Glocal Fellows 2020-2021

Albert Ayumba, MBChB, MMed, is a Master of Medicine degree holder from the University of Nairobi working in Kakamega County General Hospital in Kenya. His work involves the provision of specialist clinical care in obstetrics and gynecology, teaching and supervision of junior colleagues at one of the largest public referral hospitals in the western counties of Kenya. As the head of the maternity unit, Dr. Ayumba is also a member of the technical committee on elimination of mother-to-child transmission of HIV (eMTCT) and reduction of maternal deaths. He gives lectures on reproductive health at Masinde Muliro University of Science and Technology. Albert is a trainer in emergency obstetrics and neonatal care under the Liverpool School of Tropical Medicine program and medical oncology under the East African Development Bank program. He has public health experience in preventive, promotive health and disease surveillance with aspirations to build a synergized clinical and research career in emerging global health challenges.

Project

Comparison of retinovascular findings in HIV infected pregnancies on highly active antiretroviral treatment (HAART) and uninfected pregnancies complicated with preeclampsia and severe features

Hypertensive retinopathy complicates about 40-100% of pregnancies with hypertensive disorders per the UNAIDS report for Kenya of 2018. Approximately 910,000 (65%) of the 1.4 million adults living with HIV were women. In Kenya, 91% of pregnant mothers accessed antiretroviral therapy for prevention of mother-to-child transmission (PMTCT). Most patients with these morbidities report mild to no visual complaints, yet there are possible long-term effects associated with retinovascular changes in these settings. Digital fundus photography can be applied in both non-acute and acute clinical setups and additionally in large population screening programs. Availability of treatment options for diagnosed new or severe HIV and hypertension associated microvasculopathy could significantly curtail rapid progression and potential long-term effects.

Mentors: Stephanie Gaw, MD, PhD (UCSF), Moses M. Obimbo, MD, PhD (University of Nairobi, Kenya), Jeremy Keenan, MD, MPH (UCSF)

ayumbaalb@gmail.com

Pamela Chacón, DDS, is a Master's candidate in Epidemiological Research at UPCH sponsored by a NIH Fogarty grant. She works in Emerge, the Emerging Diseases and Climate Change Research Unit at UPCH, where she improved her quantitative methods knowledge after applying it in data analyses of randomized clinical trials and epidemiological studies. Since 2017, she has been a member of the Basic Stomatological Sciences and Public Health Research Group at Universidad Nacional Mayor de San Marcos, where she participates in oral public health and epidemiological research, including novel topics such as the study of the role of the oral microbiome. Dr. Chacón is interested in the implementation of oral health prevention programs as part of primary care to reduce the burden of and health disparities in dental caries. Her long-term goal is to become an independent investigator in global health and develop adequate methodologies to implement and evaluate oral health interventions.

Project

Integration of dental referrals into primary care services in Piura and Lima, Peru

Dental caries are extremely common in Peru with a prevalence of 86% in children aged 3-15 years, and early intervention can have an important role in preventing dental caries by acting before the dentition. The Peruvian Ministry of Health recommends that the first visit to the dentist must take place in the first year of life for children. However, mothers mostly take their children to health facilities with dental care services when they already have oral diseases. We hypothesize that prevention through dental service referrals from pre- and post-natal care professionals will improve hygiene and oral care, as well as dental services use later in life, leading to improved oral health. Dr. Chacón will conduct a proof-of-concept intervention to assess the feasibility of a short-term oral health program. This will require improving knowledge and perceptions of dental health among pregnant women, mothers of children y than three months old, and primary care personnel.

Mentors: Francisco Ramos-Gómez, DDS, MS, MPH (UCLA), Andrés G. Lescano, PhD, MHS (UPCH), Elisa Juárez-Chávez, MD, MSPH (UPCH)

pamela.chacon@upch.pe

Abigail Cortez, MD is an orthopedic surgery resident at UCLA with an interest in hand and trauma surgery. She received her undergraduate degree with honors at UC Berkeley, where she studied Molecular and Cell Biology with an emphasis in Neurobiology. She attended medical school at UCSF, where she was involved in student groups and extra-curricular activities that focused on medical student education and public health. While at UCSF, she completed the Clinical & Translational Research Pathway in the Department of Orthopedics, studying infection outcomes after the implementation of a screen-and-treat program for Staphylococcus aureus nasal colonization in patients receiving operative fixation for traumatic fractures. She presented her work as a podium presentation at the 2017 Orthopedic Trauma Association annual meeting. Abigail is interested in expanding her interest and skills in trauma research into the growing field of global orthopedics.

Project

Long-term outcomes after treatment of open tibia fractures with external fixation versus intramedullary nailing at the Muhimbili Orthopedic Institute in Dar es Salaam, Tanzania

The tibial shaft is the most common site of long-bone and open fractures. It is reasonable to assume that the incidence of tibial fractures and disability is rising due to a well-documented increase in road traffic injury in LMICs. The optimal method of definitive stabilization remains unclear. While studies in high-income countries recommend intramedullary nailing (IMN) over external fixation (EF), we do not know whether these findings apply to similarly injured patients in LMICs using locally available facilities and implants. Our previous randomized controlled trial comparing these two treatments was the first to provide high-quality information on the outcomes of open tibial fractures treated with IMN or EF. The current study will lengthen follow-up of this cohort up to five years. The expanded follow-up will provide clinical, radiographic, and quality of life outcomes that are unprecedented in any prospectively followed sample of patients with open tibia fractures.

Mentors: Saam Morshed, MD, PhD, MPH (UCSF), Billy Haonga, MD (Muhimbili Orthopaedic Institute), Hendry Sawe, MD (Muhimbili University of Health and Allied Sciences)

abigailcortez@mednet.ucla.edu

Halie Kampman, MA, is a doctoral candidate in environmental studies at the University of California, Santa Cruz. She received her undergraduate degree from the University of California, Los Angeles in international development studies and a master’s degree in development studies at the Graduate Institute of International and Development Studies, Switzerland. Since 2014, she has conducted qualitative research on food systems and human health in sub-Saharan Africa. Her master’s research explored the recycling of treated wastewater for irrigation in peri-urban farms in Senegal. Following this, she worked as a consultant at the International Food Policy Research Institute. There she contributed to a Senegal case study addressing how action for nutrition may be scaled up. While in her doctoral program she has been a fellow at the UCSC Science and Justice Research Center and the UC Global Food Initiative, and conducted research in Senegal as a Fulbright student.

Project

Food landscapes in West Africa: navigating policy and programs for changing nutrition realities

Increasingly, people in Ghana are said to feel the effects of the double burden of malnutrition, defined as the simultaneous manifestation of both undernutrition and overnutrition. While action for nutrition across sub-Saharan Africa has long addressed undernutrition, overnutrition presents a new and challenging paradox. From an institutional perspective, this research explores how government, non-governmental organizations and research institutions address the double burden through policy and programs. This includes efforts to modify eating habits through the promotion of biofortified crops bred for higher micronutrient content, community gardens for diet diversity and educational nutritional awareness campaigns. From a community perspective, the research explores people’s interactions with nutrition interventions, as well as their everyday and embodied experiences with growing, preparing and consuming food. This research is paired with a comparative study in Senegal.

Mentors: Madeleine Fairbairn, PhD (UC Santa Cruz), Seth Adu-Afarwuah, BSc, PhD (University of Ghana), Charlotte Biltekoff, PhD (UC Davis)

hkampman@ucsc.edu

Frank Mulindwa, MBChB, MMed, is currently a research scholar in the capacity building program in the Infectious Diseases Institute (IDI) in Uganda. He works as a hospitalist in the Ugandan capital, Kampala. He holds a bachelor’s degree in medicine and surgery and a master’s degree in internal medicine, both from Makerere University. After receiving his medical degree, Frank worked as a clinician in an HIV clinic with more than 4,500 patients caring for both ambulatory and admitted patients. He also coordinated multi-drug resistant tuberculosis surveillance in southwestern Uganda. Following a global health elective with the Yale New Haven Hospital Neurology service where he spent most of the time with the stroke and vascular team, he came to appreciate the volume of resources needed to rehabilitate patients after neurovascular accidents. This experience informed his research interest in determining the burden and preventive strategies of neurovascular diseases in people living with HIV in resource-limited settings.

Project

Glucose metabolism changes in HIV patients starting dolutegravir based antiretroviral treatment in Uganda

With the longevity of antiretroviral therapy, the burden of non-communicable diseases (NCDs) has been on the rise in HIV positive patients. Compared to communicable diseases, diagnosis and treatment of NCDs is much more complex and costly, even more so in resource-limited settings. This underscores the need for active surveillance and prevention of NCDs before overt disease. In 2016, the WHO adopted Dolutegravir (DTG) as first and second line therapy and Uganda adopted the strategy in 2018 with active transitioning of patients on first line ART to DTG containing regimens. Despite the demonstrated efficacy and good side effect profile, DTG has been associated with increased incident and worsening diabetes, which is likely to add to the already increasing NCD burden. The aim of the study is to demonstrate if there is temporality between changes in insulin resistance, pancreatic beta cell function, blood glucose and duration on DTG in an ART naïve cohort on DTG for 48 weeks.

Mentors: Jean-Marc Schwarz, MD (UCSF), Barbara Castelnuovo, MBChB, MS, PhD, (IDI), Joshua Rhein, MD (University of Minnesota)

mulindwafrank93@gmail.com

Lucy Mupfumi, BSc, MPhil, PhD is an infectious disease research scientist with interests in the epidemiology of HIV and tuberculosis (TB) in HIV-prevalent settings in sub-Saharan Africa. She recently completed her PhD at the University of Botswana focusing on the incidence of TB in the Botswana national antiretroviral (ART) program and the identification of biomarkers of early TB treatment response. For her master’s degree, Lucy led one of the first clinical trials evaluating the impact of Xpert MTB/RIF in HIV-infected individuals on ART in Zimbabwe. It was during that time that she was first exposed to biostatistics and epidemiology through a Fogarty AIDS International Training and Research Program at UC Berkeley, where she spent two months in the epidemiology department under Professor Art Reingold. During her GloCal fellowship year, Lucy will develop an epidemiologic model to understand the changing transmission of TB with expanded HIV treatment in Botswana.

Project

Modeling the impact of long-term antiretroviral therapy on tuberculosis incidence

Although the benefits of antiretroviral therapy (ART) in reducing the incidence of TB are well-described, the incidence of TB remains higher in HIV-infected individuals on ART compared to HIV-uninfected individuals. This project aims to predict the trajectory of TB incidence in Botswana with early ART initiation. In an analysis of patients initiating ART and followed up over time between 2011 and 2015, Lucy and colleagues showed an overall incidence rate of 1.9/100 py, increasing to 3.0/100 py in the first year of ART (Mupfumi L, et al. AIDS, 2019). A key question from this analysis was how this incidence compares to the population-level incidence and what the impact of early ART initiation would be on this reported incidence. Therefore, building on this work, Lucy will develop a mathematical model to predict 1) the impact of community ART coverage on TB incidence and 2) the trajectory of the TB epidemic with early ART initiation alone or in combination with other strategies (e.g. TB preventive treatment).

Mentors: Jeffrey Klausner, MD, MPH (UCLA), Sanghyuk Shin, PhD (UC Irvine), Chelsea Morroni, MD, MPH, PhD (Botswana UPenn Partnership), Chawangwa Modongo, MD (Botswana UPenn Partnership)

lmupfumi@gmail.com

Emily Nuss is a rising 4th year medical student at University of Massachusetts Medical School. After graduating from Middlebury College, she completed a Princeton in Latin America Fellowship in Guatemala. She then worked as a Clinical Research Assistant at Beth Israel Deaconess Medical Center (BIDMC) in Boston on a study focused on how racial, socioeconomic, and environmental stress can lead to epigenetic changes that contribute to preterm birth. At UMASS Medical School, Emily applied to be a member of the Population Urban Rural Community Health program. She has also been involved in a community-driven service project aimed at reducing the disparity in infant mortality rates among the Black and Latinx populations in Worcester. Emily plans to pursue a career in either Family Medicine or OBGYN. She is committed to working with underserved patients both in the U.S. and globally, and aims to combine clinical care with a public health approach to reduce health disparities.

Project

Household Air Pollution and Health (HAPIN) trial

Air pollution significantly contributes to morbidity and mortality worldwide. While this has been established in the existing literature, there is a need for additional investigation on how household air pollution impacts pregnancy and child development outcomes. Many low-resource countries cook predominately with open fire cookstoves, which results in widespread exposure to smoke. The Universidad del Valle de Guatemala’s (UVG) Household Air Pollution and Health (HAPIN) trial is a multi-centered randomized control trial assessing the effects of household air pollution on maternal and child health outcomes. Emily will work with the branch of the HAPIN trial focused on child health, including stunting and cognitive development. She will assist in capacity building, working with nurses to ensure that there is a consistent and accurate method of collecting data from questionnaires as well as of conducting growth monitoring, physical exam, and developmental exam.

Mentors: Lisa Thompson, RN, FNP-BC, MS, PhD, FAAN (Emory University), Anaité Díaz (Universidad del Valle de Guatemala) John P. McCracken, MPH, PhD (Universidad del Valle de Guatemala)

emily.nuss@umassmed.edu

Tatiana Petrovick is a medical student attending the University of Massachusetts Medical School. She received her Bachelor’s degree in Biochemistry from Boston College in 2015. Prior to entering medical school, she worked in Guatemala and worked on projects related to primary care delivery, maternal and child health, and diabetes education in rural areas. While at the University of Massachusetts, Tatiana has been involved in the Global Health Track and spent a summer in Bolivia working with a non-governmental organization that advocates for improved health and human rights for LGBTQ+ and HIV positive populations. Additionally, she has been involved in the Population-Based Urban and Rural Community Health (PURCH) Track, which is a longitudinal, four-year program focused on the health of medically underserved populations. Tatiana is interested in researching women’s health in low-resource areas and underserved populations, particularly in the region of Latin America.

Project

Quality Control and Local Capacity Building as Part of the HAPIN Trial in Guatemala

In many low and middle-income countries, families will often cook over an open fire in the home instead of over a gas stove. This can expose household members to air pollutants and cause numerous negative health effects, including poor birth outcomes, respiratory infections, and heart disease. The HAPIN Trial will study the effect of gas cooking stove and fuel distribution on these health outcomes. The study has recruited 3,200 households in Guatemala, India, Peru, and Rwanda including pregnant women, their infants, and older adult women and randomly assigned half of them to receive a gas cookstove and fuel. Participating households will be followed for 18 months with monitoring of stove use and personal exposure to household air pollution, as well as assessments of health outcomes. The goal of this project is to conduct quality control on the health assessments portion of the study and identify potential areas of capacity building for local staff.

Mentors: Lisa Thompson, RN, FNP, PhD (Emory University), Anaité Díaz Artiga, PhD (Universidad del Valle Guatemala), John McCracken, PhD (Universidad del Valle Guatemala)

tatiana.petrovick@umassmed.edu

FULBRIGHT-FOGARTY FELLOWS