GLOCAL FELLOWS 2023-2024

Dr. Gama Petulo Bandawe, PhD is a medical virologist and a senior lecturer in the Biological Sciences Department in the Academy of Medical Sciences at the Malawi University of Science and Technology (MUST). He obtained his PhD from the University of Cape Town and returned to Malawi to assist in growing the newly established MUST, which opened its doors in 2014. Dr. Bandawe has since led the setting up of laboratories and the establishment of Malawi’s first focused undergraduate programs in medical microbiology and immunology. Dr. Bandawe has served on the National Expert Committee on COVID-19 under the presidential taskforce, is on the National Expert Committee on Genomic Sequencing, and is an associate editor of the Malawi Medical Journal. His research interests include HIV, emerging infectious diseases and zoonotic infections as well as virus surveillance and discovery. He is currently researching the etiology of undiagnosed febrile illnesses in Malawian children.

Project

Use of next-generation metagenomic sequencing to determine the etiology of respiratory febrile illness in Malawian Children

Febrile illness in African children caused by sepsis, malaria and viral infection is a major public health challenge. Studies from Malawi show that viruses causing respiratory illness are diverse, involve coinfections and fluctuate seasonally. It is thus likely that studies done with multiplex molecular tests may not be truly reflective of all viruses circulating in the population. There is also little information available on the etiological agents of respiratory illness in rural areas in Malawi. Metagenomic next generation sequencing (mNGS) offers an unbiased approach to characterizing pathogens associated with respiratory illness, however, limited capacity for mNGS exists in Malawi. Dr. Bandawe and his mentorship team hypothesize that febrile respiratory illness in Malawian children is caused by a diversity of viral pathogens including some not previously described. The objective of the study is to use mNGS to identify viruses associated with respiratory infections in children presenting at two Malawian hospitals

Mentors: Teresa Kortz (UCSF), Sam Phiri (Partners in Hope), Cristina Tato (CZ Biohub)

gbandawe@must.ac.mw

Dr. Merlyn Joseph, MBBS, MD, DNB is a senior resident in the Department of Community Health, St. John’s Medical College Hospital, Bangalore. She completed her MD in Community Medicine from St. John’s Medical College and Diplomate in Community Medicine (DNB) from the National Board of Examination, Delhi. She previously attended the Global Health Summer program at Ben Gurion University, Israel which incidentally sparked her interest in global health issues. She has received the “Young Scientist Award” from the Indian Association of Occupational Health (IAOH) for her presentation on garment factory workers. She is the State Council Member at the Association of Occupational Health in Karnataka (AOHK) and is the Project Coordinator for two large factory-based projects across India which aim at improving health literacy and quality of life of employees in the apparel and manufacturing industries. Her interests lie in the field of occupational health especially migrant health issues.

Project

Mental health status of migrant workers in the tea plantation industry of South India - a mixed methods study

Migrant mental health issues are of global concern and unique socio-environmental and cultural barriers are attributed to higher prevalence of mental health issues among this population. Dr. Joseph will use a mixed methods approach to identify the mental health status and barriers to accessing mental health care among the migrant workers at the tea plantations in South India. Her study will also use qualitative techniques to understand the shared perceptions of key stakeholders regarding the unmet mental health needs of the migrant population working in the plantation sector. The study’s findings can help shed light on the social determinants of migrant mental health in India and pave the way for future research and policy implications. Inclusion of mental health screening and treatment in the basic health care package offered at the plantation hospitals, training of healthcare providers for early identification, and prompt treatment/counselling for mental illness are a few long-term implications that Dr. Joseph aims to achieve through the study.

Mentors: Maria Ekstrand (UCSF), Denis Xavier (St. John’s Medical College), Bobby Joseph (St. John’s Medical College)

merlyn.j@stjohns.in

Dr. Uetela completed a medical degree at Universidade Eduardo Mondlane (UEM) in Mozambique in 2009, a master's in health sciences at the Fiocruz in 2015, and a PhD in implementation science at the University of Washington in 2023. Her research interests include health system strengthening and HIV service delivery. She has led the clinical unit of the Mozambique Instituto Nacional de Saúde research center (CISPOC) and the HIV cluster of the Mozambique national health observatory (ONS). Under her leadership, the ONS launched the country’s first free-access HIV dashboard in 2017. For her doctoral dissertation, she conducted a process, impact, and economic evaluation of the nationwide implementation of eight differentiated service delivery models for HIV treatment being implemented in Mozambique since 2018. This dissertation was nominated by the University of Washington Department of Global Health to be considered as the University 2023 Distinguished Dissertation in the Social Sciences category.

Project

Health and economic evaluation of the implementation of the six-month model of HIV treatment in Mozambique

In 2022, the Mozambique Ministry of Health launched guidelines for a phased implementation of a model of care consisting of a six-month dispensing of antiretrovirals (6MM), a differentiated service delivery model for HIV treatment. Dr. Uetela and her team aim to evaluate the health and economic impact of this implementation. For the health impact evaluation, an uncontrolled interrupted time series design will be applied to compare retention in antiretroviral therapy (ART) and viral suppression 12 months after ART initiation, before and after the implementation of the 6MM model. For the economic evaluation, a dynamic transmission model, simulating heterosexual HIV transmission among the general population, will be used to conduct a cost-effectiveness analysis from the health system perspective. The results of this study will inform the Mozambique Ministry of Health of the health and economic impact of the implementation of the 6MM model, for informed decision-making on the scale-up of this intervention.

Mentors: Natasha Martin (UCSD), Emilia Noormahomed (UEM), Baltazar Chilundo (UEM)

ueteladorlim@gmail.com

Shadia Nakalema, MBChB, MSc DTM&H is a final year internal medicine resident at Makerere University. She is part of the Contraceptive Implant Research Consortium for Low income countries (CIRCL) whose main mandate is to generate evidence for the safe and effective use of contraceptive implants among women living with HIV by using sound research methods to explore drug-drug interactions between antiretroviral drugs and progestin contraceptive implants. Her current research interest is to explore the correlation between genetic polymorphisms and the pharmacokinetics, efficacy and safety of chronic pharmacotherapies used in the management of both communicable and non-communicable diseases. She intends to constitute a Pharmacogenomics (PGx) research special interest group that will work with clinical research organizations in Uganda. The objectives of the group will be to develop a well cataloged repository for PGx samples to foster collaborations and ease access to samples, advocacy and capacity building.

Project

Association of pharmacogenomics markers in CYP3A4, CYP3A5, CYP2C19, UGT1A1, UGT1A4 and SLCO3A1 on the pharmacokinetics of rilpivirine and darunavir in HIV-positive women.

Rilpivirine (RPV) and darunavir (DRV) can be used as alternatives to the standard of care in the treatment of HIV/AIDS. Unfortunately, this is limited by poor virologic response in at least 10% of patients which is in turn associated with suboptimal drug concentrations. Studies have shown that genetic polymorphisms can influence the pharmacokinetics of both RPV and DRV. There is however limited data on the genotypic frequency of the perpetrator polymorphisms among black African populations despite the relevance in HIV/AIDS in the sub-Saharan African context. In this study, Dr. Nakalema seeks to identify and examine the correlation between single nucleotide polymorphisms (SNPs) in CYP3A4, CYP3A5, CYP2C19, UGT1A1, UGT1A4 and SLCO3A1 genes on the plasma concentration of RPV and DRV in HIV-positive women. This sub-study will build on existing work conducted at the Infectious Diseases Institute through the Contraceptive Implant Research Consortium for Low income countries.

Mentors: Bani Tamraz (UCSF), Christine Sekaggya (IDI), Monica Gandhi (UCSF)

snakalema@idi.co.ug

Elise Reynolds, MPH, is a PhD candidate in Nutritional Biology at the University of California, Davis. She earned her MPH in Health Behavior and Health Education from the University of Michigan School of Public Health. Her interests are in child and adolescent nutrition in low-income settings globally. Her research explores the role of food systems and food environments on the nutritional status of at-risk populations and interventions that work within these areas. She has worked on projects investigating the role of agricultural interventions on the dietary diversity of women/children in a protracted humanitarian crisis in South Sudan, analyzed the accuracy of data collection methods on estimating dietary diversity for children in Cambodia and Zambia, described barriers and facilitators to complementary feeding in an informal settlement in Kenya, and assessed the potential outcomes of impact investing in food enterprises on nutritional status across sub-Saharan Africa.

Project

Sukuu Tenabia Edziban Papa (STEP-uP): Promoting health and food security for Ghanaian adolescents through healthy school food environments

Adolescence is a period of physical, social, and cognitive development and nutrient-rich diets are essential to support optimal growth and development during this period. School environments can be important influencers of adolescent nutrition and health especially in Ghana where school attendance has been increasing steadily for adolescents. This project will use mixed methods to describe adolescent school food environments from the perspective of various stakeholders, understand how adolescents make food choices within their school environment, and analyze how these choices/environments influence adolescents’ experiences of food insecurity at school. The project will use Photovoice, a method in which adolescents visually communicate and tell stories about their food environments through photos. This will be accompanied by structured environmental observations, focus groups discussions with key stakeholders, and validated scales to quantitatively assess food insecurity.

Mentors: Christine Stewart (UC Davis), Amos Laar (University of Ghana), Christiana Nsiah-Asamoah (University of Cape Coast)

ecreynolds@ucdavis.edu

Deepa Srinivasan, MD, is a public health specialist with a background in medicine. She completed her medical degree at PSG Institute of Medical Sciences and her masters from St. John’s Medical College, India. Throughout her academic journey, she received training in research methodology, evidence-based medicine, randomized controlled trials (RCT), and health economics. Following her masters, she joined the Division of Clinical Research and Training at St. John's Research Institute as a senior resident. She actively contributes to the design and implementation of various national and international research projects focusing on non-communicable diseases (NCDs). Her key research interest lies in identifying effective, economically feasible, and sustainable strategies for socio-economically disadvantaged communities, particularly those affected by NCDs. She is now planning to identify culturally sensitive strategies aimed at improving adherence to NCD treatments among tribal populations.

Project

Culturally sensitive risk reduction strategies for cardiovascular disease centered on optimal uptake of evidence-based treatments among patients with multimorbidity in a resource constrained tribal setting – INTEGRATE

Multimorbidity, predominantly cardiovascular diseases (CVDs) are exponentially increasing in LMICs like India and the effects are multifold with higher risk to socio-economically disadvantaged (SED) populations. Management of CVDs is more complex in the presence of multimorbidity emphasizing the importance of systematic integration of management of chronic diseases. In India, where over one-third of the global tribal population resides, these marginalized communities face significant health disparities. Hence, Dr. Srinivasan proposes to conduct a mixed-methods research to comprehensively understand the characteristics, treatment patterns, and medication adherence for CVD. Through qualitative techniques, she will also delve into the factors that induce behavior change and foster optimum treatments for CVD in the context of multimorbidity. By doing so, she aims to develop novel, culturally sensitive, and patient-centered strategies that address the unique challenges of these tribal communities in India.

Mentors: Maria Ekstrand (UCSF), Denis Xavier (St. John's Medical College and Research Institute), Kavitha Singh (Public Health Foundation of India)

deepa.sn@sjri.res.in

Judith Amutuhaire Ssemasaazi, MBCHB, MSc is a resident of internal medicine at Makerere University College of Health Sciences, Uganda. Previously, she completed master of science training in clinical epidemiology and biostatistics at the same university and during this training, she became interested in infectious diseases research. Her residency in internal medicine would later expose her to the double burden of noncommunicable diseases, especially kidney diseases and infectious diseases. Her research interests have since focused on noncommunicable diseases in the aging HIV population. With the success of anti-retroviral therapy, people living with HIV are surviving longer. Dr. Amutuhaire Ssemasaazi wants to be part of the community of global health researchers that will provide lasting solutions so that people living with HIV can enjoy their improved life expectancy. Beyond the GloCal Health Fellowship, she wants to continue to build an impactful career in global health research and nephrology clinical practice.

Project

Chronic Kidney Disease Progression Among Older Adults Living with HIV at a Large HIV Care Facility in Uganda

With expanded access to antiretroviral therapy (ART), aging with HIV is now possible, however, it carries a risk of multimorbidity. People living with HIV (PLWH) are three-fold more likely to develop chronic kidney disease (CKD), estimated glomerular filtration rate [eGFR] ≤60mls/ min/1.73m2 than those without HIV. However, the rate of progression remains unknown unlike in the general population. This study aims to assess CKD progression among older PLWH aged ≥60 years in Uganda by 1) Evaluating the prevalence of albuminuria (spot urine albumin-to-creatinine ratio [UACR] ≥30 mg/g) and 2) Determining longitudinal eGFR change and its predictors among older PLWH aged ≥60 years in Uganda. secondarily, the recovery of renal function following the withdrawal of Tenofovir Disoproxil Fumarate (TDF) will be assessed. This study will provide baseline information on the rate of CKD progression in the aging HIV population which is key to informing kidney disease monitoring programs for this population.

Mentors: Michelle Estrella (UCSF), Barbara Castelnuovo (IDI), Robert Kalyesubula (Makerere University)

amutuhairejudith@gmail.com

Charles Ssemugabo, MPH, DPRM, PhD, is a Research Associate in the Department of Disease Control and Environmental Health at Makerere University School of Public Health. Charles has varied research interests in the areas of environmental risk assessment for non-communicable diseases, integrating epidemiology with high quality exposure assessment. For his PhD, he looked at exposure to pesticide residues in fruits and vegetables and associated health risks among consumers in Uganda. Dr. Ssemugabo also studies unintentional childhood injuries where he has worked mainly on understanding their burden, designing and implementing prevention strategies. He has 40 publications in peer-reviewed journals and has presented in over 20 national and international conferences. He was a predoctoral Fogarty Global Health Program trainee through the UJMT consortium in 2019-2020. He was previously an Emerging Voices for Global HealthFellow in 2016, a network he currently chairs.

Project

Exposure assessment correlation between dietary pesticide intake and biomonitoring among children under five years in Kampala Metropolitan Area in Uganda

The proposed cross-sectional study that will be carried out among 100 households will establish a correlation between environmental and biomonitoring exposure assessment to pesticides in fruits and vegetables among children under 5 years in Kampala, Uganda. From each household, one child under 5 years will be selected. During the first visit, parents will be interviewed using a semi-structured questionnaire to collect socio-demographics, anthropometric, health symptoms, and pesticide use data. Parents will be asked to collect samples of foods their children consume for 24 hours and their urine in 500 ml polypropylene bottles. Collected samples will be picked up within 24 hours during the second visit. Samples will be analyzed using tandem liquid chromatography – mass spectrometry. Generalized estimating equations will be used to evaluate the relation between fruits and vegetable intake with specific individual pesticide metabolites biomarkers and their sum.

Mentors: Jose Ricardo Suarez (UCSD), John Ssempebwa (Makerere University), Asa Bradman (UC Merced)

cssemugabo@gmail.com

Archana Verma, PhD, is an anthropologist and socio-behavioral research scientist focused on HIV prevention and care, co-infections, and psychosocial health among vulnerable populations including adolescents, women, injecting drug users, and LGBT. She received her Ph.D.in anthropology from the National AIDS Research Institute at Savitribai Phule Pune University in Pune. Her doctoral research explored the psychosocial needs of HIV-infected adolescents with gaps in HIV program for adolescent HIV epidemic management in India. She is a recipient of the Senior Research Fellowship from the Indian Council of Medical Research. Her technical expertise lies in designing and implementing large-scale surveys, qualitative and mixed-methods research studies, and rapid assessment of programs. She has examined the community’s acceptance of new HIV prevention technologies, adolescent reproductive and sexual health education, HIV disclosure, sexual and social networks among hard-to-reach men who have sex with men (MSM) and people who inject drugs (PWIDs) in India.

Project

Understanding cervical cancer stigma, HPV vaccination awareness and acceptance among adolescents and young adults living with HIV in India: a step towards the elimination of cervical cancer by 2030

There is a high HPV prevalence and increased risk of cervical cancer (CC) among Adolescents and Young Adults Living with HIV (AYALHIV). Early and unprotected sex, sexually transmitted infections, and smoking are factors associated with HPV infection among AYALHIV, owing to their socio-economic conditions, HIV disclosure, adherence, and lack of reproductive and sexual health counseling. Despite the proven safety and immunogenicity of quadrivalent HPV vaccine among female AYALHIV and its commercial availability in India, HPV vaccine is still not the part of National Immunization Program. India has the highest population of youth and AYALHIV but no studies have explored knowledge of CC and prevention strategies among AYALHIV in India. During her GloCal fellowship, Dr. Verma will explore awareness of CC, prevention strategies, and acceptance of HPV vaccination among AYALHIV. Findings could inform evidence-driven strategies to integrate HPV vaccination into existing HIV programs.

Mentors: Maria L. Ekstrand (UCSF), Premalatha TS (SJRI), Tony Raj (SJRI)

archana.verma@sjri.res.in

Nafisa Wara is a medical student at the University of California, Los Angeles (UCLA) David Geffen School of Medicine. Ms. Wara is passionate about using implementation science to inform the integration of preventive sexual and reproductive care for people of reproductive age in resource-limited settings. She graduated from Harvard University in 2019 and pursued postgraduate research in Durban, South Africa, where she worked with the AIDS Healthcare Foundation South Africa and Massachusetts General Hospital on the design and evaluation of community-based delivery models of HIV prevention and sexual health care. These years inspired her current work assessing the feasibility and acceptability of long-acting PrEP modalities (e.g., injectable cabotegravir, dapivirine vaginal ring) among pregnant and lactating people, on which she has collaborated with researchers at UCLA, the University of Cape Town (UCT), the University of Washington, and Kenyatta National Hospital (Kenya).

Project

Development of patient-centered decision support to improve pre-exposure prophylaxis (PrEP) decision-making among pregnant and lactating people in Cape Town, South Africa

Despite high reported rates of daily oral pre-exposure prophylaxis (PrEP) uptake among pregnant and lactating people (PLP) in South Africa, individuals have reported substantial logistical and sociocultural barriers to adherence on daily oral PrEP. Long-acting PrEP modalities (e.g., eight-week injectable cabotegravir and four-week dapivirine vaginal ring) may mitigate barriers to adherence and persistence, and recent data show both high theoretical acceptability of injectable cabotegravir as PrEP among PLP, as well as continued interest by some in daily oral PrEP. With the approval and impending rollout of long-acting PrEP modalities in South Africa, there is an urgent need to integrate strategies that support PLP in choosing between PrEP modalities. Ms. Wara’s project will use mixed methods to engage with PLP and healthcare workers to inform the pre-implementation development of a patient-centered decision-support model for PrEP modality selection among PLP in Cape Town, South Africa.

Mentors: Risa Hoffman (UCLA), Dvora Joseph Davey (Desmond Tutu Health Foundation/UCT), Catherine Orrell (Desmond Tutu Health Foundation/UCT)

nwara@mednet.ucla.edu

FULBRIGHT-FOGARTY FELLOWS