining a large HIV test-and-treat cluster randomized trial called Sustainable East African Research in community health (SEARCH) as a co-Investigator and director of clinical services. Besides this, he serves as a member of the technical working group for the Kenya national HIV treatment guidelines and a reviewer for a number of health journals.

Project

Barriers to and facilitators of HIV care engagement among HIV infected mobile persons and potential care delivery models for mobile populations.

Antiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV; however, not all people are taking full advantage of this. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement due to discontinuations in care engagement and may thus not benefit fully from ART. To maximize the gains of treatment among this group and realize the benefits of treatment as prevention for the general population, barriers to care engagement among HIV infected mobile persons need to be understood and strategies developed to ensure continued care engagement.

The goal of the research project proposed by James is to investigate barriers to and facilitators of engagement in HIV care among HIV infected mobile persons living in rural Kenya and Uganda and to identify promising intervention approaches to enhance care engagement and individual positive health outcomes among mobile populations.

Mentors: Carol Camlin, PhD, MPH (UCSF), Elizabeth Bukusi, MBChB, MD, MPH, PhD (KEMRI), Edwin Charlebois, PhD, MPH (UCSF)

jimayieko@gmail.com

Sarah J. Coates, MD, is a graduate of the UCSF Dermatology residency program. She received her BA in Government from the University of Texas, and her MD from Weill Cornell Medical College. As a medical student, she participated in clinical programs that benefited Tanzanian patients with oculocutaneous albinism. She later returned to Tanzania to build a teledermatology consult system that connected local primary care physicians to dermatologists in New York to improve the care of skin disease. During her GloCal fellowship, she will work closely with physicians at the Infectious Diseases Institute in Uganda to examine how artificial intelligence may improve healthcare access and the speed of diagnosing Kaposi’s Sarcoma among HIV-positive patients. After the GloCal fellowship, she will complete additional pediatric dermatology training, and plans to build a global health career in pediatric dermatology, with specializations in infectious diseases and cutaneous oncology.

Project

Utilization of Point-of-Care Molecular Diagnostics and Machine Learning to Improve the Diagnosis of Kaposi’s Sarcoma among HIV-positive patients in sub-Saharan Africa

Despite antiretroviral therapy, Kaposi’s sarcoma (KS) continues to be the most common HIV-associated malignancy in East Africa and remains the cause of substantial HIV-associated comorbidity. Dr. Coates’ project will focus on 1) improving the understanding of how KS lesion morphology correlates with intralesional HHV-8 viral load, as measured by polymerase chain reaction, so that providers can know the highest-yield lesions for securing a tissue diagnosis, 2) determining whether trained artificial intelligence software can readily distinguish KS from non-KS lesions, and 3) determining whether trained artificial intelligence software can accurately differentiate various morphologies of KS. Her team plans to use this information to improve access to care for HIV-positive patients with KS, such that it may one day be possible for patients situated in remote regions of East Africa to be linked to appropriate care on the basis of patient-uploaded photographs.

Mentors: Toby Maurer, MD (UCSF), Barbara Castelnuovo, MD (Infectious Diseases Institute), Jeff Martin, MD, MPH (UCSF)

sarah.coates@ucsf.edu

Monica Diaz, MD, is a post-doctoral fellow and neurologist at University of California, San Diego who specializes in neurological complications of HIV and neuroimmunology. She received her MD from State University of New York - Downstate College of Medicine and completed neurology residency at Yale University. She completed a fellowship in neuroHIV and neuroimmunology and is currently completing a Master’s degree in Clinical Research through the Medical University of South Carolina as an American Academy of Neurology’s TRANSCENDS scholar. Dr. Diaz’s research interests are on: effects of HIV-associated co-infections on neurocognitive impairment, ethnic health disparities of HIV-associated neurocognitive impairment in the U.S., and the overlap of HIV and Alzheimer’s Disease. Her current research at UC San Diego investigates immune activation differences related to HIV-associated neurocognitive impairment and risk of Alzheimer’s Disease among Latino vs non-Latinos with HIV.

Project

Characterization of HIV-associated neurocognitive impairment in persons living with HIV in Lima, Peru

The number of people living with dementia worldwide in 2015 was estimated at 48 million and is expected to rise to 135 million by 2050. As the world’s population ages, dementia is becoming one of the most critical diseases to address. With increasing use of antiretroviral medications, people with HIV are living to geriatric ages, increasing the risk of developing neurocognitive impairment (NCI). There exists a need to characterize the aging HIV population in Peru and determine the prevalence of and factors associated with NCI in HIV. To address this gap, Dr. Diaz and her team plan to implement a study to: 1) characterize the neurocognitive profile of the aging HIV population of Lima, Peru; and 2) validate a tablet-based NCI screening tool addressing the socio-cultural context of Peru that may be applied in the primary care setting for detection of HIV-associated NCI. This is the first step in generating awareness of dementia in the public health domain for those living with HIV in Peru.

Mentors: Ronald Ellis, MD, PhD (UC San Diego), Patricia Garcia, MD, MPH, PhD (UPCH), Serggio Lanata, MD (UCSF)

mmdiaz@ucsd.edu

Anne E. Fehrenbacher, PhD, MPH, is a public health scientist and postdoctoral fellow in the UCLA Department of Psychiatry and Biobehavioral Sciences. Since 2011, Dr. Fehrenbacher has collaborated with the Durbar Mahila Samanwaya Committee of Sex Workers in India to examine migration narratives of sex workers, the impact of economic insecurity on consistent condom use, and self-regulatory boards led by sex workers to prevent labor exploitation. Dr. Fehrenbacher is the Principal Investigator for a pilot study with Durbar on PrEP acceptability and adherence barriers among hard to reach sex workers. Dr. Fehrenbacher is also an ethnographer for the Sexual Humanitarianism Research Team, an international consortium of scholars investigating the relationship between migration, sex work, and trafficking in the global sex industry. Dr. Fehrenbacher received her PhD and MPH from the UCLA Fielding School of Public Health and her BA in Public Health from Johns Hopkins University.

Project

Implementation Science to Improve PrEP Delivery within Transgender Communities in South India

India does not have a generalized HIV/AIDS epidemic, but concentrated epidemics exist among highly stigmatized groups such as transgender people, with the highest incidence rates in South India. Pre-exposure prophylaxis (PrEP) provides promise for reducing the incidence of HIV among trans people and other key populations. For the GloCal Fellowship, Dr. Fehrenbacher will work with the Public Health Research Institute of India to examine PrEP uptake, adherence, and persistence within trans communities in Mysore, Karnataka building on the recently completed PrEP Demonstration Project with Sex Workers in India conducted by the Durbar Mahila Samanwaya Committee in Kolkata and the Ashodaya Samithi Sex Worker Network in Mysore. Dr. Fehrenbacher's community-based participatory research study will include a formative needs assessment with trans PrEP users and multidimensional cluster analyses to map cross-level stakeholder priorities to improve PrEP implementation within trans communities.

Mentors: Jeffrey Klausner, MD, MPH (UCLA), Vijaya Srinivas, MBBS, DFW, DGO (ICMCH), FCGP (Public Health Research Institute of India), Sheldon Morris, MD, MPH (UC San Diego)

afehrenbacher@mednet.ucla.edu

Cusi Ferradas, DVM, MPH, is an infectious diseases epidemiologist working at Emerge, the Emerging Diseases and Climate Change Research Unit at UPCH. She obtained her DVM from UPCH and her MPH from Johns Hopkins University. Dr. Ferradas’ previous research focused on creating nanoparticle-based diagnostic techniques for malaria and toxoplasmosis, as well as studying the environmental, human, and animal-related risk factors for multi-drug resistant staphylococcus carriage among domestic animals. While pursuing her MPH, Dr. Ferradas was an intern at the Department of Zoonotic and Vector-Borne Diseases at the Maryland Department of Health. There, she became aware of the high burden of ectoparasite-borne diseases and decided to address this understudied topic in Peru. Therefore, her long-term goal is to establish a research group in ectoparasite-borne diseases in the Peruvian Amazon to more accurately diagnose them and establish effective preventive and control measures.

Project

The role of domestic animals and rodents in the ecology and epidemiology of rickettsias in the Peruvian Amazon Basin

A high seroprevalence of human rickettsiosis has been reported in the Peruvian Amazon Basin. However, little is known about the interplay between sylvatic and domestic animals and humans in the transmission cycle. To better understand the eco-epidemiology of rickettsial diseases, Dr. Ferradas will address the following questions: 1) Are rodents potential reservoirs of Rickettsias? 2) Which species of Rickettsia are circulating in the Peruvian Amazon Basin? and 3) What is the seroprevalence of rickettsial species among humans, domestic animals, and rodents? Rodents will be captured using live traps, blood and tissue samples, and ectoparasites will be collected. Blood samples of randomly selected inhabitants of neighboring villages and their domestic animals will be also collected. ELISAs will be used to determine the seroprevalence of rickettsias and real-time PCR plus Sanger sequencing will be used to molecularly characterize the isolated rickettsial species.

Mentors: Janet Foley DVM, MS, PhD (UC Davis), Andrés G. Lescano PhD, MHS (UPCH), Gabriela Salmon-Mulanovich, PhD (UPCH)

cusi.ferradas@upch.pe

Douglas Gaitho, MBChB, MMed (Pediatrics and Child Health), works with the Christian Health Association of Kenya (CHAK) as the senior technical advisor for the HIV prevention, care and treatment program, which provides services in 79 faith-based health facilities in 19 counties across Kenya with 48,567 enrolled patients. In this capacity, he develops and oversees quality improvement initiatives to optimize treatment outcomes for people living with HIV. He completed his medical training in 2010 and pediatrics specialization in 2017 from the University of Nairobi. Between 2012 and 2014 he worked with the Academic Model Providing Access to Healthcare (AMPATH), a large HIV treatment program based in Western and North Rift Kenya with a total enrolment of 160,000 patients. His overall career objective is to become an independent investigator of mental health among HIV-infected adolescents in sub-Saharan Africa, in order to contribute to improvement of the adolescent HIV care cascade.

Project

Depression among Adolescents Living with HIV: A Cross-Sectional Study of Care-engaged Youth in Kenya

Depression is an understudied and potent correlate of sub-optimal HIV outcomes among adolescents. There are few studies in sub-Saharan Africa which extend this work to investigate how depression and/or associated antiretroviral therapy (ART) adherence impact HIV viral load among adolescents living with HIV (ALHIV). Viral load is a primary clinical marker of HIV treatment success and a driver of HIV care policies. This research gap is of great public health significance for ALHIV. Dr. Gaitho and his team propose to address this by building on their prior investigations with ALHIV in Kenya and using a cross sectional study of a large, representative cohort of care-engaged ALHIV in Kenya. They will use a locally-validated version of the PHQ-9 to determine the prevalence of depression (Aim 1) and its association with key HIV outcomes including ART adherence and HIV viral load (Aim 2).

Mentors: Susan Meffert, MD (UCSF), Elizabeth Bukusi, MBChB, MD, MPH, PhD (KEMRI), Linnet Ongeri, MBChB, MMed (KEMRI)

dgaitho@gmail.com

Divya Hegde, MD, completed her medical school training at the K.S. Hegde Medical Academy. Her interest in the field of mental health led her to pursue psychiatry post-graduation, where she undertook roles of an administrator, researcher, and academician. Her main areas of interest include schizophrenia, community health, suicide and women’s mental health. Previously Dr. Divya was closely associated with a rural community mental health program called “Maanasi”, which caters to the psychiatric needs of rural people in India. In 2017 she was awarded the prestigious S.S Jayaram Award at a national conference in India. Currently, she is working as faculty in the Department of Psychiatry at St John’s National Academy of Health Sciences, Bangalore. 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

Effectiveness of Training Health Workers in Providing Brief Intervention to Males with Hazardous Drinking and Assessment of Depression in Their Spouses in Rural South India

Alcohol use disorders (AUDs) comprise various conditions like hazardous drinking, harmful drinking, and dependent drinking reflecting progressively more serious forms of illness. AUDs are a major public health problem and contribute substantially to disability and premature mortality and years of life lost. AUDs could also affect the wellbeing of one’s spouse and the family. Common mental disorders such as anxiety and depression have also been identified among spouses/intimate partners. A recent national survey in India reported a treatment gap of 86% for AUDs in the previous year. Brief psychological treatments for harmful drinking, based on motivational enhancement, are acceptable, feasible, and cost-effective. Health workers play an important role in providing mental health services in the community. Dr. Hegde’s research involves training health workers to deliver mental health interventions at the primary care level. This may help to address the treatment gap.

Mentors: Maria L. Ekstrand, PhD (UCSF), K Srinivasan, MD (St. John’s Research Institute), Johnson Pradeep MBBS, MD (St. John’s National Academy of Health Sciences)

divyahegde19@gmail.com

Racheal S. Dube Mandishora, PhD, graduated from the University of Zimbabwe College of Health Sciences (UZCHS) in 2018, where she is currently working in the Medical Microbiology Department. She graduated with a Master’s of Science degree in Applied Microbiology and Biotechnology in 2013 and a BSc honors in Medical Laboratory Sciences in 2007. She is an early career Molecular Virologist who has research interests in genomic diversity of Human papillomavirus (HPV) associated with anogenital cancers. She is currently rounding up a project on whole genome HPV variants in vulval cancers detected in HIV positive women. Dr. Dube Mandishora is growing her research scope into molecular characterization of HPV from multiple anatomical sites and also understanding the role of vaginal microbiome profiles in persistent HPV infections.

Project

The role of Human Papillomavirus (HPV) whole genome diversity on cervical cancer and pre-cancerous lesions in HIV positive women.

Dr. Dube Mandishora’s PhD research unveiled unexpected high levels of intra-host viral genetic variation in HPV from anogenital swab samples, from women reporting for routine cervical cancer screening. Similar patterns were also reported in samples from a collaborating Norwegian study. The diversity was more pronounced in HIV positive women, who were amongst the Zimbabwean sample set. Since it is established that HPV evolves slowly at population level, such levels of within-host diversity were surprising. With such intriguing findings, the next step was to expand and strengthen the inferences concluded. In this GloCal fellowship, she will look at the evolution of HPV in confirmed cervical pre-cancer and cancer cases. The broad aim would be to understand the role of HPV whole genome diversity on histologically confirmed biopsies in comparison to a cancer-free group. The study name is HPV Zimbabwe Variability and Evolution Data (HPV-ZimVED).

Mentors: Joel Palefsky , MD (UCSF), ZM Chirenje, MD, FRCOG (UZCHS-Clinical Trials Research Centre), Trine Rounge, PhD (Cancer Registry of Norway)

racheal.mand@gmail.com

Chemtai Mungo, MD, MPH, is an Ob/Gyn and clinical researcher who was born and raised in Kenya. She received a bachelor’s degree with Honors from the University of California in Berkeley and completed her medical school at the University of California San Francisco (UCSF). At UCSF, she was a Doris Duke International Clinical Research Fellow and spent a year in Kisumu, Kenya working on cervical cancer prevention among HIV-infected women. She also completed a Master’s in Public Health (Epidemiology and Biostatistics) from the Johns Hopkins Bloomberg School of Public Health. Dr. Mungo's career goal is to use research, advocacy, and capacity-building to pursue equity in global women’s health. She is also passionate about advancing opportunities for leadership and mentorship of African investigators in global health, particularly women. Her primary research is focused on increasing access to effective, evidence-based cervical cancer screening and prevention in low-income countries.

Project

Evaluation of the safety, acceptability, and efficacy of an alternative ablation method for treatment of precancerous lesions among HIV-infected women in low-income countries

Although cervical cancer is preventable, in 2018, an estimated 570,000 new cases were diagnosed, 90 percent in low- and middle-income countries (LMICs). Women infected with HIV are at increased risk of cervical cancer. The World Health Organization recommends cervical cancer screening using Visual Inspection with Acetic Acid (VIA) or HPV testing in LMICs, followed by immediate treatment with cryotherapy. Currently, widespread implementation of cryotherapy programs has proven to be challenging given the need for bulky equipment that limits mobility and a need for an ongoing supply of expensive gas. Recent data primarily among HIV-negative women suggests that thermal coagulation, an alternative treatment method, may be more feasible for implementation in LMICs, with similar efficacy to cryotherapy. This project will investigate the effectiveness and acceptability of thermal coagulation among HIV-positive women by assessing the rates of HPV persistence and cervical dysplasia at 12 months.

Mentors: Craig Cohen, MD, MPH (UCSF) Elizabeth Bukusi, MBChB, MD, MPH, PhD (KEMRI), Megan Huchko, MD, MPH (Duke University)

chemtai.mungo@ucsf.edu

Liberata Mwita, MSc, PhD, is a Lecturer in the Department of Pharmaceutical Microbiology at Muhimbili University of Health and Allied Sciences in Tanzania. She collaborates with the Sickle Cell Program (SCP) in the Department of Haematology of the same university as a bioinformatician. She acquired her PhD from University of Pretoria, South Africa. She has an MSc in Biotechnology and BSc in Molecular Biology and Biotechnology from University of Dar-es-salaam, Tanzania. The collaboration with SCP gives her opportunity to contribute to the development of bioinformatics capacity in Tanzania and apply her PhD skills to find solutions to health related problems, specifically understanding genetic and molecular mechanisms underlying diseases important in global health. During her fellowship, she will be identifying genetic markers associated with anemia in individuals affected with sickle cell disease, which is an important step towards explaining the varying symptoms demonstrated by the individuals

Project

Identification of genetic markers associated with anemia in individuals affected with sickle cell disease

Sickle cell disease (SCD) is a genetic disease that affects many people, particularly common among those whose ancestors came from sub-Saharan Africa. All SCD individuals experience anemia because the sickle shaped cells have a short life unlike normal red blood cells; this increases the morbidity and mortality. Despite the similarity in the origin of the disease, individuals demonstrate varying symptoms and severity; however much of the variation in phenotype is yet to be explained. This study plans to use Genome Wide Association Studies (GWAS) data of SCD individuals to identify genetic variants associated with anemia in sickle cell individuals. In the long-term, it will contribute to efforts to improve the life expectancy of individuals by quickly identifying single nucleotide polymorphisms related to anemia in SCD and enabling early and better prediction and prevention.

Mentors: David Dynerman, MA, PhD (UC Berkeley), Raphael Zozimus Sangeda, MSc, PhD (MUHAS), Julie Makani, MD, PhD, FRCP (MUHAS)

libemwi@yahoo.co.uk

John Nesemann is a medical student at the David Geffen School of Medicine at UCLA. In 2015 he graduated with a degree in Anthropology from the University of Virginia, where he completed a thesis exploring Amerindian narratives of illness and healing in the Guyanese Amazon. In medical school he has been involved in co-directing the Los Angeles Global Health Conference and leading the Global Health and Wilderness Medicine Interest Groups. He spent the summer after his first year of medical school as a Blum Center Scholar in Nicaragua mapping the geographic distribution of suicides and mental health resources in Leon. His current interests center around the epidemiology and public health aspects of eye diseases in resource limited settings. Mr. Nesemann’s long-term career goals are in academic medicine with a focus on global health in South America.

Project

Trachoma prevalence and risk factors for blindness in the Loreto region of Peru

Trachoma is the leading infectious cause of blindness, disproportionately affecting populations in crowded living conditions with inadequate sanitation. The World Health Organization (WHO) estimates that trachoma causes visual impairment in 2.2 million people, of whom 1.2 million are blind. An additional 232 million people living in trachoma-endemic districts are at risk, especially preschool aged children. The WHO’s goal of eliminating trachoma by 2020 requires a reduction in the prevalence of trachomatous follicular inflammation (TF) in children aged 1-9 years to less than 5%. A survey conducted in Loreto, Peru by the Pan American Health Organization (PAHO) in 2017 identified a TF prevalence between 5-10%. Mr. Nesemann’s project will expand this survey to districts bordering the endemic evaluation unit in Loreto and provide information for public health decision making. His project will also identify risk factors for low vision in the populations being assessed for trachoma.

Mentors: Jeremy Keenan, MD (UCSF), Andrés Lescano, PhD (UPCH), Jeffrey Klausner, MD, MPH (UCLA)

JNesemann@mednet.ucla.edu

Aslam Nkya, MD, MMed graduated from his residency training in Otorhinolaryngology at Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania. He later obtained fellowship training in head and neck surgery in Yonsei University, South Korea. He also holds a diploma in global health from Tampere University in Finland and a certificate in designing clinical research (DCR) from UCSF. He has been actively involved in community outreach health education, campaigning on both communicable and non-communicable diseases and its impact to the health sector. Besides research activities, he also teaches both surgical and clinical skills for undergraduate and resident postgraduate students at MUHAS. His research interest is in studying Human Papilloma Virus (HPV) infections in head and neck cancers in Tanzania, particularly in HIV infected individuals.

Project

Human Papilloma Virus (HPV) and Human Immunodefiency Virus (HIV) Co-Infection among Head and Neck Squamous Cancer patients in Tanzania

Head and neck squamous cancers are a diverse group of cancers commonly associated with smoking and alcohol use. Recently, much attention has been given to focusing on the role of HPV in head and neck squamous cancers with 25% of all oropharyngeal squamous cancer deaths being attributed to HPV infections, particularly the high-risk HPV genotypes 16 and 18 with its incidences increasing in both developed and undeveloped countries.

HIV immunosuppression is a strong risk factor for oral HPV incidence, with persistence being 2-3 times higher in HIV infected populations. Low CD4 T cell count and high HIV viral load in advanced stage HIV predispose individuals to increased oral HPV prevalence, reflecting loss of viral control in those with compromised immune systems and thus oncogenic progression. Dr. Nkya’s study aims to determe the prevalence and assessment of risk factors and clinico-pathological characteristics of HPV-HIV co-infected individuals with head and neck squamous cancers

Mentors: Katherine Van Loon, MD (UCSF), Elia Mbaga, MD, MPH (MUHAS), Patrick Ha, MD (UCSF)

aslamnkya@gmail.com

Kasusu K. Nyamuryekung’e, DDS, MPhil, PhD is a young scientist whose research interests primarily lie in the economic and social factors which influence utilization patterns of oral health services in resource-poor settings. He just finished his PhD at the University of Turku in Finland, focusing on the intersection between public oral health and health economics. He graduated from MUHAS with a DDS in 2009 and subsequently earned an MPhil in international health from the University of Bergen, Norway in 2012. Currently, he is a staff member in the Department of Orthodontics, Pedodontics and Community Dentistry at MUHAS. Dr. Nyamuryekung’e is interested in oral health diseases of public health importance in developing countries, and is eager to apply the findings in new projects with a particular focus in equitable healthcare utilization.

Project

Determinants of provision and utilization of tooth fillings in a low-income setting.

Tanzania is low-income east African country with a population of approximately 55 million people. Its population to dentist ratio is about 125,000:1 and toothaches due to dental caries remain the single major reason for visits to oral care facilities. The vast majority (about 95%) of all provided treatment in dental facilities within the country are tooth extractions. Although complete tooth removal may alleviate pain, it leaves the patient less able to chew, speak and smile, negatively affecting their oral health related quality of life. This may bring about disparities in oral health outcomes dependent on the oral health services being utilized. For his project, Dr. Nyamuryekung’e will identify and determine factors associated with provision and utilization of tooth filling services. Further, using a standardized tool, he will conduct a pilot study to assess the feasibility of using mobile phones to determine treatment outcomes in Tanzania.

Mentors: Benjamin Chaffee, DDS, MPH, PhD (UCSF), Matilda Mlangwa, DDS, MPhil, PhD (MUHAS), Hendry Sawe, MD, MMED, MBA (MUHAS)

kasusuklint@yahoo.com

Stephen Ojiambo Wandera, PhD, MSc, is a graduate of the Consortium for Advanced Research Training in Africa (CARTA) and Makerere University in Kampala, Uganda. He holds a PhD in Population Studies and his thesis focused on the disparities in access to healthcare among older persons in Uganda. Dr. Wandera has also researched spousal sexual violence and self-reported sexually transmitted infections among married people in Uganda. Recently, he examined the determinants of HIV testing among older persons in Uganda. For his GloCal Health Fellowship, he is aiming to investigate HIV risk among young people from fishing communities in Uganda. His research interest is focused on the nexus between alcohol use, intimate partner violence and HIV risk among young people in Uganda.

Project

Alcohol use, Intimate Partner Violence (IPV) & HIV Risk among Young People in three fishing communities on the shores of Lake Victoria, Uganda

Uganda’s national HIV prevalence is estimated at 6.2% in the adult population (15-64 years) and at 25-29% in the fishing communities on the shores of Lake Victoria. The aim of the study is to investigate the factors associated with HIV risk behavior among young people in fishing communities on the shores of Lake Victoria. Three fishing communities will be selected: Lugala from Namayingo district (eastern Uganda), Buvuma from Buikwe district (east central Uganda) and Katosi landing site from Mukono district (central Uganda). The estimated sample size sample size is 527 young people from the three study sites. In addition, qualitative data will be collected to supplement survey data.

Mentors: Jennifer Wagman, PhD, MHS (UC San Diego), Nazarius Mbona Tumwesigye, PhD, MA, MSc (Makerere University), Eddy Walakira, PhD, MA (Makerere University)

swandera@gmail.com

Cathrine Tadyanemhandu, PhD, MSc, is a postdoctoral fellow whose research interest focuses on improving the management and long-term outcomes of patients’ post-tuberculosis treatment. She is a physiotherapy lecturer in the Department of Rehabilitation at the University of Zimbabwe. She finished her Master's degree in Physiotherapy (Cardiorespiratory) at the University of Cape Town, South Africa in 2014 and her subsequent PhD research focused on translating research evidence into clinical practice in relation to early mobilization of intensive care unit patients in Zimbabwe and South Africa. For her PhD at the University of the Witwatersrand (SA) she was a fellow in the Fogarty HIV Implementation Science Research Training Program (FHISRTP). Based on her PhD thesis findings, she intends to apply her skills to the field of HIV and TB to develop rehabilitation exercise programs that can be implemented in limited resource settings to improve patients body function, structure and quality of life (QoL).

Project

Effectiveness of a home-based pulmonary rehabilitation program to enhance functional status and quality of life in people with tuberculosis chronic lung disease (TB-CLD) in Harare, Zimbabwe-a pragmatic randomized trial

Tuberculosis (TB) remains the leading infectious cause of death worldwide and it is highly associated with human immunodeficiency virus (HIV). Even though TB is curable, it requires long-term therapy and chronic lung disease frequently develops, with significant impact on QoL. Patients with TB, despite receiving appropriate pharmacologic treatment, continue to have post-TB respiratory impairment which is clinically challenging and often occurs years after the first episode. Predictors of severity and heterogeneity of post-TB sequelae needs to be better understood on an individual patient basis. Dr. Tadyanemhandu's project, under the supervision of her mentors, will evaluate a broad-based TB-CLD randomized intervention incorporating home-based PR with a view to contribute to the evidence base around feasibility, acceptability, pragmatism, and expansion of TB-CLD management in high-burden settings in Zimbabwe.

Mentors: John Metcalfe, MD, PhD, MPH (UCSF), Joconiah Chirenda, MBChB, MPH, MBA, PhD (UZ), Christine Garvey, FNP, MSN (UCSF)

cathytadya@gmail.com

Pablo Tsukayama, PhD, MSc, is a Peruvian microbiologist with a long-standing interest in infectious diseases affecting Latin American populations. His research training and interests lie at the interface of genomics, public health, and infectious disease epidemiology. In 2015, he obtained his PhD in Molecular Microbiology at Washington University in St. Louis under the guidance of Prof. Gautam Dantas. Later, through a Chevening Scholarship, he obtained an MSc in Public Health in Developing Countries at the London School of Hygiene and Tropical Medicine. In 2017, he returned to Peru to establish a research group at Universidad Peruana Cayetano Heredia. As principal investigator of the Microbial Genomics Laboratory, he leads an interdisciplinary team of biologists, veterinarians, clinicians and epidemiologists working on the genomic surveillance of bacterial pathogens relevant to Peruvian public health.

Project

Genomic characterization of resistance determinants and transmission patterns of Mycobacterium tuberculosis in high-incidence district in Lima, Peru

Tuberculosis (TB) caused an estimated 1.3 million deaths in 2017. The increase of multidrug resistant (MDR) and extensively drug-resistant (XDR) strains in recent years has resulted in higher rates of treatment failure and patient mortality and threatens the control of TB at national and international scales. In 2014, the World Health Organization established the aim to ‘End TB’ by 2035, acknowledging that success of this strategy relies on the development of improved tools to prevent, diagnose, and treat TB. Despite a greater demand for universal access to such methods, the high costs of the procedures and lack of trained laboratory workers limit their implementation in countries with a high incidence of TB like Peru. The goal of this project is to apply methods in genomics, bioinformatics, and epidemiology to characterize circulating TB genotypes, emergence patterns of drug resistance and transmission routes in a high-incidence district in Lima.

Timothy Brewer, MD, MPH (UCLA), Larissa Otero, MD, MPH (UPCH), Ashlee Earl, PhD (Broad Institute)

pablo.tsukayama@upch.pe

Mario Valladares, MD, is a physician epidemiologist working in the Emerging Diseases and Climate Change Research Unit (Emerge) at UPCH. He holds a Master’s in Epidemiological Research at UPCH sponsored by a NIH Fogarty grant. He was president of the Latin American Federation of Medical Student Scientific Society (FELSOCEM, acronym in Spanish). In 2016, he began his work in Emerge assessing the impact of the El Niño Phenomenon on maternal and child health. Currently, he supports the data management process for a randomized clinical trial of neurocysticercosis treatment funded by NINDS. Mario is interested in studying how to mitigate the impact of climate change and also in the development of research capacities in resource-limited settings. His current research will allow him to build a line of research and in the future become an independent investigator in global mental health, to bring solutions in post-disaster scenarios.

Project

Persistent post-traumatic stress disorder and resilience on people affected by the 2017 Coastal El Niño in Piura and Lima, Peru

Between February and April 2017, the Peruvian coast was unexpectedly affected by a major coastal El Niño event, the largest since 1925. Substantial and continuous rainfalls caused major floods and landslides and hit the most unprepared peri-urban areas of Piura and Lima, causing a significant impact. Preliminary findings in the population affected by Coastal El Niño showed a major mental health impact. In Piura, Dr. Valladares and his team found 38% of the population was affected by post-traumatic stress disorder (PTSD) three months after the floods, but virtually zero PTSD one year after the event. In contrast, the prevalence of PTSD in Lima one year after landslides was still 21%. The hypothesis is that there are differences in resilience levels and prevalence of chronic PTSD between historically- and recently-affected communities. Dr. Valladares will follow up with populations affected by El Niño events in Lima and Piura to study their resilience and its relationship with chronic PTSD patterns using a mixed-methods approach.

Mentors: David J. Grelotti, MD (UC San Diego), Andrés G. (Willy) Lescano, PhD, MHS, MHS (UPCH), German F. Alvarado, MD, MPH, PhD (UPCH)

mario.valladares@upch.pe

Vania Wang, MPH, is a doctoral candidate in geography at UC Santa Barbara, with an NSF Integrative Graduate Education and Research Traineeship (IGERT) in network and data science. She received her undergraduate degree from the University of Washington, Seattle in microbiology, and a master of public health from the University of California, Berkeley in infectious diseases and vaccinology. Following her undergraduate studies, Vania joined the US Peace Corps to serve as a community health volunteer in Vanuatu. There she helped create participatory health education curriculums for HIV education; and led infrastructure projects that brought sanitation services and potable water to her village. After completing her MPH, Vania received the Allan Rosenfield Global Health Fellowship with the US CDC, to lead a population size estimation activity of HIV key populations in southern China. Vania is interested in using spatial and computational tools to understand human movement and health.

Project

WeMap: A methodology to map unplanned settlements using social sensing and volunteered geographic information

While residents of industrialized nations are accustomed to applications like Google Maps, navigation in resource-poor communities rely on spatial cognition. In the absence of planned pathways, merged movement trajectories from social sensing devices (SSD) can be leveraged to create maps that show frequently traveled paths and locations of unmapped spaces. By tracking people living with HIV (PLWH) in least developed countries (LDC), these maps can inform placement of treatment and self-testing centers in unmapped villages. Community mapping has been used to document travel paths within informal urban and peri-urban settlements, and remote sensing can monitor changes in informal settlement development. However, community mapping is laborious and satellite images cannot reveal unpaved footpaths commonly used in villages. Using methods from spatial science and public health, WeMap aims to address these challenges by mapping pathways within unplanned villages in Malawi using SSD.

Mentors: Susan Cassels, PhD, MPH (UC Santa Barbara), Kathryn Dovel, PhD, MPH (Partners in Hope), Pamina Gorbach, MHS, DrPH (UCLA)

vaniawang@ucsb.edu

Clara Wekesa, MBChB, MMed, is currently pursuing a doctoral degree at Makerere University, College of Health Sciences. She completed her Master's degree in Internal Medicine in 2012 at Makerere University which led her to pursue a career in research. She has led various research projects in both rural and urban Uganda focusing on non-communicable diseases and their interplay with infectious agents. In 2015 she was awarded the GSK Trust in Science Africa Grant to evaluate for liver disease in an established rural cohort in Uganda. In 2017 under funding from THRIVE, she extended this body of work into the urban region. Her current research interest focuses on evaluating liver fibrosis non-invasively among HIV-infected persons in the era of ART. The purpose of this research is to be able to identify cheap and readily accessible methods that can be incorporated into HIV care programs to identify individuals at risk of severe liver disease in a timely manner.

Project

Assessment of Liver Fibrosis among an ART Experienced Clinic Cohort: Comparison of Diagnostic Yields of Transient Elastography and Indirect Serum Bio-markers

In the era of ART, persons living with HIV/AIDS are living long enough to develop other causes of disease and death. Liver disease is one such morbidity that accounts for 14-18% of deaths among HIV-infected persons. Regardless of the cause of liver disease, liver fibrosis is the primary pathology observed. Evaluation for liver fibrosis can be performed non-invasively using imaging modalities and or blood based testing. Fibroscan® remains costly for most low-income countries and proxy measures (such as serum bio-markers) may suffice especially as surveillance tools for liver disease in hard to reach areas. Serum bio-markers are derived from relatively inexpensive tests that are readily available and performed routinely for patients with suspected liver disease. Using an HIV-infected population, Dr. Wekesa and her team plan to determine the level of agreement of indirect serum bio-markers and determine the correlation between Fibroscan® and pro-fibrotic cytokines and growth factors among people living with HIV/AIDS.

Mentors: Melanie Ott, MD, PhD (UCSF), Damalie Nakanjako, MBChB, MMED, PhD (IDI), Ponsiano Ocama, MBChB, MMED, PhD (Makerere University)

clara.wekesa@gmail.com

Keenan Withers is a medical student attending the David Geffen School of Medicine at UCLA. While at UCLA, Keenan has held leadership roles as a UCLA Global Health Selective leader and Global Short Term Training Program grant recipient to Vietnam under the mentorship of Drs. Jeffrey Klausner and Le Minh Giang. While in Vietnam, Keenan and his team evaluated the field performance of a rapid point of care immunoassay for HIV/syphilis among men who have sex with men and pregnant women. In 2013, Mr. Withers received a Bachelor's of Arts in Psychology from the University of North Carolina Wilmington where he also studied a semester abroad in the United Kingdom. Subsequently, Mr. Withers was selected as 2013 United States Fulbright Scholar to the Republic of Mauritius where he worked with the Mauritius Ministry of Health and National Cancer Registry. His research interest focuses on reducing HIV/AIDS disparities both locally and internationally.

Project

An in-depth qualitative analysis on the factors that impact Pre-exposure prophylaxis (PrEP) adherence and retention among Vietnamese MSM with history of recreational drug use.

Recreational drug use (RDU) (e.g. methamphetamine) among men who have sex with men (MSM) in Vietnam is a serious public health concern. Numerous studies have reported that RDU leads to high risk behaviors such as condomless anal sex and multiple sexual partners. These behaviors have been found to significantly increase MSM risk for HIV and other sexual transmitted infections. RDU may also impact the ability of MSM to adequately engage in biomedical HIV preventative services such as Pre-Exposure Prophylaxis (PrEP). In 2018, the Vietnam Ministry of Health announced a national plan to scale up PrEP to at least 7,300 people representing at least 11 provinces by 2020. The purpose of this study is to provide an in-depth qualitative analysis of the facilitators and barriers that impact PrEP adherence and retention among HIV negative MSM with recent history of RDU who are both PrEP naïve and/or currently using PrEP.

Mentors: Steve Shoptaw, PhD (UCLA), Le Minh Giang MD, PhD (Hanoi Medical University), Jeffrey Klausner, MD, MPH (UCLA)

kwithers@mednet.ucla.edu