Glocal Fellows 2023-2024 | UC Global Health Institute

Angel B. Algarin, PhD, MPH, is a public health scientist and a NIDA T32 postdoctoral fellow in the Division of Infectious Diseases and Global Public Health at the University of California San Diego. His research focus on HIV-, PrEP-, and sexuality-related stigma and their impact on the wellbeing of sexual and gender minorities. Most currently, Dr. Algarin has been conducting analyses using data from the Encuesta de Sexo Entre Hombres study among a nationally recruited sample of >15,000 men who have sex with men in Mexico. Dr. Algarin received his PhD in public health from Florida International University, his MPH from the University of Kentucky, and his BA in Spanish from The Ohio State University.

Project

Understanding Pre-exposure Prophylaxis (PrEP) stigma, knowledge, and interest among Transgender Women in Tijuana, Mexico: a step towards ending AIDS by 2030

In Tijuana, HIV prevalence among transgender women (TW) is estimated at 22%, mirroring similar global disparities among TW. Oral preexposure prophylaxis (PrEP) is >90% effective at preventing HIV acquisition when taken as directed, making it a key component in UNAIDS’s strategy to end AIDS. While Mexico is working to add PrEP to its national healthcare formulary, preemptive research to address implementation barriers related to PrEP knowledge, interest, and uptake is needed to ensure a strong rollout plan once it is added. Globally, a significant barrier to PrEP implementation is PrEP stigma. Understanding PrEP stigma at community and individual levels among TW can inform tailored PrEP implementation policies and interventions to improve PrEP knowledge and interest, a step towards ending AIDS by 2030. The proposed study will be embedded in the TransSalud study (Co-PIs: Navarro and Pitpitan).

Mentors: Laramie R. Smith, PhD (UCSD), Samuel Navarro, MD, MPH (Universidad Autónoma de Baja California), Eileen Pitpitan, PhD (San Diego State University)

aalgarin@health.ucsd.edu

Lourdes Johanna Avelar Portillo, MA, PhD, is a postdoctoral fellow at the University of California, San Diego in the Department of Medicine and Global Health. She received her PhD from the University of Southern California, where she developed a project to investigate the impacts of water insecurity on unhoused communities of Skid Row, Los Angeles. During her master’s degree, Dr. Avelar explored the intersections of gender, psychosocial stressors and water insecurity in rural communities in El Salvador. These experiences have largely shaped Dr. Avelar’s research interests, which include water insecurity and health equity through an intersectional lens. Dr. Avelar’s overarching career goal is to generate actionable research for underserved communities and to translate knowledge produced into informed policies. Dr. Avelar believes in improving community health by targeting and promoting programs and services that are cost-effective, provide a real benefit, and are informed by lived experience.

Project

Water, Sanitation, and Hygiene (WaSH) Insecurity Experiences Among Unhoused People Who Inject Drugs Along the U.S.-Mexico Border

Dr. Avelar is collaborating with the La Frontera study (R01DA049644: PI Strathdee), to understand how at-risk unhoused populations in San Diego, CA and Tijuana, Mexico navigate different spaces and places to access water, sanitation, and hygiene (WaSH) services. Specifically, she will use mixed-methodologies to examine the association between WaSH insecurity and anxiety using survey data and conduct focus groups with unhoused people to identify and design WaSH interventions. The aims of her GloCal project are: 1) to measure psychosocial stress among unhoused people who inject drugs in the two communities as it relates to WaSH insecurity 2) to use geographic information systems to identify locations where WaSH interventions are needed, and 3) to understand the design of services needed in these communities. Findings from this study will be used to develop transnational, WaSH-based measures that reduce health risks and transmission of infectious diseases in unhoused, at-risk populations.

Mentors: Georgia Kayser, PhD (UCSD), Alicia Harvey-Vera, PhD, MPH (Universidad Xochicalco), Susie Cassels, PhD, MPH (UCSB)

avelarpo@usc.edu

Mariah Coley is a doctoral candidate in the Geography Graduate Group and the Department Land, Air, and Water Resources at UC Davis. She earned an MSc in international agricultural development from UC Davis with a study of participatory scenario modeling of farm systems with rural communities in Eastern Uganda, where she was supported by a UC Davis / USAID Research and Innovation in Food and Agriculture fellowship. Prior to her graduate education, Mariah held positions at the Agricultural Sustainability Institute at UC Davis and in the Dartmouth College Environmental Studies program, where she contributed to research and public outreach projects related to sustainable agriculture and food systems. She earned her undergraduate degree at Dartmouth College in classical studies and studio art. Her current research interests broadly address the relationships between human health, rural livelihoods in the Global South, and environmental change.

Project

Investigating the influence of environmental exposure to soil microbiota on the gut microbiome and impacts on childhood diarrheal disease burden in western Kenya

Healthy soil can support high-yielding crops, but can it also grow healthy kids? Recent evidence suggests childhood environmental exposure to microorganisms, such as through contact with soils, dust, and animals, may have broad health benefits. At the same time, the human gut microbiome is increasingly implicated as a driver of health, with greater gut microbial diversity linked to enhanced immune function and disease resilience. However, little evidence relates the varied microbial communities in soils with the human gut microbiome and child health. This research addresses the associations among these three areas through an investigation of diarrheal disease and exposure to soils among children in western Kenya. Findings will demonstrate whether exposure to soils is significantly associated with diarrheal disease burden, and whether the diversity of soil microbiota in outdoor areas of the home is associated with the diversity and functional profile of gut microbiota in children.

Mentors: Kate Scow, PhD (UCD), Phelgona Otieno, MBChB, MPH (KEMRI), Craig Cohen, MD, MPH (UCSF), Carolyn Slupsky, PhD (UC Davis)

mlcoley@ucdavis.edu

Jalika J Joyner, DVM, is a graduate of North Carolina State College of Veterinary Medicine who has a passion for One Health. While in veterinary school, she performed One Health based research in Uganda as a Morris Animal Foundation Scholar by investigating the possibility of shared pathogenicity of Salmonella among mountain gorillas and livestock in the Bwindi region. Dr. Joyner plans to continue her veterinary career as a public health researcher, outbreak investigator, and policy reformer. Her goal is to prevent disease outbreaks by identifying high risk regions and mitigating the factors involved with emerging infectious zoonotic diseases, namely those at the wildlife-livestock-human interface. In addition, she intends to address the inequalities of health systems and global health policies in underdeveloped countries by focusing research efforts in these regions and empowering communities to sustainably improve their health.

Project

Mosquito behavior characterization as a predictive factor for arboviral infectious disease spillover in the Bwindi region of Uganda

The majority of emerging infectious diseases (EID) were found to be zoonotic with ~72% of them originating from wildlife populations. The mosquito genera Culex, Aedes, and Anopheles are responsible for the majority of all zoonotic, arboviral diseases and are largely found in the equatorial regions of Africa. Because mosquitos are the main propagators of the most common vector-borne EIDs, it is important to quantify the risk they pose for disease spillover in these high-risk areas. The goal of this project is to characterize those risk factors by studying the feeding behavior of mosquitoes in Uganda’s Bwindi Impenetrable National Park and the adjacent residential areas. Mosquito blood meals will be analyzed to determine vertebrae hosts preferences and feeding patterns. In addition, spatial analysis of mosquito species based on the coordinates of the traps will be performed. Altogether, this information can provide predictive indicators for an arboviral spillover.

Mentors: Christine Kreuder Johnson, DVM, MPVM, PhD (UCD), John Bosco Nizeyi, DVM (Makerere University), Tierra Smiley Evans, DVM, PhD (UCD)

jalika.joyner@gmail.com

Alex Kityamuwesi, MD, MSc is a physician scientist whose research focuses on innovations that advance quality of care for TB and HIV patients in high burden, low-resource settings. He completed his medical training and post graduate training in clinical epidemiology and biostatistics at Makerere University in Kampala, Uganda. His education was fully funded by the Government of Uganda and by the NIH Fogarty International Center D43-funded Pulmonary Complications of AIDS Research Training (PART). He has worked on research projects assessing the effectiveness, implementation and costs of rapid, onsite molecular testing for TB. His masters research focused on costs and socioeconomic consequences for patients with chronic cough accessing diagnostic evaluation for tuberculosis at primary health care facilities in Uganda. He currently coordinates the scale-up project of 99DOTS, a low-cost digital adherence technology aimed at improving tuberculosis treatment outcomes.

Project

The role of digital cough monitoring to predict tuberculosis medication adherence in people living with and without HIV

People living with HIV suffer more severe forms of TB and the burden of TB/HIV co-infection, both of which complicate adherence. Novel tools that identify patients with poor TB medication adherence are essential for early intervention and support. Cough patterns have been shown to correlate with TB disease severity and treatment response. Cough frequency, duration and amplitude can be objectively monitored via deep learning algorithms with high accuracy. Such algorithms have now been integrated into a mobile phone application to allow continuous cough monitoring. These developments provide an opportunity to determine if objective, continuous monitoring of cough can predict adherence to TB treatment and help earlier identification of patients at risk of poor outcomes. Dr. Kityamuwesi’s research will compare continuous cough pattern changes during TB treatment in people living with and without HIV, and determine if changes in cough pattern are associated with TB medication adherence.

Mentors: Adithya Cattamanchi, MD, MAS (UCSF), Christine Sekaggya-Wiltshire, MBChB, MMed, PhD (IDI), Ernest Mwebaze, PhD (Makerere University)

akityamuwesi95@gmail.com

Atuganile Malango, MD, MMed is a staff pathologist at Muhimbili National Hospital (MNH), the largest national referral hospital in Tanzania and affiliated teaching hospital for Muhimbili University of Health and Allied Sciences (MUHAS). Her work involves the provision of anatomical pathology services which include attending cytology clinics, reporting histology and cytology specimen, performing autopsy and supervising residents. She became interested in how research can develop pathology capacity after attending trainings on ultrasound-guided fine needle aspiration biopsy (FNAB) and rapid on-site evaluation which were jointly hosted by MUHAS and UCSF. She first became exposed to using research and structured training to develop pathology capacity in low resources settings as a member of the MUHAS-ORCI-UCSF Cancer Collaboration. She is now interested in leveraging telepathology to improve diagnostic capacity and quality assurance/improvement research.

Project

Impact of Telepathology Consultation on Central Nervous System Tumor Diagnosis as Part of Neuropathology Quality Assurance Program in Tanzania

Neuropathology services in Tanzania are limited by multiple factors which include insufficient workforce, lack of ancillary confirmatory testing, and quality improvement programs. Currently in Tanzania there are 35 anatomical pathologists serving a population of about 58 million, none of whom have subspecialty expertise in neuropathology. In pathology, most errors are interpretative errors and a second review can minimize these. Telepathology is the forum in pathology practice which allows distance transmission of macroscopic and microscopic images for second review and can also be used for training, quality assurance, and research. Dr. Malango’s study aims to utilize telepathology to improve diagnostic accuracy of pathology diagnosis for patients with central nervous system tumors which is expected to improve patient care and outcomes at MNH. The study is intended to be a building block of further future studies in quality assurance in anatomical pathology diagnoses at MNH.

Mentors: Tarik Tihan, MD, PhD (UCSF), Edda Vuhahula, DDS, PhD (MUHAS), Dianna L. Ng, MD (Memorial Sloan Kettering Cancer Center)

amallango@gmail.com

Lara Marquez, PhD, MPH is an infectious disease epidemiologist and modeler and postdoctoral fellow at the University of California San Diego. Her research focuses on modeling transmission and prevention of infectious diseases including HIV and hepatitis C, particularly among marginalized populations in low- and middle-income settings. Dr. Marquez has worked for over 15 years in global settings in Latin America, Africa, and Southeast Asia to improve the health of hard-to-reach and vulnerable populations. Dr. Marquez is passionate about leveraging evidence-based results to propose data-driven solutions to effect change in public health, programs, and policy globally. She received her PhD from the University of California San Diego/ San Diego State University Joint Doctoral Program in Epidemiology, her MPH in global epidemiology from Emory University Rollins School of Public Health, and her BS in neurobiology with minors in Spanish, Portuguese, and chemistry from the University of Miami.

Project

Modeling hepatitis C elimination and impact on HIV incidence among people who inject drugs in Mexico

Of the 71 million chronic hepatitis C (HCV) infections globally, 80% occur in low- to middle-income countries. In 2016, the World Health Organization set HCV elimination targets (80% incidence reduction, 65% HCV-related mortality reduction) between 2015-2030. In 2019, Mexico became the first Latin American country to launch a national elimination strategy. Within Mexico, HCV seroprevalence over 90% has been observed among high-risk populations such as people who inject drugs (PWID). Under Mexico’s national elimination plan, free screening and treatment will be prioritized to high-risk populations including PWID and patients coinfected with HIV/HCV. This project will develop a national HCV elimination model to evaluate progress towards these goals by projecting annually achievable programmatic targets and providing data-driven plans to implement successful programs to achieve HCV elimination by 2030 and if maintained, will prevent additional transmission in these communities thereafter.

Mentors: Natasha Martin, DPhil (UCSD), Carlos Magis-Rodriguez, MD, PhD (Universidad Xochicalco), Kimberly Brouwer, PhD (UCSD)

lkusnezo@health.ucsd.edu

Ernesha Webb Mazinyo, PhD, MPH, began her public health career at the New York City Department of Health and Mental Hygiene. She has gone on to lead efforts in health systems strengthening in East and Southern Africa over the past decade. Through her work at the Foundation for Professional Development, based in South Africa, she has gained extensive experience in both the successful implementation and failure of large-scale public health programs in Malawi, Kenya, Uganda, Tanzania and South Africa, which has resulted in her keen interest in approaching program implementation with a scientific rigor. As a GloCal postdoctoral fellow, Dr. Mazinyo is transitioning from program implementation and developing as an independent investigator of the systematic barriers and contextual factors that impact implementation of evidence-based interventions (EBIs) globally. Her goal is to become a global implementation scientist who can improve the relevance and uptake of EBIs in real-world settings.

Project

Implementation of Sexually Transmitted Infection screening during antenatal care visits in South African public health facilities

Sexually Transmitted Infections (STIs) during pregnancy are associated with an increased risk of preterm birth, low birth weight, perinatal death, congenital infections and mother-to-child HIV transmission. South Africa’s National Strategic Plan for HIV, TB and STIs recommends Point-of-Care (POC) testing for the detection of STIs, yet there are no policies or guidelines to inform the adoption or implementation of national POC STI testing scale-up. Drs. Andrew Medina-Marino and Jeff Klausner are currently undertaking a large clinical trial and cost- effectiveness study evaluating POC testing strategies to decrease the burden of STIs among pregnant women, and reduce STI-associated adverse birth outcomes in Eastern Cape, South Africa. Dr. Mazinyo will leverage Drs. Klausner and Medina-Marino’s NIH R01, and will use implementation science methods and frameworks to study the promotion, adoption and integration of STI POC testing into ANC services in South Africa.

Mentors: Craig Cohen, MD, MPH (UCSF), Andrew Medina-Marino, PhD (Foundation for Professional Development), Jeffrey Klausner, MD, MPH (USC), and Milton Wainberg, MD (Columbia University)

ErneshaM@Foundation.co.za

Felix Oyania, MBChB, MMed, is currently a pediatric surgery fellow at the College of Surgeons of East Central and Southern Africa (COSECSA) at Mbarara University of Science and Technology (MUST) which he began immediately after his residency, under direct supervision of Martin Situma MBChB, MMed, FCS (ECSA), together with local and international collaborators. He holds a bachelor’s degree in medicine and surgery from MUST and a master’s degree in general surgery from Makerere University. His strong interest in anorectal malformations (ARMs) began during residency, when he witnessed the challenges faced by parents of children with ARMs - among the most common conditions treated. His long-term career goal is to become an independent clinician-scientist who can design and implement surgical access solutions tailored to his setting and help grow the capacity of the surgical workforce in his country with special interests in pediatric colorectal, neonatal and minimally invasive surgery, and global surgery.

Project

Feasibility of Primary Repair for Anorectal Malformations in Uganda

In Uganda, most patients with anorectal malformation (ARM) undergo three separate staged operations: 1) initial colostomy formation; 2) repair (called anoplasty), and 3) colostomy closure. Three operations result in a long treatment duration, potential complications with each procedure, delays in care, and stigma associated with ostomies. Children live 2-3 years on average with their ostomies, fail to attend school, a third of families experience catastrophic health expenditure and half of male caregivers leave their families. An intervention that shortens duration of life with an ostomy would reduce the financial burden and social rejection, and improve school attendance. In higher-income countries, some children receive a single operation or a two-stage procedure. Feasibility of one- or two-stage procedure in Uganda is unknown, due to the different resources available. The associated social and economic impact for families is also unknown. This study design aims to address these important knowledge gaps.

Mentors: Doruk E. Ozgediz, MD, MSc (UCSF), Olivia Kituuka MBChB, MMed, FCS-ECSA (Makerere University), Francis Bajunirwe, MBChB, MSc, PhD (MUST)

oyafel@icloud.com

Lara Schwarz, MPH, is a doctoral candidate in global health in the joint doctoral program in public health at University of California San Diego and San Diego State University. She received her undergraduate degree in environment focusing on the ecological determinants of health from McGill University in Montreal and obtained her master of public health in epidemiology from San Diego State University. Her research focuses on the interface between climate and health, applying epidemiological methods to reveal the impacts of extreme weather on population health. She previously studied the impacts of heat waves and air pollution on health outcomes such as hospitalizations, low birth weight, and emergency department visits. Ms. Schwarz’s long-term goal is to quantify the effects of extreme weather events in understudied regions of the globe to understand and address global health disparities that will be accentuated in the context of climate change.

Project

Pollution knows no borders: Assessing the role of wildfire smoke in driving adverse health outcomes in the San Diego-Tijuana border region

While borders are a physical barrier to human mobility, they provide no obstruction to the transport and flow of environmental exposures. The current COVID-19 pandemic and wildfires were concurrent public health disasters that hit the San Diego-Tijuana region in 2020 and highlight the need to protect populations from these increasingly prevalent global health risks. Fine particulate matter (PM2.5), one of the main components of wildfire smoke, is associated with a range of adverse health effects and thought to be a driver of severe COVID-19. The current study will validate wildfire smoke models using air pollution samplers to isolate wildfire-specific PM2.5 and characterize its burden on population health and COVID-19 burden. Understanding the role of environmental exposures in driving adverse health outcomes in the border region is critical to protect vulnerable populations in the context of climate change and this ongoing pandemic.

Mentors: Tarik Benmarhnia, PhD (UCSD), Maria Evarista Arellano Garcia, PhD (Universidad Autónoma de Baja California), Sara Aarons, PhD (Scripps Institution of Oceanography)

lnschwar@health.ucsd.edu

Philip Smith, MSocSc, PhD is a Behavioral Scientist at the Desmond Tutu Health Foundation (DTHF), housed in the Dept. of Medicine, University of Cape Town. Philip’s research has focused on behavioral economics in limited resource communities in Cape Town, South Africa, with the aim of improving health-seeking behaviors in hard-to-reach populations, including adolescents and young men. Philip has investigated novel approaches to the problem of delivering HIV services to and supporting health outcomes for vulnerable people in limited resource communities. Young people in sub-Saharan Africa (SSA) are disproportionately affected by HIV, STIs, and unplanned pregnancies. The provision of accessible sexual and reproductive health services for young people in SSA is vital to reduce this burden. This research has identified psychosocial challenges faced by these groups, structural factors that facilitate and hamper health-seeking behavior, and contextually appropriate health services.

Project

Community PrEP for Male Partners of Women on PrEP: What do men want?

South African (SA) men have lower rates of HIV testing, HIV prevention uptake, linkage-to-care, treatment initiation, and viral suppression than their female counterparts. While PrEP is the global standard for HIV prevention, research on PrEP adherence and access has conventionally focused on women. In-depth interviews with young women in the parent study (Community PrEP Study) revealed that after PrEP disclosure to their male partners and male friends, a proportion of these men were interested in taking PrEP. Given their interest in PrEP, this study will examine factors impacting men’s interest in HIV prevention, PrEP uptake, and experience on PrEP. Male partners and contacts of female participants will be invited to participate in a study investigating men’s HIV prevention needs, measuring factors associated with PrEP uptake and adherence in high HIV disease burden communities in Buffalo City, Eastern Cape, SA. Findings will inform a proposal to assess PrEP interventions for men.

Mentors: Joseph Daniels, PhD (UCLA/Charles Drew University), Andrew Medina-Marino, PhD (Foundation for Professional Development), Linda-Gail Bekker, MBChB, DTMH, DCH, FCP (Desmond Tutu Health Foundation)

Philip.Smith@hiv-research.org.za

Richard (Ricky) Timmons-Vendryes is a medical student at the Charles R. Drew University (CDU) and David Geffen School of Medicine, at UCLA. He received a Bachelor's of Science in nutritional sciences from the University of Florida. Mr. Timmons-Vendryes is passionate about advancing the health of underserved populations across the globe, including people of color, sex/gender minorities, and homeless and low-income individuals. While at CDU/UCLA, he has been involved in numerous community outreach initiatives, mentorship for pre-medical students, and advocating for the increased availability of health resources and education to vulnerable communities. Mr. Timmons-Vendryes’ interest focuses on conducting curiosity-driven research to inform the development of community-first interventions to prevent sexual diseases and improve the health behaviors of people. He aspires to hold a dual position as a practicing emergency medicine physician and an independent global researcher to improve the health of the most disadvantaged.

Project

Assessing the feasibility, acceptability, and potential efficacy of lubrication, and postcoital urination and washing for the prevention of HIV/STI acquisition in insertive men who have sex with men (MSM) and transgender women (TW): protocol for a pilot study of a printed and digital behavioral intervention.

Mr. Timmons-Vendryes’ project will focus on addressing innovative strategies to promote behavioral change by leveraging mobile and social media technologies, integration of health education with pre-existing medical and social infrastructures, and hygiene-based prophylactic practices to prevent sexual diseases for insertive MSM and TW in Lima, Peru. The overall aims of this proposed research are to: (1) assess the cultural and personal meaning, while identifying barriers and enabling factors to lubrication use and postcoital practices of voiding and washing; (2) develop a behavioral intervention based on mixed methods data from Aim 1 and literature review of adult behavioral theories and core elements of successful public health campaigns; (3) assess the fidelity and potential efficacy of the intervention. Findings from this preliminary data will potentially lead to an R21 proposal primarily investigating the efficacy of this bundled intervention for the prevention of HIV/STI in MSM and TW in Peru.

Mentors: Dallas Swendeman, PhD (UCLA), Carlos Cáceres, MD, MPH, PhD (UPCH), Alfonso Silva-Santisteban, MD, MPH (UPCH)

rvendryes@mednet.ucla.edu

Kalin Werner, PhD, MSc is a postdoctoral fellow at UCSF. She holds a PhD in emergency medicine from the University of Cape Town (UCT), a master’s degree in health policy, planning, and financing from the London School of Hygiene and Tropical Medicine and London School of Economics, and received her undergraduate degree from UCLA. During her career she has been awarded numerous positions which contributed significantly to her understanding of health systems, including her time as a Public Health Associate with the Centers for Disease Control and Prevention, and later as a Fellow with Global Health Corps in Zambia. Her research focuses on the delivery of health care services under severe resource constraints through the lens of decision analysis and effectiveness research with the aim of contributing to findings that guide a rational approach for the allocation of limited health resources, improve access to care, and reduce morbidity and mortality globally.

Project

Understanding preferences of patients and providers regarding out-of-hospital cardiac arrest care in Western Cape, South Africa

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death globally, yet despite the investment of significant amounts of healthcare funding, OHCA survival rates remain only 6-11%. Available literature shows dramatically worse survival rates where OHCA chains of care are immature or absent, such as low-resource settings (LRS). Elements of scientific evidence are represented in decision-making through current resuscitation practice guidelines, but little is known regarding community members’ or providers’ values and preferences. Eliciting these will help guide decisions about when and how to invest in services that are acceptable to patients. This research will undertake a comprehensive assessment of the strength of preferences among communities and EMS personnel for attributes of OHCA management in a LRS through discrete choice experiments questionnaire methods. The results may assist policy makers and service providers to optimize limited health resources.

Mentors: Tracy Lin, PhD (UCSF), Andrew Medina-Marino, PhD (Foundation for Professional Development), Lee Wallis, MD, MBChB, MD, FCEM (UCT)

kalin.werner@gmail.com