Former GloCal fellow Larissa Otero likes surprises.

“One of the things I like most about public health is how often I encounter unexpected learning opportunities that change the way I think about things,” said Otero, who is an assistant professor at the School of Medicine at Universidad Peruana Cayetano Heredia (UPCH). “It happens all the time, even after many years of working in the field.”

One such surprise led her to develop a research project for her GloCal Health Fellowship in 2015-2016.

As a PhD candidate at the Institute of Tropical Medicine in Antwerp, Belgium, Otero designed an epidemiological research project focused on tuberculosis (TB). However, early on in the process, she discovered a significant operational problem in the diagnosis of TB and multidrug resistant TB: The implementation of effective interventions, even when recommended in guidelines, were only partially occurring. This realization changed the direction of Otero’s PhD project and her future research.

“That operational and health service perspective changed how I perceive TB as a public health issue and it changed the direction of my PhD project considerably. It became more of an operational and implementation-focused project rather than epidemiological,” said Otero.

Expanding on her PhD research, Otero’s GloCal project explored the process of diagnosing TB in children. She spent her fellowship year examining and identifying gaps in diagnosis practices at a hospital in Peru.

According to Otero, despite advances in diagnosing and treating TB, it is very difficult to diagnose TB in children, much more so than in adults – and, diagnosing treating and preventing TB in children remains a weak spot. “To describe this, I reviewed 10 years of clinical files and talked to staff to understand how they were and how they are now diagnosing and treating children,” said Otero. Her GloCal study found that, although children under 5 years old who are exposed to TB in the household should receive TB preventive therapy for six months, only 30% completed the treatment.

Otero’s research on TB in children did not stop after her GloCal fellowship.

In the fall of 2018, she became the first investigator in Latin America to receive the K43 Emerging Global Leader Award from the Fogarty International Center (FIC) at the National Institutes of Health (NIH) for her project titled, Patient-centered intervention to prevent tuberculosis among children < 5 years old.

“I actually applied for the K43 grant three times and got it on my third attempt,” said Otero, adding that, “persistence is very important when applying for grants.”

Otero credits the GloCal Health Fellowship program for exposing her to opportunities to pursue further research funding, including the K43 grant. “The GloCal program has affected my career quite positively,” said Otero, recalling a presentation on the K43 grant during the GloCal orientation.

Beyond sharing information with fellows, the GloCal program supports international fellows’ career development by ensuring they have protected time to focus on their research.

According to Otero, it is common in low- and middle-income countries (LMICs) for researchers’ university funds to be restrictive – meaning they can spend research funds on research costs, not on salary. Under this restriction, many LMIC researchers find other jobs to get a salary. Protected time with a monthly stipend during GloCal allows LMIC researchers to focus on advancing their careers.

Now in year two of the five-year K43 grant, Otero’s immediate goal is to complete her study and reach her research goals. She is testing an intervention to increase the percentage of children who complete the TB preventive treatment and by the end of the study, she expects to know if her intervention worked and if it did, why.

After her K43 grant is complete, Otero hopes to expand the study to other areas in Peru and, ultimately, decrease the burden of pediatric TB on a larger scale by developing sustainable, effective interventions.

Otero credits her mentors for supporting her throughout her masters, PhD, GloCal project and K43 applications.

“All my mentors – Timothy Sterling, Vanderbilt University; Joe Zunt, University of Washington; Theresa Ochoa, UPCH; Patrick Van der Stuyft, University of Gent and Institute of Tropical Medicine, Antwerp Belgium; Carlos Seas, UPCH; and Angela Bayer, California Department of Public Health, previously UCLA – have been and are currently very important in helping me navigate the system and become a better researcher,” said Otero.

With so many supportive mentors in her life, it is not surprising that Otero now enjoys mentoring trainees as well. She has mentored two GloCal trainees, including Pablo Tsukayama, who is in the upcoming 2019-2020 cohort, and multiple other trainees at UPCH.

"Mentoring is not a one-way relationship, I learn very much from my mentees,” said Otero.